中性粒细胞弹性蛋白酶与急性肺损伤/急性呼吸窘迫综合征严重程度及预后相关性的临床研究

目的 通过检测不同程度急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)患者血清及支气管肺泡灌洗液(BALF)中中性粒细胞弹性蛋白酶(NE),探讨其对评价肺损伤严重程度和预后的临床指导意义.方法 将36例ALI/ARDS患者按氧合指数进行分组:A组氧合指数为201～300mm Hg(1 mm Hg=0.133 kPa),19例;B组为150～200 mm Hg,10例;C组为<150 mm Hg,7例.并选取健康对照者16例(对照组),各组均进行血清及BALF中NE测定.结果 A、B、C三组患者血清和BALF中NE分别为(1.76.4-0.63)nmol/L和(1.67±0.59)nmol/L、(3.26±0.51) nmol/L和(3.64±0.56)nmol/L、(4.56±0.68)nmol/L和(4.62±0.39)nmol/L,均明显高于对照组[(0.67±0.54)nmol/L和(0.62±0.48)nmol/L],差异均有统计学意义;死亡组患者血清及BALF中NE明显高于存活组(P＜0.01),而且ALI/ARDS患者的血清NE与氧合指数呈显著负相关性(r=-0.901,P＜0.01).结论 ALI/ARDS患者血清和BALF中NE明显升高,其水平与患者的肺损伤严重程度和预后密切相关.

Relationship between activity of neutrophil elastase and severity and prognosis of acute lung injury/acute respiratory distress syndrome

Objective To investigate the neutrophil elastase (NE) in patients with acute lung injury (ALI)/acute respiratory distress syndrome (ARDS).Methods Thirty-six patients of ALI/ARDS and 16 healthy volunteers(control group)were involved in the study.The patients of ALI/ARDS were divided into three groups:group A (the oxygenation index was 201-300 mm Hg,1 mm Hg=0.133 kPa),group B (150-200 mm Hg),and group C (<150 mm Hg).The NE in serum and bronchoalveolar Lavage fluid (BALF) were measured.Results The NE in the serum and BALF in group A [(1.76±0.63)nmol/L and (1.67±0.59)nmol/L],group B [(3.26±0.51)nmol/L and (3.64±0.56)nmol/L] and group C [(4.56 ±0.68)nmol/L and (4.62±0.39)nmol/L] were much higher than that in control group [(0.67±0.54)nmol/L and (0.62±0.48)nmol/L].The NE in the serum and BALF of dead patients were higher than that in patients who were alive.Moreover,the NE in the patients of ALI/ARDS was inversely related to the oxygenation index (r=-0.901,P＜0.01). Conclusion The NE in patients of ALI/ARDS is higher than that in healthy people,and it is significantly related to the severity and the prognosis of ALI/ARDS.