中国全科医学
中國全科醫學
중국전과의학
CHINESE GENERAL PRACTICE
2015年
13期
1541-1544
,共4页
韩芳%王辉%倪银%孙仁华%屠越兴%江玲芝
韓芳%王輝%倪銀%孫仁華%屠越興%江玲芝
한방%왕휘%예은%손인화%도월흥%강령지
急性呼吸窘迫综合征%肺表面活性物质相关蛋白质D%血清%支气管肺泡灌洗液
急性呼吸窘迫綜閤徵%肺錶麵活性物質相關蛋白質D%血清%支氣管肺泡灌洗液
급성호흡군박종합정%폐표면활성물질상관단백질D%혈청%지기관폐포관세액
Acute respiratory distress syndrome%Surfactant protein D%Serum%Bronchoalveolar lavage fluid
目的：了解急性呼吸窘迫综合征（ ARDS）患者血清和支气管肺泡灌洗液（ BALF）中肺表面活性蛋白D（ SP-D）的动态变化，并探讨其临床意义。方法选取2008年12月—2013年12月入住浙江省人民医院重症医学科的ARDS患者79例。根据患者28 d内存活情况，将79例患者分为存活组56例和死亡组23例。另选取2011年1月—2013年12月在浙江省人民医院进行体检的健康成年人20例，作为对照组。存活组和死亡组患者分别于诊断后24 h内（D1）、第3天（D2）、第5天（D3）及第7天（D4）采取静脉血和BALF各2 ml；对照组成年人在体检日采取静脉血和BALF各2 ml。检测并比较3组血清和BALF中的SP-D水平。结果（1）3组不同时间点血清中SP-D水平比较，差异有统计学意义（ F总=73.26，P﹤0.05）；3组间比较，差异有统计学意义（ F组间=197.01，P﹤0.05）；不同时间点比较，差异亦有统计学意义（F时间=168.29，P﹤0.05）。（2）3组不同时间点BALF中SP-D水平比较，差异有统计学意义（F总=98.71，P﹤0.05）；3组间比较，差异有统计学意义（F组间=376.91，P﹤0.05）；不同时间点比较，差异亦有统计学意义（ F时间=125.08，P﹤0.05）。结论 ARDS患者血清中SP-D水平从第5天开始较对照组上升，且死亡组较存活组上升高；存活组水平在第7天下降，死亡组持续上升。ARDS患者BALF中SP-D水平在诊断初期即高于对照组；第5天时存活组水平降低，死亡组继续上升；第7天时死亡组有所下降。血清和BALF中SP-D水平的动态变化对ARDS患者的临床诊疗和预后判定有指导意义。
目的：瞭解急性呼吸窘迫綜閤徵（ ARDS）患者血清和支氣管肺泡灌洗液（ BALF）中肺錶麵活性蛋白D（ SP-D）的動態變化，併探討其臨床意義。方法選取2008年12月—2013年12月入住浙江省人民醫院重癥醫學科的ARDS患者79例。根據患者28 d內存活情況，將79例患者分為存活組56例和死亡組23例。另選取2011年1月—2013年12月在浙江省人民醫院進行體檢的健康成年人20例，作為對照組。存活組和死亡組患者分彆于診斷後24 h內（D1）、第3天（D2）、第5天（D3）及第7天（D4）採取靜脈血和BALF各2 ml；對照組成年人在體檢日採取靜脈血和BALF各2 ml。檢測併比較3組血清和BALF中的SP-D水平。結果（1）3組不同時間點血清中SP-D水平比較，差異有統計學意義（ F總=73.26，P﹤0.05）；3組間比較，差異有統計學意義（ F組間=197.01，P﹤0.05）；不同時間點比較，差異亦有統計學意義（F時間=168.29，P﹤0.05）。（2）3組不同時間點BALF中SP-D水平比較，差異有統計學意義（F總=98.71，P﹤0.05）；3組間比較，差異有統計學意義（F組間=376.91，P﹤0.05）；不同時間點比較，差異亦有統計學意義（ F時間=125.08，P﹤0.05）。結論 ARDS患者血清中SP-D水平從第5天開始較對照組上升，且死亡組較存活組上升高；存活組水平在第7天下降，死亡組持續上升。ARDS患者BALF中SP-D水平在診斷初期即高于對照組；第5天時存活組水平降低，死亡組繼續上升；第7天時死亡組有所下降。血清和BALF中SP-D水平的動態變化對ARDS患者的臨床診療和預後判定有指導意義。
목적：료해급성호흡군박종합정（ ARDS）환자혈청화지기관폐포관세액（ BALF）중폐표면활성단백D（ SP-D）적동태변화，병탐토기림상의의。방법선취2008년12월—2013년12월입주절강성인민의원중증의학과적ARDS환자79례。근거환자28 d내존활정황，장79례환자분위존활조56례화사망조23례。령선취2011년1월—2013년12월재절강성인민의원진행체검적건강성년인20례，작위대조조。존활조화사망조환자분별우진단후24 h내（D1）、제3천（D2）、제5천（D3）급제7천（D4）채취정맥혈화BALF각2 ml；대조조성년인재체검일채취정맥혈화BALF각2 ml。검측병비교3조혈청화BALF중적SP-D수평。결과（1）3조불동시간점혈청중SP-D수평비교，차이유통계학의의（ F총=73.26，P﹤0.05）；3조간비교，차이유통계학의의（ F조간=197.01，P﹤0.05）；불동시간점비교，차이역유통계학의의（F시간=168.29，P﹤0.05）。（2）3조불동시간점BALF중SP-D수평비교，차이유통계학의의（F총=98.71，P﹤0.05）；3조간비교，차이유통계학의의（F조간=376.91，P﹤0.05）；불동시간점비교，차이역유통계학의의（ F시간=125.08，P﹤0.05）。결론 ARDS환자혈청중SP-D수평종제5천개시교대조조상승，차사망조교존활조상승고；존활조수평재제7천하강，사망조지속상승。ARDS환자BALF중SP-D수평재진단초기즉고우대조조；제5천시존활조수평강저，사망조계속상승；제7천시사망조유소하강。혈청화BALF중SP-D수평적동태변화대ARDS환자적림상진료화예후판정유지도의의。
