中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2014年
18期
4-8
,共5页
郑青%符先先%巫翠云%李国栋%王永卿%钟祥旭%崔华%杨瑶
鄭青%符先先%巫翠雲%李國棟%王永卿%鐘祥旭%崔華%楊瑤
정청%부선선%무취운%리국동%왕영경%종상욱%최화%양요
支气管肺发育不良%呼吸%人工%转化生长因子β1%β-联蛋白%Ⅱ型肺泡细胞表面抗原%Clara细胞分泌蛋白
支氣管肺髮育不良%呼吸%人工%轉化生長因子β1%β-聯蛋白%Ⅱ型肺泡細胞錶麵抗原%Clara細胞分泌蛋白
지기관폐발육불량%호흡%인공%전화생장인자β1%β-련단백%Ⅱ형폐포세포표면항원%Clara세포분비단백
Bronchopulmonary dysplasia%Respiration,artificial%Transforming growth factor beta1%β-catenin%Krebs von den Lungen-6%Clara cell secretion protein
目的 动态监测支气管肺发育不良(BPD)患儿产后及不同机械通气时段血浆β-联蛋白、Ⅱ型肺泡细胞表面抗原(KL-6)、Clara细胞分泌蛋白(CC16)、转化生长因子β1(TGF-β1)水平的变化,探讨其在机械通气肺损伤中的作用及BPD发生的高危因素.方法 将90例早产儿分为早产非机械通气组、机械通气非BPD组和机械通气BPD组,每组30例;另选择足月健康新生儿40例作为健康对照组.酶联免疫吸附试验法检测四组通气前,通气后1,24,48,72 h及撤机后24h血浆β-联蛋白、KL-6、CC16、TGF-β1水平.结果 健康对照组、早产非机械通气组、机械通气非BPD组、机械通气BPD组胎龄和出生体质量[(40.50±1.46)、(33.07±2.42)、(31.67±2.73)、(29.80±1.71)周和(3 184.33±548.99)、(1 752.33±255.81)、(1 433.00±177.30)、(1 254.50±117.78)g]逐渐降低,两两比较差异均有统计学意义(P＜0.05);机械通气BPD组机械通气时间和吸氧时间均明显长于机械通气非BPD组[(15.23±4.28)d比(3.53±1.01)d和(45.57±7.89)d比(18.57±3.93)d],差异有统计学意义(P＜0.05).健康对照组、早产非机械通气组、机械通气非BPD组、机械通气BPD组血浆β-联蛋白和TGF-β1逐渐升高,血浆CC16逐渐降低,两两比较差异有统计学意义(P＜0.05).四组血浆KL-6比较差异无统计学意义(P＞0.05).机械通气BPD组多数机械通气时段血浆KL-6、CC16、TGF-β1、β-联蛋白均差于机械通气非BPD组.β-联蛋白与TGF-β1、KL-6有相关性(r=0.374,0.418,P＜0.01).多元逐步回归分析结果显示,低出生体质量、机械通气时间延长、产后高血浆TGF-β 1、β-联蛋白及低血浆CC16为BPD发生的高危因素(P＜0.01或＜0.05).结论 产后高血浆β-联蛋白、TGF-β1及低血浆CC16可能与BPD的发生密切相关,β-联蛋白、KL-6、TGF-β1在BPD的发生和发展中互为因果关系.动态监测机械通气早产儿血浆β-联蛋白、KL-6、CC16、TGF-β1水平,有助于监测机械通气肺损伤的发生,对BPD早期诊断、治疗及预后评估具有重要的临床指导价值.
