支气管肺发育不良%呼吸,人工%支气管肺泡灌洗%转化生长因子β1%β-联蛋白%Ⅱ型肺泡细胞表面抗原6%Clara细胞分泌蛋白
支氣管肺髮育不良%呼吸,人工%支氣管肺泡灌洗%轉化生長因子β1%β-聯蛋白%Ⅱ型肺泡細胞錶麵抗原6%Clara細胞分泌蛋白
지기관폐발육불량%호흡,인공%지기관폐포관세%전화생장인자β1%β-련단백%Ⅱ형폐포세포표면항원6%Clara세포분비단백
Bronchopulmonary dysplasia%Respiration,artificial%Bronchoalveolar lavage%Transforming growth factor beta1%β-catenin%Krebs von den Lungen-6%Clara cell secretion protein
目的 探讨早产儿支气管肺泡灌洗液(BALF)中β-联蛋白、转化生长因子β1(TGF-β1)、Clara细胞分泌蛋白16(cc16)、Ⅱ型肺泡细胞表面抗原6(KL-6)水平动态变化在机械通气肺损伤乃至支气管肺发育不良(BPD)中的意义.方法 选择机械通气早产儿60例,将30例诊断为BPD的患儿作为试验组,30例非BPD患儿作为对照组,酶联免疫吸附试验(ELISA)法测定机械通气后所有患儿1,24,48,72 h BALF中β-联蛋白、TGF-β1、cc16、KL-6水平.结果 试验组患儿胎龄及出生体质量明显低于对照组,吸氧时间及机械通气时间明显长于对照组,差异均有统计学意义(P＜0.01).随着机械通气时间的延长,试验组BALF中β-联蛋白、TGF-β1、KL-6水平呈逐渐升高趋势,cc16水平呈逐渐降低趋势,且机械通气48,72 h后与机械通气1h后比较差异有统计学意义[(304.64±64.84),(358.39±61.81) ng/L比(251.84±59.51) ng/L; (305.6±76.4),(380.8±88.3) μgL比(200.5±63.8)μg/L; (972.6±232.0),(1 114.8±253.1) U/L比(822.2±239.9) U/L;(69.92±12.37),(57.46±12.22)μg/L比(83.24±15.41)μg/L](P＜ 0.05).对照组cc16、TGF-β 1机械通气72 h后与机械通气1h后比较差异有统计学意义[(84.08±19.90) μg/L比(106.90±30.58) μg/L,(185.2±75.3) μg/L比(137.5±59.1) μg/L](P＜0.01),而KL-6、β-联蛋白各机械通气时段比较差异无统计学意义(P＞0.05).试验组各机械通气时段TGF-β1、β-联蛋白水平均高于对照组、cc16水平均低于对照组,而KL-6水平机械通气48,72 h后高于对照组,差异均有统计学意义(P＜0.01).Pearson分析结果显示,机械通气1h后BALF中TGF-β1与胎龄呈负相关(r=-0.274,P＜ 0.05),cc16与体质量呈正相关(r=0.375,P＜0.01),β-联蛋白与体质量呈负相关(r=-0.414,P＜0.01),β-联蛋白与cc16呈负相关(r=-0.248,P＜0.05),与TGF-β1呈正相关(r=0.290,P＜0.05).多元逐步回归分析提示,机械通气、吸氧时间的延长、低1 h BALF中cc16水平是BPD发生的高危因素(P＜0.01).结论 通气初始(通气1 h)BALF中,高TGF-β1、高β-联蛋白、低cc16水平与早产儿低胎龄、低出生体质量密切相关,而通气48 h后BALF中持续显著升高的KL-6、β-联蛋白、TGF-β1水平与持续显著降低的cc16水平,有助于监测机械通气肺损伤乃至BPD的发生发展.
