严重多发伤并发急性肺损伤患者血浆中肺表面活性物质相关蛋白D的变化及意义

目的 动态观测严重多发伤患者血浆中肺表面活性物质相关蛋白D(SP-D)水平并探讨它与创伤性急性肺损伤(ALI)/ARDS之间的关系及意义.方法 将36例严重多发伤患者分为多发伤后并发ALI/ARDS组20例(ALI/ARDS组)与多发伤后未并发ALI/ARDS组16例(非ALI/ARDS组).分别于伤后第1,3,7,14天收集外周血;同时计算PaO2/FiO2并行肺损伤评分;另12例体检健康者设为正常对照组.运用ELISA测定血浆SP-D的浓度.结果 ALI/ARDS组患者血浆SP-D水平显著高于正常对照组和非ALI/ARDS组(P<0.01);ALI/ARDS患者重度肺损伤组血浆SP-D水平明显高于中度肺损伤组(P<0.05);SP-D水平与其相应的PaO2/FiO2呈负相关关系(rs=-0.745,P<0.01).结论 严重多发伤后血浆SP-D水平升高程度不仅与创伤性ALI/ARDS发生密切相关,而且与肺损伤严重程度密切相关.血浆SP-D在ALI/ARDS病程中是一种具有价值的生物学标志.

Change and significance of plasma surfactant protein D level in patients with severe multiple trauma combined with acute lung injury

Objective To dynamically measure level of surfactant protein D(SP-D)in patients with severe multiple trauma and discuss the relationship between SP-D and acute lung injury(ALI)/ARDS and its clinical significance. Methods A total of 36 patients with severe multiple trauma were divided into ALI/ARDS group(20 patients)and non-ALI/ARDS group(16 patients).Peripheral blood samples were collected at days 1,3,7 and 14 after trauma for calculating lung injury score(LIS)and PaO2/FiO2 ratio.Another 12 healthy persons were served as control group.Plasma SP-D levels were measured by using enzyme linked immunoabsorbent assay(ELISA). Results The plasma SP-D levels in ALI/ARDS group were markedly higher than those of control group and non-ALI/ARDS group(P<0.01).In ALI/ARDS group,the plasma SP-D levels in severe lung injury group were significantly higher than those of modcrate lung injury group(P<0.05).The plasma SP-D levels in ALI/ARDS group were inversely related to their PaO2/FiO2 ratios(rs=-0.745,P<0.01). Conclusions The plasma SP-D level is relevant not only to the occurrence of traumatic ALI/ARDS after multiple trauma,but also closely to the severity of lung injury,indicating that plasma SP-D is a valuable biomarker in ALI/ARDS.