脓毒症所致ARDS患者血浆肺表面活性蛋白D水平及其临床意义

目的探讨脓毒症所致急性呼吸窘迫综合征（ARDS）患者血浆肺表面活性蛋白-D（SP—D）水平动态变化的临床意义及其与临床特征的相关性。方法前瞻性研究脓毒症患者不同病程阶段血浆样本，于2012年1月至2012年10月入住重症医学科的40例患者纳入研究。根据收集血浆时患者是否符合ARDS诊断分为系统性炎症反应综合征（SIRS）组（即对照组）与ARDS组。ARDS组根据柏林ARDS诊断标准分为轻度、中度、重度3个亚组，ARDS重度患者临终前再次采集血浆样本，纳入ARDS临终组，运用酶联免疫吸附法测定各组血浆样本的SP—D水平，再结合患者的临床特征进行相关分析。结果ARDS轻度组的SP—D的血浆水平高于SIRS组（0．723±0．153rig／ml比0．510±0．187ng／ml，P〈0．05）；随着ARDS病情加重，血浆SP—D水平呈进行性升高（ARDS轻度组比中度组0．723±0．153．g／ml比1．043±0．198ng／ml，P〈0．05；中度组比重度组：1．043±0．198ng／ml比1．343±0．186ng／ml。P〈0．05）。临终组较ARDS重度组，SP—D水平无显著差异（1．343±0．186ng／ml比1．398±0．216ng／ml，P〉0．05）。血浆SP—D水平Pa02／FiO2呈负相关（r值为-0．436，P〈0．05），与AaDO2、SOFA评分和APACHEII评分呈正相关（r值分别为0．314、0．321和0．453，P〈0．05）。结论检测脓毒症患者血浆SP—D水平有助于脓毒症所致ARDS的早期诊断。

The clinical significance of plasma surfactant protein - D in patients with septic ARDS.

Objective To investigate the clinical implication of the dynamic change of plasma Surfactant protein - D （ SP - D） in septic acute re- spiratory distress syndrome （ARDS） patients. Methods Plasma samples of patients with sepsis at various stages were analyzed prospectively. 40 consec- utive patients from Jan 2012 to Oct 2012 with sepsis were enrolled into this study. The samples were divided into two groups, group of systemic inflamma tory response syndrome （SIRS） （the control group） and ARDS group according to the criteria of ARDS. Then the ARDS group were divided into 4 sub- groups, the mild, moderate, severe and terminal group according to the Berlin definition of ARDS. The correlations between the plasma samples of SP - D levels of enzyme - linked immunosorbent （ELASA） and patients＇clinical features were armlyzed. Results The SP - D level was higher in the mild ARDS patients than these in SIRS （0.723 ±0. 153 ng/ml vs 0.510 ±0.187 ng/nal, P 〈0.05）. As ARDS became seriously, the levels of plasma SP -D is progressive increase （ARDS mild vs. ARDS moderate： 0.723 ±0.153 ng/rnl vs 1.043 ±0. 198 ng/ml, P 〈0.05; ARDS moderate vs ARDS severe： 1. 043 ± 0. 198 ng/ml vs. 1. 343 -s 0. 186 ng/ml, P 〈 0.05） ; ARDS moderate vs. ARDS severe： 24.98± 1.65 ng,/ml vs. 26.18 ±2. 83 ng/rnl, P 〉 0.05 ）. The SP-D level was negatively correlated with PaO2/FiO2 （ r = -0.436, P 〈0.05）, and positively correlated with and AaDO2, SOFA score and A- PACHEII（ r =0.314,0.321 and 0.453, respectively, P 〈0.05）. Conclusion Level of sepsis patients＇plasma SP -D may be helpful in the diagnosis of septic ARDS.