Soluble Vascular Cell Adhesion Molecule-1 (sVCAM-1) Is Elevated in Bronchoalveolar Lavage Fluid of Patients with Acute Respiratory Distress Syndrome.
Soluble Vascular Cell Adhesion Molecule-1 (sVCAM-1) Is Elevated in Bronchoalveolar Lavage Fluid of Patients with Acute Respiratory Distress Syndrome.
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DOI：
10.1371/journal.pone.0149687
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Liles WC
中科院分区：
文献类型：
--
作者：
Attia EF;Jolley SE;Crothers K;Schnapp LM;Liles WC
肺血管内皮细胞活化与急性呼吸窘迫综合征（ARDS）有关，但对ARDS中肺泡腔内内皮细胞活化标志物的存在和作用知之甚少。我们假设，与健康志愿者相比，ARDS患者支气管肺泡灌洗液中内皮活化生物标志物的表达存在差异，并且生物标志物浓度与ARDS严重程度相关。我们对26例临床疑似呼吸机相关性肺炎的ARDS插管患者和5例健康志愿者的数据进行了横断面分析。患者在插管后平均5天接受支气管肺泡灌洗。健康志愿者也接受了支气管肺泡灌洗。在支气管肺泡灌洗液中测定内皮活化生物标志物（可溶性血管细胞粘附分子-1（sVCAM-1）、可溶性内皮选择素（sESEL）、血管生成素-1（Ang-1）和血管生成素-2（Ang-2）。临床疑似呼吸机相关性肺炎经微生物培养数据证实。与健康志愿者相比，ARDS患者支气管肺泡灌洗液中sVCAM-1的中位浓度显著更高（985 vs 119 pg/mL，p = 0.03）。此外，与轻度ARDS患者相比，中度/重度ARDS患者的支气管肺泡灌洗液sVCAM-1浓度有升高的趋势（1395 vs 209 pg/mL，p = 0.06）。我们没有检测到ARDS患者和健康志愿者之间的支气管肺泡灌洗液中sESEL、Ang-1或Ang-2水平的显著差异。支气管肺泡灌洗液中位生物标志物水平在有和没有微生物学证实的呼吸机相关性肺炎的患者之间没有差异。与健康对照组相比，ARDS患者支气管肺泡灌洗液中sVCAM-1浓度显著更高，并且与轻度ARDS相比，中度/重度ARDS中sVCAM-1浓度往往更高。我们的研究结果增加了越来越多的证据支持的概念，内皮细胞活化在ARDS的发病机制中起着重要的作用。有必要进一步研究sVCAM-1和其他内皮活化标志物在ARDS肺泡腔中的作用和/或临床意义。
Pulmonary vascular endothelial activation has been implicated in acute respiratory distress syndrome (ARDS), yet little is known about the presence and role of endothelial activation markers in the alveolar space in ARDS. We hypothesized that endothelial activation biomarkers would be differentially expressed in bronchoalveolar lavage fluid from patients with ARDS compared with healthy volunteers, and that biomarker concentrations would be associated with ARDS severity. We performed a cross-sectional analysis of data from 26 intubated patients with ARDS undergoing evaluation for clinically suspected ventilator-associated pneumonia and five healthy volunteers. Patients underwent bronchoalveolar lavage a median of five days after intubation. Healthy volunteers also underwent bronchoalveolar lavage. Endothelial activation biomarkers (soluble vascular cell adhesion molecule-1 [sVCAM-1], soluble endothelial selectin [sESEL], angiopoietin-1 [Ang-1] and angiopoietin-2 [Ang-2]) were measured in bronchoalveolar lavage fluid. Clinically suspected ventilator-associated pneumonia was confirmed with microbiologic culture data. Patients with ARDS had significantly higher median sVCAM-1 concentrations in the bronchoalveolar lavage fluid compared with healthy volunteers (985 vs 119 pg/mL, p = 0.03). Additionally, there was a trend toward greater bronchoalveolar lavage fluid sVCAM-1 concentrations among patients with moderate/severe compared to mild ARDS (1395 vs 209 pg/mL, p = 0.06). We did not detect significant differences in bronchoalveolar lavage fluid levels of sESEL, Ang-1 or Ang-2 between patients with ARDS and healthy volunteers. Median bronchoalveolar lavage fluid biomarker levels did not differ between patients with and without microbiologically-confirmed ventilator-associated pneumonia. sVCAM-1 concentrations were significantly higher in the bronchoalveolar lavage fluid of patients with ARDS compared to healthy controls, and tended to be higher in moderate/severe ARDS compared to mild ARDS. Our findings add to the growing evidence supporting the concept that endothelial activation plays an important mechanistic role in the pathogenesis of ARDS. Further studies are necessary to characterize the role and/or clinical significance of sVCAM-1 and other endothelial activation markers present in the alveolar space in ARDS.