目的 探討早產兒支氣管肺泡灌洗液(BALF)中β-聯蛋白、轉化生長因子β1(TGF-β1)、Clara細胞分泌蛋白16(cc16)、Ⅱ型肺泡細胞錶麵抗原6(KL-6)水平動態變化在機械通氣肺損傷迺至支氣管肺髮育不良(BPD)中的意義.方法 選擇機械通氣早產兒60例,將30例診斷為BPD的患兒作為試驗組,30例非BPD患兒作為對照組,酶聯免疫吸附試驗(ELISA)法測定機械通氣後所有患兒1,24,48,72 h BALF中β-聯蛋白、TGF-β1、cc16、KL-6水平.結果 試驗組患兒胎齡及齣生體質量明顯低于對照組,吸氧時間及機械通氣時間明顯長于對照組,差異均有統計學意義(P＜0.01).隨著機械通氣時間的延長,試驗組BALF中β-聯蛋白、TGF-β1、KL-6水平呈逐漸升高趨勢,cc16水平呈逐漸降低趨勢,且機械通氣48,72 h後與機械通氣1h後比較差異有統計學意義[(304.64±64.84),(358.39±61.81) ng/L比(251.84±59.51) ng/L; (305.6±76.4),(380.8±88.3) μgL比(200.5±63.8)μg/L; (972.6±232.0),(1 114.8±253.1) U/L比(822.2±239.9) U/L;(69.92±12.37),(57.46±12.22)μg/L比(83.24±15.41)μg/L](P＜ 0.05).對照組cc16、TGF-β 1機械通氣72 h後與機械通氣1h後比較差異有統計學意義[(84.08±19.90) μg/L比(106.90±30.58) μg/L,(185.2±75.3) μg/L比(137.5±59.1) μg/L](P＜0.01),而KL-6、β-聯蛋白各機械通氣時段比較差異無統計學意義(P＞0.05).試驗組各機械通氣時段TGF-β1、β-聯蛋白水平均高于對照組、cc16水平均低于對照組,而KL-6水平機械通氣48,72 h後高于對照組,差異均有統計學意義(P＜0.01).Pearson分析結果顯示,機械通氣1h後BALF中TGF-β1與胎齡呈負相關(r=-0.274,P＜ 0.05),cc16與體質量呈正相關(r=0.375,P＜0.01),β-聯蛋白與體質量呈負相關(r=-0.414,P＜0.01),β-聯蛋白與cc16呈負相關(r=-0.248,P＜0.05),與TGF-β1呈正相關(r=0.290,P＜0.05).多元逐步迴歸分析提示,機械通氣、吸氧時間的延長、低1 h BALF中cc16水平是BPD髮生的高危因素(P＜0.01).結論 通氣初始(通氣1 h)BALF中,高TGF-β1、高β-聯蛋白、低cc16水平與早產兒低胎齡、低齣生體質量密切相關,而通氣48 h後BALF中持續顯著升高的KL-6、β-聯蛋白、TGF-β1水平與持續顯著降低的cc16水平,有助于鑑測機械通氣肺損傷迺至BPD的髮生髮展.
목적 탐토조산인지기관폐포관세액(BALF)중β-련단백、전화생장인자β1(TGF-β1)、Clara세포분비단백16(cc16)、Ⅱ형폐포세포표면항원6(KL-6)수평동태변화재궤계통기폐손상내지지기관폐발육불량(BPD)중적의의.방법 선택궤계통기조산인60례,장30례진단위BPD적환인작위시험조,30례비BPD환인작위대조조,매련면역흡부시험(ELISA)법측정궤계통기후소유환인1,24,48,72 h BALF중β-련단백、TGF-β1、cc16、KL-6수평.결과 시험조환인태령급출생체질량명현저우대조조,흡양시간급궤계통기시간명현장우대조조,차이균유통계학의의(P＜0.01).수착궤계통기시간적연장,시험조BALF중β-련단백、TGF-β1、KL-6수평정축점승고추세,cc16수평정축점강저추세,차궤계통기48,72 h후여궤계통기1h후비교차이유통계학의의[(304.64±64.84),(358.39±61.81) ng/L비(251.84±59.51) ng/L; (305.6±76.4),(380.8±88.3) μgL비(200.5±63.8)μg/L; (972.6±232.0),(1 114.8±253.1) U/L비(822.2±239.9) U/L;(69.92±12.37),(57.46±12.22)μg/L비(83.24±15.41)μg/L](P＜ 0.05).대조조cc16、TGF-β 1궤계통기72 h후여궤계통기1h후비교차이유통계학의의[(84.08±19.90) μg/L비(106.90±30.58) μg/L,(185.2±75.3) μg/L비(137.5±59.1) μg/L](P＜0.01),이KL-6、β-련단백각궤계통기시단비교차이무통계학의의(P＞0.05).시험조각궤계통기시단TGF-β1、β-련단백수평균고우대조조、cc16수평균저우대조조,이KL-6수평궤계통기48,72 h후고우대조조,차이균유통계학의의(P＜0.01).Pearson분석결과현시,궤계통기1h후BALF중TGF-β1여태령정부상관(r=-0.274,P＜ 0.05),cc16여체질량정정상관(r=0.375,P＜0.01),β-련단백여체질량정부상관(r=-0.414,P＜0.01),β-련단백여cc16정부상관(r=-0.248,P＜0.05),여TGF-β1정정상관(r=0.290,P＜0.05).다원축보회귀분석제시,궤계통기、흡양시간적연장、저1 h BALF중cc16수평시BPD발생적고위인소(P＜0.01).결론 통기초시(통기1 h)BALF중,고TGF-β1、고β-련단백、저cc16수평여조산인저태령、저출생체질량밀절상관,이통기48 h후BALF중지속현저승고적KL-6、β-련단백、TGF-β1수평여지속현저강저적cc16수평,유조우감측궤계통기폐손상내지BPD적발생발전.
