急性肺损伤患者血清肺表面活性物质蛋白A的变化及其意义

目的;动态观测急性肺损伤虱血清肺表面活性物质蛋白Ａ（ＳＰ－Ａ）的变化,并探讨其临床意义。方法：选择符合ＡＬＩ诊断标准并已给予机械通气治疗的患者２０例,于入组时和出组时抽取静脉血,多数患者在观察期间病情有明显变化时重复抽血,共收集静脉血标本７１例次;并同时记录动脉血气测值和呼吸机参数,计算动脉血氧分压与吸入气氧浓度比值和静态总呼吸顺应性。

Determination of serum pulmonary surfactant protein A and its significance in patients with acute lung injury

Objective:To dynamically assess the surfactant protein A(SPA) concentration in serum of patients with acute lung injury(ALI),and discuss its clinical significance.Methods:71 serum samples were collected from 20 ALI patients under mechanical ventilation (ALI group) and 22 from healthy volunteers (control group). In ALI patients,serum samples were obtained both at the time of their entry into the study (T E) and at the time of termination of ventilation (T L,i.e.,when the patients were weaned from ventilator or immediately prior to their death).For most patients,serum samples were also collected when their conditions altered obviously.For each blood sample collected in ALI group,arterial blood gas values and ventilator parameters were recorded to calculate PaO 2/FiO 2 ratio and static total respiratory compliance (TRC).Serum samples were stored for determination of SPA using Western dot blot method.Results:At T E,the serum SPA concentrations in ALI group were significantly higher than those of control group( P <0 001).In ALI group,the serum SPA concentrations in 8 patients who died from acute respiratory distress syndrome (ARDS) and multiple organ failure (MOF) were significantly higher than those of 10 patients who survived( P <0 01).At T L,the serum SPA concentrations in 8 patients who died from ARDS and MOF were significantly higher than those of 10 patients who survived and also their own values at T E( P <0 005 and P <0 05),whereas the serum SPA levels in 10 survivors were lower as compared with their own values at T E ( P <0 001).During the whole observation period,serum SPA concentrations in ALI patients were inversely related to their PaO 2/FiO 2 ratios and TRC values (all P <0 001).Conclusions:Serum SPA concentration in ALI patients is significantly elevated.Serum SPA is a lungspecific serum marker for evaluation of the severity and prognosis of ALI.