早产儿慢性肺疾病支气管肺泡灌洗液中细胞外基质的变化

目的探讨细胞外基质在早产儿慢性肺疾病(CLD)支气管肺泡灌洗液(BALF)中动态改变及其在CLD形成中的作用。方法对1999 12—2004 11在华中科技大学同济医院NICU住院需机械通气的62例患儿每日行支气管肺泡灌洗,并检测灌洗液中细胞总数及分类、透明质酸(HA)、Ⅲ型胶原(PCⅢ)及羟脯氨酸(Hyp)水平。病例分为4组:肺炎组20例；肺透明膜病(HMD)组13例；CLD组15例；对照组14例(无肺部疾病者)。结果(1)CLD组BALF中HA和PCⅢ水平分别较肺炎组及HMD组明显升高，并且也分别高于对照组BALF中的水平；(2)CLD组BALF中的HA和Hyp均分别与细胞总数和中性粒细胞数(%)呈正相关，而PCⅢ与肺泡巨噬细胞总数呈正相关。另外，HA、PCⅢ及Hyp之间均呈明显的正相关。结论CLD患儿肺内HA、PCⅢ及Hyp产生增多；BALF中HA、PCⅢ及Hyp的水平从不同侧面反映了疾病活动性并具有估计预后的作用。

Changes of extracellular matrix components in bronchoalveolar lavage fluid in premature infants with chronic lung disease.

AbstractObjectiveTo clarify the roles of HA、PCⅢ、Hyp in bronchoalveolar lavage fluid with chronic lung disease(CLD) of prematurity and their effect on the progression of CLD.MethodsLung lavage was serially obtained every day from 62 ventilated premature infants that were hospitalized in NICU from December 1999 to November 2004. Total cell counts, neutrophilic granulocyte counts, HA、PCⅢ、Hyp in bronchoalveolar lavage fluid were examined. Among the 62 cases, 20 developed pneumonia, 13 HMD, 15 CLD and 14 without lung disease as control.ResultsThe levels of HA、PCⅢ、Hyp in CLD group were not only significantly higher than those in HMD、pneumonia group, but also significantly higher than those in BALF in control group. In CLD group, the levels of HA and Hyp in BALF were respectively correlated with total cell numbers and neutrophils. PCⅢlevels were related to alveolar macrophages. Also, there were positive correlation between PCⅢ、HA and Hyp in BALF. ConclusionThese results suggest that the production of PCⅢ、HA and Hyp in lung in CLD were increased and that the levels of PCⅢ、HA、Hyp in BALF might reflect the activity of the disease from different aspects and play a role in estimating prognosis.