Objective To investigate the significance of β-catenin,transforming growth factor-β 1 (TGF-β 1),Clara cell secretion protein 16 (cc16),Krebs von den Lungen-6 (KL-6) level changes in bronchoalveolar lavage fluid (BALF) of premature for mechanical ventilation lung injury and bronchopulmonary dysplasia (BPD).Methods Selected 60 mechanical ventilation preterm infants,basing on the BPD diagnosis criterion that the United States national institutes of health research joint BPD team released in 2001,30 BPD children were disposed as experimental group,other 30 non-BPD children as control group.The levels of β-catenin,KL-6,cc16,TGF-β1 in BALF were measured by enzyme-linked immunosorbent assay(ELISA) after mechanical ventilation 1,24,48,72 h.Results The gestational age and body mass in experimental group were significantly lower than those in control group (P＜ 0.01),the time of mechanical ventilation and oxygen inhalation was significantly longer than that in control group (P ＜ 0.01).The levels of β-catenin,TGF-β 1,KL-6 in 48,72 h after mechanical ventilation in experimental group were significantly higher than those of 1 h [(304.64 ± 64.84),(358.39 ± 61.81) ng/L vs.(251.84 ± 59.51) ng/L; (305.6 ± 76.4),(380.8 ± 88.3) μ g/L vs.(200.5 ± 63.8) μ g/L; (972.6 ± 232.0),(1 114.8 ± 253.1) U/L vs.(822.2 ± 239.9) U/L](P＜ 0.05),the level of cc16 was significantly lower than that of 1 h[(69.92 ± 12.37),(57.46 ± 12.22) μg/L vs.(83.24 ± 15.41) μg/L](P＜ 0.05).The differences of levels ofcc16,TGF-β 1were significant between 72 h and 1 h after mechanical ventilation [(84.08 ± 19.90) μ g/L vs.(106.90 ± 30.58) μg/L,(185.2 ±75.3) μg/L vs.(137.5 ±59.1)μg/L] (P ＜0.01),the difference of KL-6,β-catenin in various mechanical ventilation time was not statistically significant (P ＞ 0.05).The levels of TGF-β,β-catenin in various mechanical ventilation time in experimental group were significantly higher than those in control group (P ＜ 0.01),the level of cc16 was significantly lower than that in control group (P＜ 0.01),the levels in 48,72 h of KL-6 after mechanical ventilation were significantly higher than those in control group (P＜ 0.01).Pearson analysis showed that,1 h after mechanical ventilation,TGF-β 1 negatively correlated with gestational age (r =-0.274,P ＜ 0.05),cc 16 positively correlated with body mass (r =0.375,P ＜ 0.01),β-catenin negatively correlated with body mass (r =-0.414,P ＜ 0.01),β-catenin negatively correlated with cc 16 (r =-0.248,P ＜ 0.05),β-catenin negatively correlated with TGF-β 1 (r =0.290,P ＜0.05).Multiple stepwise regression analysis indicated that,mechanical ventilation,longer time of oxygen inhahtion,lower level of 1 h BALF and cc16 were risk factors for the occurrence of BPD (P ＜ 0.01).Conclusions Higher TGF-β 1,β-catenin and lower cc16 levels of BALF in 1 h after ventilation are closely related to gestational age and body mass,while after being ventilated for 48 h,higher KL-6,β-catenin,TGF-β 1 and lower cc16 level of BALF in infants are helpful to monitor the mechanical ventilation lung injury and the development of BPD.
