模式识别受体PRRs在急性肺损伤/急性呼吸窘迫综合征发病机制中的作用研究进展

急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)是继发于肺内或全身的炎症反应过程,它由肺泡损伤导致并形成炎症性非心源性的肺水肿.模式识别受体(PRRs)参与先天免疫系统的激活,PRRs可以启动炎症信号级联反应,并释放促炎细胞因子.本综述对PRRs所包括的跨膜受体TLRs、胞质受体RLRs和NLRs以及下游炎症通路N...     

急性肺损伤/急性呼吸窘迫综合征相关微RNA研究进展

微RNA(miRNA)是一组高度保守的长度约22个核苷酸的非编码RNA,通过靶定相应的互补序列导致mRNA的沉默或者抑制翻译以调节基因和蛋白的表达。急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)的发病机制错综复杂,涉及失控性炎症反应、细胞凋亡及肺泡液体清除异常等多个层面,而且各个层面相互影响形成复杂的细胞网络和细胞因子网络,其通过不同的信号转导通路调控机体炎症反应。ALI发病过程中miRNA表达异常,miRNA可通过与靶mRNA部分结合在转录和转录后水平调节靶基因表达,参与ALI的整个发病过程。本文总结了国内外ALI发病过程中相关miRNA的研究进展,旨在寻找和验证miRNA在ALI炎症激活和信号转导途径中的作用,为ALI的诊疗提供新靶点。     

NOD样受体蛋白炎症体亚家族研究进展

炎症体作为固有免疫的一类模式识别受体,在抵抗外来病原微生物和自身非菌性炎症反应中发挥重要作用.NOD样受体(NLR)蛋白炎症体亚家族属于NLRs炎症体家族的一员,随着NLRPs炎症体生理功能的不断外延,它们不仅参与固有免疫的过程,而且参与到其他的常见生理过程,并发挥重要的调控作用.本文主要综述了近年来NLR蛋白炎症体亚家族的研究进展.     

慢性酗酒与急性肺损伤/急性呼吸窘迫综合征

急性肺损伤/急性呼吸窘迫综合征(acute lung injury/accute respiratory distress syndrome,ALI/ARDS)是在非心源性疾病过程中.     

NLRP3炎症小体与支气管哮喘关系研究进展

NOD样受体热蛋白结构域相关蛋白3(NLRP3)炎症小体是细胞内的免疫复合物,通过NOD受体识别进而激活并释放caspase-1、IL-1β、IL-18等炎症因子诱导免疫反应,与哮喘的发病密切相关.本文介绍了NLRP3炎症小体的激活方式,并对NLRP3炎症小体在哮喘气道炎症细胞和组分中的作用机制、气道重塑和气道上皮细胞...     

活性氧在急性肺损伤/急性呼吸窘迫综合征中的作用

<正>活性氧(reactive oxygen species,ROS)是普遍存在于有氧代谢中的产物,包括氧自由基和非基团物质,如超氧化物、过氧化氢、羟基等,其化学性质极为活跃。机体内的ROS以氧自由基为主,占95%以上。ROS可通过脂质过氧化反应等途径损伤组织细胞,其作用已逐渐得到认识和重视。由于肺组织的特殊结构和功能,肺是含氧     

NLRP3炎性小体在动脉粥样硬化中的研究进展

炎性小体是一种胞内多蛋白复合物,是固有免疫的重要组分,其中以NOD样受体蛋白3(NOD-like receptor pyrin domain containing 3,NLRP3)炎性小体最为著名。动脉粥样硬化(atherosclerosis,AS)是诱发心血管疾病的重要风险因素。在AS病情发展过程中,机体通过释放白细...     

