机械通气新生儿血浆肺表面活性物质蛋白A和血清铁蛋白的变化

Changes of Plasma Pulmonary Surfactant Protein-A and Serum Ferritin in Neonates with Mechanical Ventilation

目的观察机械通气时新生儿血浆肺表面活性物质蛋白A(SP-A)和血清铁蛋白(SF)的变化,探讨其在呼吸机诱发肺损伤(VILI)中的意义。方法机械通气组使用机械通气新生儿36例,非机械通气组未使用机械通气31例。机械通气组在机械通气后1、24、48、72h和撤机后24h采集静脉血,非机械通气组在同样时段采集静脉血;采用免疫印迹法检测血浆SP-A水平,采用放射免疫方法检测SF水平。结果机械通气组通气后24、48、72h血浆SP-A水平明显高于非机械通气组;机械通气组通气后1、24、48、72h和撤机后24hSF水平显著高于非机械通气组,差异有显著性(P<0.05,0.01);且升高程度与使用机械通气天数呈显著相关性(r=0.451,0.431Pa<0.05)。机械通气后48h血浆SP-A和SF水平出现明显变化,且持续在高水平上波动,随着病情好转撤机,SP-A及SF水平渐回落。结论动态观察机械通气新生儿血浆SP-A和SF水平可能有助于监测VILI的发生,指导临床诊治。

Objective To observe the changes of plasma pulmonary surfactant protein - A （ SP - A） and serum ferritin （SF） in neonates with mechanical ventilation and its clinical significance in ventilation - induced lung injury （VILI）. Methods The study was carried out in 36 neonates with mechanical ventilation and 31 neonates without mechanical ventilation . Plasma SP - A and SF levels in venous blood were measured on 1,24,48,72 hours after mechanical ventilation and 24 hours after mechanical ventilation removal by Western -dot blot and radioimmunoassay （RIA）. Plasma SP - A and SF levels of non - mechanical ventilation group were determined at the same time. Results Plasma SP - A levels in neonates on 24,48,72 hours after mechanical ventilation were significantly higher than those of non - mechanical ventilation group[ （2.20 ±0.22）vs（ 1.97 ）0.29） μg/L,（2.43 s0.28）vs（ 1.94 ±0.33） μg/L,（2.61 ±0.38）vs（ 1.80 ±0.34） μg/L, respectively P 〈0.05,0.01 ] ,and SF level in neonates on 1,24,48,72 hours after mechanical ventilation and 24 hours after mechanical ventilation removal were obviously higher than those of non - mechanical ventilation group [ （ 2.67 ± 0.44 ） vs （ 2.38 ± 0.31 ）μg/L, （ 2.79 ± 0.41 ） vs （ 2.34 ± 0.39） μg/L, （2.93 ±0.45）vs（2.28 ±0.26）μg/L, （3.16 ±0.38） vs（2.23 ±0.30） μg/L, （2.57 ±0.51 ）vs（2.20 ± 0.40） μg/L, respectively P 〈 0.05, 〈 0.01 ]. Plasma SP - A and SF levels were correlated with the use of mechanical ventilation and the days requiring mechanical ventilation（ r =0. 451,0.431, respectively Pα 〈0.05 ）. Plasma SP -A and SF levels in neonates on 48 hours after mechanical ventilation were obviously elevated. Plasma SP - A and SF levels were prolonged elevation after mechanical ventilation. Conclusion Evaluating plas- ma SP - A and SF levels in neonate after mechanical ventilation may help monitor the development and gnid the clinical diagnosis and treatment of VILI.