Objective To investigate the dynamic changes of lung surfactant protein D ( SP - D ) in serum and bronchoalveolar lavage fluid( BALF)in patients with acute respiratory distress syndrome( ARDS)and to examine its clinical significance. Methods A total of 79 patients with ARDS treated in Zhejiang Provincial People's Hospital ICU between December 2008 and December 2013 were included in this study. We divided the patients into two groups:the survival group(n=56)and the death group(n=23). Another 20 healthy adults who received physical examination in Zhejiang Provincial People's Hospital between January 2011 and December 2013 were enrolled as the control group. We sampled 2 ml of venous blood and 2 ml of BALF from each subject of the survival group and the death group on day 1(D1),day 3(D2),day 5(D3)and day 7(D4)after their diagnosis. We also sampled 2 ml of venous blood and 2 ml of BALF from each subject of the control group on each of the four days. The SP-D levels of serum and BALF of the three groups were tested and compared. Results ( 1 ) The SP-D levels of serum were significantly different(Ftotal =73. 26,P﹤0. 05)at different time points among the three groups. The SP-D levels of serum were significantly different(Finter-group =197. 01,P﹤0. 05)among the three groups. The SP-D levels of serum were also significantly different( Ftime points = 168. 29, P ﹤ 0. 05 ) at different time points. ( 2 ) The SP - D levels of BALF were significantly different(Ftotal =98. 71,P﹤0. 05)at different time points among the three groups. The SP-D levels of BALF were significantly different(Finter-group =376. 91,P﹤0. 05)among the three groups. The SP-D levels of BALF were also significantly different(Ftime points =125. 08,P﹤0. 05)at different time points. Conclusion The SP-D level of serum in the subjects with ARDS began to rise higher than the control group,with the death group rising higher than the survival group;the SP-D level of serum in the survival group began to decrease on day 7,while that in the death group continued to rise. The SP-D level of BALF in the subjects with ARDS was higher than the control group from the early stage after diagnosis;the SP-D level of BALF in the survival group began to decrease on day 5 , while the death group continued to increase and began to decrease on day 7. The research of dynamic changes of SP-D level in serum and BALF was of guiding significance in clinical diagnosis and treatment and prognosis judgment for patients with ARDS.
