Pepsin, a reliable marker of gastric aspiration, is frequently detected in tracheal aspirates from premature ventilated neonates: Relationship with feeding and methylxanthine therapy
Pepsin, a reliable marker of gastric aspiration, is frequently detected in tracheal aspirates from premature ventilated neonates: Relationship with feeding and methylxanthine therapy
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DOI：
10.1097/01.mpg.0000232015.56155.03
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发表时间：
2006-09-01
影响因子：
2.9
通讯作者：
Mehta, Devendra I.
中科院分区：
文献类型：
--
作者：
Farhath, Sabeena;Aghai, Zubair H.;Mehta, Devendra I.
目的：探讨机械通气早产儿气管抽吸物(TA)中胃蛋白酶的检测情况及其与喂养和甲基黄嘌呤治疗的关系。以荧光底物为底物的酶法检测胃蛋白酶。结果：45例早产儿共采集239例TA样本，平均出生体重762±166g，平均胎龄25.5±1.5wk。在239份TA样本中，222份(92.8%)检测到胃酶，没有一份血清样本检测到胃酶。胃酶在第1天(平均为170+/-216 ng/mL)显著低于其他时间点(P<；0.05)。婴儿不喂养时胃酶平均浓度(265+/-209 ng/m L)显著低于喂养期间(390+/-260 ng/m L，P=0.02)。接受黄嘌呤治疗的早产儿胃蛋白酶水平(419+/-370 ng/m L)显著高于未接受黄嘌呤治疗的早产儿(295+/-231 ng/m L，P=0.037)。喂奶的婴儿胃蛋白酶水平高于未喂奶的婴儿。黄嘌呤治疗还与TA样本中胃蛋白酶的增加有关。慢性吸入胃内容物可能会加重早产儿的肺部疾病。
Objectives: To determine the frequency of pepsin detection in tracheal aspirate (TA) samples of mechanically ventilated premature neonates and its association with feedings and methylxanthine therapy.Patients and Methods: Serial TA samples (days 1, 3, 5, 7, 14, 21, 28 and > 28 days) were collected from premature neonates receiving ventilatory support. An enzymatic assay with a fluorescent substrate was used to detect pepsin. Pepsin was also measured in 10 serum samples collected in conjunction with the TA samples from 8 neonates.Results: A total of 239 TA samples was collected from 45 premature neonates (mean birth weight, 762 +/- 166 g; mean gestational age, 25.5 +/- 1.5 wk). Pepsin was detectable in 222 of 239 TA samples (92.8%) and in none of the serum samples. Pepsin was significantly lower on day 1 (mean, 170 +/- 216 ng/mL) when compared with all other time points (P < 0.05). Mean concentration of pepsin was significantly lower when infants were unfed (265 +/- 209 ng/mL) compared with levels during feeding (390 +/- 260 ng/mL, P = 0.02). The mean level of pepsin was significantly higher in infants during xanthine therapy (419 +/- 370 ng/mL) compared with no xanthine therapy (295 +/- 231 ng/mL, P = 0.037).Conclusion: Pepsin, a marker of gastric contents, was detected in more than 92% of TA samples from premature infants on mechanical ventilation. The level of pepsin was higher in fed infants when compared with unfed infants. Xanthine therapy was also associated with increased pepsin in TA samples. Chronic aspiration of gastric contents may worsen lung disease in premature infants.