目的 動態鑑測支氣管肺髮育不良(BPD)患兒產後及不同機械通氣時段血漿β-聯蛋白、Ⅱ型肺泡細胞錶麵抗原(KL-6)、Clara細胞分泌蛋白(CC16)、轉化生長因子β1(TGF-β1)水平的變化,探討其在機械通氣肺損傷中的作用及BPD髮生的高危因素.方法 將90例早產兒分為早產非機械通氣組、機械通氣非BPD組和機械通氣BPD組,每組30例;另選擇足月健康新生兒40例作為健康對照組.酶聯免疫吸附試驗法檢測四組通氣前,通氣後1,24,48,72 h及撤機後24h血漿β-聯蛋白、KL-6、CC16、TGF-β1水平.結果 健康對照組、早產非機械通氣組、機械通氣非BPD組、機械通氣BPD組胎齡和齣生體質量[(40.50±1.46)、(33.07±2.42)、(31.67±2.73)、(29.80±1.71)週和(3 184.33±548.99)、(1 752.33±255.81)、(1 433.00±177.30)、(1 254.50±117.78)g]逐漸降低,兩兩比較差異均有統計學意義(P＜0.05);機械通氣BPD組機械通氣時間和吸氧時間均明顯長于機械通氣非BPD組[(15.23±4.28)d比(3.53±1.01)d和(45.57±7.89)d比(18.57±3.93)d],差異有統計學意義(P＜0.05).健康對照組、早產非機械通氣組、機械通氣非BPD組、機械通氣BPD組血漿β-聯蛋白和TGF-β1逐漸升高,血漿CC16逐漸降低,兩兩比較差異有統計學意義(P＜0.05).四組血漿KL-6比較差異無統計學意義(P＞0.05).機械通氣BPD組多數機械通氣時段血漿KL-6、CC16、TGF-β1、β-聯蛋白均差于機械通氣非BPD組.β-聯蛋白與TGF-β1、KL-6有相關性(r=0.374,0.418,P＜0.01).多元逐步迴歸分析結果顯示,低齣生體質量、機械通氣時間延長、產後高血漿TGF-β 1、β-聯蛋白及低血漿CC16為BPD髮生的高危因素(P＜0.01或＜0.05).結論 產後高血漿β-聯蛋白、TGF-β1及低血漿CC16可能與BPD的髮生密切相關,β-聯蛋白、KL-6、TGF-β1在BPD的髮生和髮展中互為因果關繫.動態鑑測機械通氣早產兒血漿β-聯蛋白、KL-6、CC16、TGF-β1水平,有助于鑑測機械通氣肺損傷的髮生,對BPD早期診斷、治療及預後評估具有重要的臨床指導價值.
목적 동태감측지기관폐발육불량(BPD)환인산후급불동궤계통기시단혈장β-련단백、Ⅱ형폐포세포표면항원(KL-6)、Clara세포분비단백(CC16)、전화생장인자β1(TGF-β1)수평적변화,탐토기재궤계통기폐손상중적작용급BPD발생적고위인소.방법 장90례조산인분위조산비궤계통기조、궤계통기비BPD조화궤계통기BPD조,매조30례;령선택족월건강신생인40례작위건강대조조.매련면역흡부시험법검측사조통기전,통기후1,24,48,72 h급철궤후24h혈장β-련단백、KL-6、CC16、TGF-β1수평.결과 건강대조조、조산비궤계통기조、궤계통기비BPD조、궤계통기BPD조태령화출생체질량[(40.50±1.46)、(33.07±2.42)、(31.67±2.73)、(29.80±1.71)주화(3 184.33±548.99)、(1 752.33±255.81)、(1 433.00±177.30)、(1 254.50±117.78)g]축점강저,량량비교차이균유통계학의의(P＜0.05);궤계통기BPD조궤계통기시간화흡양시간균명현장우궤계통기비BPD조[(15.23±4.28)d비(3.53±1.01)d화(45.57±7.89)d비(18.57±3.93)d],차이유통계학의의(P＜0.05).건강대조조、조산비궤계통기조、궤계통기비BPD조、궤계통기BPD조혈장β-련단백화TGF-β1축점승고,혈장CC16축점강저,량량비교차이유통계학의의(P＜0.05).사조혈장KL-6비교차이무통계학의의(P＞0.05).궤계통기BPD조다수궤계통기시단혈장KL-6、CC16、TGF-β1、β-련단백균차우궤계통기비BPD조.β-련단백여TGF-β1、KL-6유상관성(r=0.374,0.418,P＜0.01).다원축보회귀분석결과현시,저출생체질량、궤계통기시간연장、산후고혈장TGF-β 1、β-련단백급저혈장CC16위BPD발생적고위인소(P＜0.01혹＜0.05).결론 산후고혈장β-련단백、TGF-β1급저혈장CC16가능여BPD적발생밀절상관,β-련단백、KL-6、TGF-β1재BPD적발생화발전중호위인과관계.동태감측궤계통기조산인혈장β-련단백、KL-6、CC16、TGF-β1수평,유조우감측궤계통기폐손상적발생,대BPD조기진단、치료급예후평고구유중요적림상지도개치.