急性肺损伤／急性呼吸窘迫综合征的生物疗法

急性肺损伤／急性呼吸窘迫综合征是临床常见的急危重症,目前仍缺乏有效的药物干预措施。本文归纳了近年来极具临床应用潜力的、包括抗炎治疗、生长因子治疗、凝血因子治疗、干细胞治疗、基因治疗等在内的生物疗法以供临床治疗和科研参考。     

急诊肺炎患者发生急性肺损伤/急性呼吸窘迫综合征危险因素分析

目的探讨急诊肺炎患者发生急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)的早期危险因素。方法回顾性分析中国医科大学附属第一医院急诊科收治的100例肺炎患者,其中男性62例,女性38例;年龄49~79岁,平均年龄62岁。观察72h,发展至ALI/ARDS为ALI/ARDS组,未发展至ALI/ARDS的分为单纯肺炎组。收集两组患者的年龄、性别、生命体征、初始所需吸氧浓度及初诊的实验室检查(白细胞、血小板计数、血清白蛋白、尿素氮、丙氨酸氨基转移酶)指标,对各项因素进行单因素分析,单因素分析有显著意义的变量行二项分类的Logistic回归分析。结果 100例患者35例发展为ALI/ARDS,65例未发展为ALI/ARDS。单因素分析结果显示,患者是否发展为ALI/ARDS与年龄、性别、体温、呼吸频率、休克、白细胞计数、尿素氮等比较,差异无统计学意义(P0.05);初始所需吸氧浓度(维持血氧饱和度≥90%)、改良后的快速急诊内科评分(REMS)、低蛋白血症与发展为ALI/ARDS差异有统计学意义(P0.05)。二项分类的Logistic回归分析显示,仅吸氧浓度、改良后的REMS评分是发展为ALI/ARDS的独立危险因素。其中吸氧浓度2 L/min的灵敏度为77.1%,特异度为86.2%;改良后的REMS≥7发生ALI/ARDS灵敏度为74.3%,特异度为72.3%。结论初始吸氧浓度及改良后的REMS评分与ALI/ARDS的发生存在正相关,初始吸氧浓度2 L/min和/或改良后的REMS≥7的肺炎患者应予以重视,是ALI/ARDS的高危患者,争取做到早期诊治。     

Alveolar recruitment maneuvers in acute lung injury/acute respiratory distress syndrome

Mechanical ventilation can worsen lung damage in acute lung injury and acute respiratory distress syndrome. The use of low tidal volumes is one of the strategies that has been shown to reduce lung injury and improve outcomes in this situation. However, low tidal volumes may lead to alveolar derecruitment and worsening of hypoxia. Recruitment maneuvers along with positive end-expiratory pressure may help to prevent derecruitment. Although recruitment maneuvers have been shown to improve oxygenation, improved clinical outcomes have not been demonstrated. The optimal recruitment strategy and the type of patients who might benefit are also unclear. This review summarizes the impact of recruitment maneuvers on lung mechanics and physiology, techniques of application, and the clinical situations in which they may be useful.     

Incidence and outcome of acute lung injury and acute respiratory distress syndrome in the surgical intensive care unit

Introduction:

To determine the incidence and mortality of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) in a cohort of patients with risk factors admitted to the Surgical Intensive Care Unit (SICU).

Materials and Methods:

A prospective observational inception cohort study with no intervention was conducted over 12 months. All patients with at least one known risk factor for ALI/ARDS admitted to the SICU were included in the study. The APACHE II severity of disease classification system scoring was performed within 1 h of admission. The ventilatory parameters and chest radiographs were recorded every 24 h. The P/F ratio, PEEP and Lung Injury Score were calculated each day until the day of discharge from the Intensive Care Unit or for the first 7 days of admission, whichever was shorter.

Results:

The incidence of ARDS among those who were mechanically ventilated was 11.4%. Sepsis was the most common (34.6%) etiology. Among those with risk factors, the incidence of ARDS was 30% and that of ALI was 32.7%. The mortality in those with ARDS was 41.8%. Those who develop ARDS had higher APACHE II scores, lower pH and higher PaCO₂ at admission compared with those who developed ALI or no lung injury.

Conclusion:

The incidence and mortality of ARDS was similar to other studies. Identifying those with risk factors for ARDS or mortality will enable appropriate interventional measures.     

