胎粪吸入综合征患儿一氧化氮和内皮素-1水平变化及意义

The change of nitrous oxide and endothelin-1 levels in newborn baby with meconium aspiration syndrome

目的探讨胎粪吸入综合征(MAS)患儿支气管肺泡灌洗液及血中一氧化氮(NO)和内皮素-1(ET-1)水平变化规律,为临床治疗提供依据。方法采用硝酸盐还原法和放射免疫法分别测定29例重度MAS患儿血及肺泡灌洗液中NO和ET-1浓度、31例轻度MAS患儿和32名正常新生儿血中NO和ET-1浓度。结果与健康新生儿相比,MAS患儿病程初期血中NO浓度降低而ET-1浓度升高(P<0.05),轻度MAS患儿随病情好转NO和ET-1浓度逐渐恢复正常,但重度MAS患儿随病程出现NO的异常增高而ET-1降低(P<0.05),然后又逐渐恢复正常,支气管肺泡灌洗液中NO浓度呈现先低后渐升高趋势(P<0.05),而ET-1浓度呈现先高后渐降低趋势(P<0.05),与血中变化趋势一致。结论NO和ET-1参与了MAS早期肺部病理生理变化,使肺血管过度收缩导致肺动脉高压,恢复期NO异常升高可能与持续的肺部炎症及损伤有关,病程的不同时期应采用适宜的治疗手段。

Objective To investigate the changes of nitrous oxide （NO） and endothelin-1 （ET-1） in the bronchoalveolar lavage fluid and serum of newborn baby with meconium aspiration syndrome （MAS） and its clinical significance. Methods Using nitrate deoxidize method and radioimmunoassay to evaluate the levels of NO and ET-1 in serum and bronchoalveolar lavage fluid of 29 newborn baby with severe MAS, and those in serum of 31 children with mild MAS and 32 healthy newborn boby. Results Compared with healthy newborn baby, the level of NO in serum of newborn baby with MAS was decreased and ET-1 increased （P 〈0.05 ） at the initial stage of disease. The levels of NO and ET-1 in mild MAS returned to normal with the progress of the disease, but the level of NO increased and ET-1 decreased remarkably in newborn baby with severe MAS （ P 〈 0.05 ） , then returned to normal gradually. While the level of NO in bronchoalveolar lavage fluid decreased initially and then increased gradually （ P 〈 0.05 ） , but the changes of level of ET-1 were reversed （ P 〈 0.05 ）, it was same as in serum. Conclusions NO and ET-1 participated in patho-physiological courses of the lung at the initial stage of MAS and induce excessive contraction of pulmonary blood vessel to pulmonary artery hypertension. The increased level of NO abnormally in restoration stage may be associated with the pulmonary inflammation and injury persistently, appropriate treatment should be taken in different stages of the disease.