Objective To dynamically monitor the changes of plasma β-catenin,transforming growth factor-β 1(TGF-β 1),Clara cell secretion protein(CC16),Krebs yon den Lungen-6 (KL-6) level of bronchopulmonary dysplasia (BPD) premature children after birth and in different mechanical ventilation period,so as to discuss the function in ventilator-induced lung injury and explore the risk factors of BPD.Methods Ninety premature children were divided into non-mechanical ventilation group,non-BPD mechanical ventilation group,BPD mechanical ventilation group and 30 cases in each group.Besides,another 40 normal term infants to make comparison were selected as control group.The levels of plasma β-catenin,KL-6,CC 16,TGF-β 1 were measured by enzyme-linked immunosorbent assay before mechanical ventilation and 1,24,48,72 h after mechanical ventilation and 24 h after weaning.Results Gestational age and birth weight decreased in control group,non-mechanical ventilation group,non-BPD mechanical ventilation group,BPD mechanical ventilation group [(40.50 ± 1.46),(33.07 ± 2.42),(31.67 ± 2.73),(29.80 ± 1.71) weeks and (3 184.33 ± 548.99),(1 752.33 ±255.81),(1 433.00 ± 177.30),(1 254.50 ± 117.78) g],pairwisecomparisons were statistically significant differences (P ＜0.05).The time of mechanical ventilation andoxygen inhalation in BPD mechanical ventilation group was longer than that in non-BPD mechanical ventilation group [(15.23 ± 4.28) d vs.(3.53 ± 1.01) d and (45.57 ± 7.89) d vs.(18.57 ± 3.93) d],and there was significant difference (P ＜ 0.05).The level of plasma β-catenin,TGF-β1 was increased and the level of plasma CC 16 was decreased in control group,non-mechanical ventilation group,non-BPD mechanical ventilation group,BPD mechanical ventilation group,pairwise comparisons were statistically significant differences (P ＜ 0.05).There was no significant difference in the level of plasma KL-6 among four groups (P ＞ 0.05).The level of plasma KL-6,CC 16,TGF-β1,β-catenin in BPD mechanical ventilation group at mostly period was worse than that in non-BPD mechanical ventilation group.In BPD mechanical ventilation group,the level of plasma β-eatenin directly correlated with TGF-β 1,KL-6 (r =0.374 and 0.418,P ＜ 0.01).Multi-factor stepwise regression analysis indicated that the lower birth weight,longer mechanical ventilation,higher β-catenin,TGF-β 1 after birth,lower CC16 level were the risk factor of BPD(P＜ 0.01 or ＜ 0.05).Conlusions Higher plasma β-catenin,TGF-β1 and lower CC16 after birth have close relation with BPD,the level of plasma β-catenin,KL-6,TGF-β 1 in BPD development interact as both cause and effect.Dynamic detection of plasma β-catenin,TGF-β 1,KL-6,CC16 changes of mechanical ventilation in premature children will help monitor lung injury of mechanical ventilation,for the early diagnosis of BPD,treatment,and the evaluation of prognosis have important clinical value.
