Serial changes in surfactant-associated proteins in lung and serum before and after onset of ARDS
Serial changes in surfactant-associated proteins in lung and serum before and after onset of ARDS
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DOI：
10.1164/ajrccm.160.6.9901117
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发表时间：
1999-12-01
影响因子：
24.7
通讯作者：
Martin, TR
中科院分区：
文献类型：
--
作者：
Greene, KE;Wright, JR;Martin, TR
本研究的目的是确定发生在支气管肺泡灌洗液（BAL）和血清中的表面活性物质相关蛋白的变化，在ARDS的风险和ARDS的过程中。我们发现，在临床定义的肺损伤发生之前，有ARDS风险的患者的BAL中SP-A和SP-B的浓度较低，而SP-D的浓度是正常的。在已确诊的ARDS患者中，在整个14天的观察期内，BAL SP-A和SP-B浓度较低，但SP-D浓度中位数仍在正常范围内。免疫反应性SP-A和SP-D在有ARDS危险的患者血清中没有增加，但在ARDS发作后第3天增加到最大值，并保持升高长达14天。BAL SP-A浓度在发生ARDS的高危患者中显著较低，BAL SP-A浓度大于1.2 μ g/ml的患者均未发生ARDS。在ARDS的第1天和第3天，死亡患者的BAL SP-D浓度显著降低，并且BAL SP-D浓度与PI（O2）/FI（O2）比值显著相关。因此，表面活性蛋白异常发生在ARDS发作之前和之后，并且SP-A、SP-B和SP-D的反应在重要方面不同。BAL SP-A和SP-D测量可用于将患者分类为进展为ARDS和/或ARDS发作后死亡的高风险或低风险。增加ARDS患者肺中这些表面活性蛋白的策略可能有助于改变ARDS的发病或病程。
The goal of this study was to determine the changes that occur in surfactant-associated proteins in bronchoalveolar ravage fluid (BAL) and serum of patients at risk for ARDS and during the course of ARDS. We found that the concentrations of SP-A and SP-B were low in the BAL of patients at risk for ARDS before the onset of clinically defined lung injury, whereas the concentration of SP-D was normal. In patients with established ARDS, BAL SP-A and SP-B concentrations were low during the entire 14-d observation period, but the median SP-D concentrations remained in the normal range. Immunoreactive SP-A and SP-D were not increased in the serum of patients at risk for ARDS, but both increased after the onset of ARDS to a maximum on Day 3 and remained elevated for as long as 14 d. The BAL SP-A concentrations were significantly lower in at-risk patients who developed ARDS, and no patient with a BAL SP-A concentration greater than 1.2 mu g/ml developed ARDS. On Days 1 and 3 of ARDS, the BAL SP-D concentration was significantly lower in patients who died, and the BAL SP-D concentration was significantly related to the Pl(O2)/Fl(O2), ratio. Thus, surfactant protein abnormalities occur before and after the onset of ARDS, and the responses of SP-A, SP-B, and SP-D differ in important ways. The BAL SP-A and SP-D measurements can be used to classify patients as high or low risk for progression to ARDS and/or death after the onset of ARDS. Strategies to increase these surfactant proteins in the lungs of patients with ARDS could be useful to modify the onset or the course of ARDS.