中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

急性呼吸窘迫综合征及其高危患者机械通气时呼出气冷凝液 8-异前列腺素水平的研究

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目的检测急性呼吸窘迫综合征(ARDS)及其高危患者机械通气时呼出气冷凝液(EBC)中 8-异前列腺素(8-iso-PG)水平,探讨其临床意义。方法选择 2014 年 2 月至 2016 年 6 月 ICU 病房机械通气的 ARDS 及其高危患者 55 例为研究对象,同期正常体检者 30 例作为对照组。使用 EcoScreen 冷凝器收集 EBC 标本。观察轻、中、重度 ARDS 以及高危患者之间 EBC 中 8-iso-PG 水平的差异,并与临床指标作相关性分析。结果55 例 ARDS 及其高危患者机械通气时 EBC 中 8-iso-PG[(44.83±11.58)ng/L 比(19.47±4.06)ng/L]和血清 8-iso-PG[(481.53±444.94)ng/L 比(19.91±17.60)ng/L]均较对照组明显升高(均 P<0.05)。中度(15 例)和重度 ARDS 患者(7 例)EBC 中 8-iso-PG 浓度[(47.18±11.68)ng/L 和(50.29±11.06)ng/L]较轻度 ARDS(7 例)和高危患者(26 例)均显著升高[(33.04±7.62)ng/L 和(37.17±11.08)ng/L](均P<0.05),而轻度 ARDS 患者与高危患者 EBC 中 8-iso-PG 浓度无显著差异(P>0.05)。EBC 中 8-iso-PG 升高对诊断 ARDS 的 ROC 曲线下面积为 0.73。相关分析发现机械通气时 EBC 中 8-iso-PG 浓度与肺损伤评分(LIS)(r=0.418,P<0.01)、氧合指数(PaO2/FiO2)(r=–0.378,P<0.05)、胸部 X 线评分(r=0.410,P<0.05)、肺泡-动脉氧压差(AaDO2)(r=0.368,P<0.05)以及急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分(r=0.718,P<0.05)有相关性。结论检测机械通气患者 EBC 中 8-iso-PG 可以了解其肺部氧化应激程度,有助于中重度 ARDS 的诊断和病情评估。

ObjectiveTo detect the concentration of 8-isoprostane (8-iso-PG) in exhaled breath condensate (EBC) of patients with or at risk for ARDS in ventilation, and investigate its clinical significance.MethodsFifty-five patients with or at risk for ARDS in ventilation admitted between February 2014 and June 2016 were recruited as an experimental group, and simultaneous 30 normal cases were recruited as a control group. Their EBC was collected with EcoScreen condenser. The EBC 8-iso-PG level of the patients between different grades of ARDS (mild, moderate, and sever) or at risk for ARDS was compared, and the correlation of EBC 8-iso-PG with the clinical indicators was analyzed.ResultsThe 8-iso-PG levels in EBC and serum of the patients with or at risk for ARDS in ventilation were higher than those in the control group [EBC: (44.83±11.58) ng/L vs. (19.47±4.06) ng/L; serum: (481.53±444.94) ng/L vs. (19.91±17.60) ng/L] (all P<0.05). The EBC 8-iso-PG of the patients with moderate ARDS (n=15) and severe ARDS (n=7) [(47.18±11.68) ng/L and (50.29±11.06) ng/L] was higher than those with mild ARDS (n=7) or at risk for ARDS (n=26) [(33.04±7.62) ng/L) and (37.17±11.08) ng/L] (all P<0.05). However EBC 8-iso-PG was not different between the patients with mild ARDS and those at risk for ARDS (P>0.05 ). The increased EBC 8-iso-PG could predict ARDS with an area under the receiver operating curve of 0.73. The EBC 8-iso-PG of the patients with or at risk for ARDS was correlated with lung injury score (r=0.418, P<0.01), PaO2/FiO2 (r=–0.378, P<0.05), chest radiograph scores (r=0.410, P<0.05), AaDO2 (r=0.368, P<0.05), and APACHEⅡ score (r=0.718, P<0.05).ConclusionEBC 8-iso-PG can reflect the oxidative stress in lung of ARDS patients in ventilation, and can contribute to the diagnosis and evaluation for moderate and severe ARDS.

关键词: 急性呼吸窘迫综合征; 机械通气; 呼出气冷凝液; 8-异前列腺素

Key words: Acute respiratory distress syndrome; Mechanical ventilation; Exhaled breath condensate; 8-isoprostane

引用本文: 张文彬, 周曙俊, 王瑰, 金肇权, 朱明慧. 急性呼吸窘迫综合征及其高危患者机械通气时呼出气冷凝液 8-异前列腺素水平的研究. 中国呼吸与危重监护杂志, 2018, 17(1): 66-70. doi: 10.7507/1671-6205.201708042 复制

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