CAJ | 학술논문

目的：研究胸科手术机械通气前后血清中脂多糖结合蛋白（ LBP）表达的差异，寻求早期诊断呼吸机相关性肺损伤（ VALI）的特异性标志物，并作为临床治疗的作用靶点。方法将入选行开胸肺叶切除手术的20例患者采用随机对照研究方法，将手术部位、术式相同的患者分别纳入双肺通气（ TLV）组和单肺通气（ OLV）组，每组10例。每例分别在机械通气前（ T0）、手术结束时（ T1）、术后24 h（ T2）和术后48 h（ T3）采取静脉血样本，离心取上清液置-80℃保存。 Western Blot法检测血清中LBP的表达水平。结果 LBP随着时间延长呈不断升高趋势，两组中各时点间LBP表达水平比较差异有统计学意义（ P＜0.05），但两组间各时点比较差异无统计学意义（ P＞0.05），组间与时点间存在交互作用，即两组LBP升高的幅度不同，OLV组较TLV组上升幅度大。结论 LBP的表达水平随着机械通气的时长呈升高趋势，OLV升高幅度较TLV大，机械通气会影响LBP的表达水平，LBP可能参与了VLAI的过程。
목적：연구흉과수술궤계통기전후혈청중지다당결합단백（ LBP）표체적차이，심구조기진단호흡궤상관성폐손상（ VALI）적특이성표지물，병작위림상치료적작용파점。방법장입선행개흉폐협절제수술적20례환자채용수궤대조연구방법，장수술부위、술식상동적환자분별납입쌍폐통기（ TLV）조화단폐통기（ OLV）조，매조10례。매례분별재궤계통기전（ T0）、수술결속시（ T1）、술후24 h（ T2）화술후48 h（ T3）채취정맥혈양본，리심취상청액치-80℃보존。 Western Blot법검측혈청중LBP적표체수평。결과 LBP수착시간연장정불단승고추세，량조중각시점간LBP표체수평비교차이유통계학의의（ P＜0.05），단량조간각시점비교차이무통계학의의（ P＞0.05），조간여시점간존재교호작용，즉량조LBP승고적폭도불동，OLV조교TLV조상승폭도대。결론 LBP적표체수평수착궤계통기적시장정승고추세，OLV승고폭도교TLV대，궤계통기회영향LBP적표체수평，LBP가능삼여료VLAI적과정。
Objective To study the difference between the expression of lipopolysaccharide binding protein ( LBP) in serum before and after mechanical ventilation , explore the specific marker in early diagnosis of ventilator-induced lung ( VALI) injury and find out the target of clinical treatment .Methods Twenty patients who received rad-ical resection of lung cancer were selected .Every two lung cancer patients with the same surgical sites and methods were divided into the TLV group and the OLV group .Venous blood was collected at the moment before mechanical ventilation(T0), at the end of operation(T1),at 24 h after operation(T2) and at 48 h after operation(T3).After the blood was separated by centrifugation , the supernatant was collected and stored them at -80℃.Western blot meth-od was used to measure the LBP expression levels .Results The difference in the two groups was statistically signifi-cant at each time point ( P<0.05 ) , but the difference between the groups at each time point was not statistically sig-nificant(P>0.05), there was an interaction between the groups and each time points .The increased amplitude of LBP was different in the two groups ,the OLV group had a bigger rise than the TLV group .Conclusion Mechanical ventilation affects the LBP expression level , and the LBP indeed plays an important role in the VALI .