干细胞旁分泌效应在ALI/ARDS治疗中的研究进展

急性肺损伤(acute lung injury,ALI)以及它的严重形式——急性呼吸窘迫综合征(acute respiratorydistress syndrome,ARDS)是危重病人发病和死亡的重要原因之一,最近2个世纪以来,死亡率仍在36%～44%左右。ALI/ARDS的病因众多,发病机制十分复杂,涉及的环节多,受损的靶细胞多,主要涉及的环节有:炎症反应失控、细胞损伤与修复、细胞凋     

肺血管内皮细胞分泌功能的改变与急性肺损伤/急性呼吸窘迫综合征

急性肺损伤(acute lung injury,ALI)/急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)是临床上常见的急危重症,病死率高达25%~45%,治疗上主要限于器官功能与全身支持治疗,尤其是呼吸支持治疗,“等待”肺损伤的缓解。在ARDS发病机制中肺血管内皮细胞(pulmonary vascular endothelial cell,PVEC)既是受损的主要靶细胞,更是活跃的炎症和效应细胞,血管内皮细胞(vascular endothelial cell,VEC)的激活和损伤程度与ARDS预后密切相关。本文将主要阐述ALI/ARDS发病机制中PVEC部分分泌功能的改变。     

A study on the role of noninvasive ventilation in mild-to-moderate acute respiratory distress syndrome

Aim:There is sparse data on the role of noninvasive ventilation (NIV) in acute respiratory distress syndrome (ARDS) from India. Herein, we report our experience with the use of NIV in mild to moderate ARDS.Results:A total of 41 subjects (27 women, mean age: 30.9 years) were included in the study. Tropical infections followed by abdominal sepsis were the most common causes of ARDS. The use of NIV was successful in 18 (44%) subjects, while 23 subjects required intubation. The median time to intubation was 3 h. Overall, 19 (46.3%) deaths were encountered, all in those requiring invasive ventilation. The mean duration of ventilation was significantly higher in the intubated patients (7.1 vs. 2.6 days, P = 0.004). Univariate analysis revealed a lack of improvement in PaO₂/FiO₂ at 1 h and high baseline Acute Physiology and Chronic Health Evaluation II (APACHE II) as predictors of NIV failure.Conclusions:Use of NIV in mild to moderate ARDS helped in avoiding intubation in about 44% of the subjects. A baseline APACHE II score of >17 and a PaO₂/FiO₂ ratio <150 at 1 h predicts NIV failure.     

急性肺损伤/急性呼吸窘迫综合征与NF-κB信号转导关系的研究进展

急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)是临床上最常见的急危重症,其发病机制错综复杂,缺乏主动性治疗措施,病死率高。研究表明,核因子κB(NF-κB)为一种诱导型核转录因子,在ALI/ARDS发展过程中发挥极为广泛的功能,并与炎症反应具有密切的关系。现就ALI/ARDS、NF-κB信号转导通路及两者的关系作一简要的论述。     

Isolation and phenotypic characteristics of microparticles in acute respiratory distress syndrome

Objective: To investigate the alterations of microparticles in acute respiratory distress syndrome (ARDS) in rats. Methods: 18 Wistar male rats were randomly divided into three groups: no intervention, sham (saline control) group and ARDS group (LPS induced). Blood was collected from abdominal aorta and microparticles were extracted through multiple rounds of centrifugation. Particles were analyzed by flow cytometry and transmission electron microscope. Results: The circulating concentration of total microparticles of rats with ARDS induced by lipopolysaccharide (LPS) did not change compared with other two groups. However, ARDS rats expressed higher concentration of leukocyte- and endothelium- derived microparticles in the three groups. Conclusion: Our results indicate that leukocyte and endothelial cell-derived particles may play an important role in ARDS. Thus it is important not only to monitor total microparticle levels but also the phenotypes, which may contribute to the prevention and early treatment of ARDS.     

Acute respiratory distress syndrome: Pulmonary and extrapulmonary not so similar

Acute respiratory distress syndrome (ARDS) is characterized by acute onset respiratory failure with bilateral pulmonary infiltrates and hypoxemia. Current evidence suggests different respiratory mechanics in pulmonary ARDS (ARDSp) and extrapulmonary ARDS (ARDSexp) with disproportionate decrease in lung compliance in the former and chest wall compliance in the latter. Herein, we report two patients of ARDS, one each with ARDSp and ARDSexp that were managed using real-time esophageal pressure monitoring using the AVEA ventilator to tailor the ventilatory strategy.