新生儿急性肺损伤血浆基质金属蛋白酶2的测定及临床意义

The measurement of plasma MMP-2 and its clinical significance in newborn infants with acute lung injury

目的探讨新生儿急性肺损伤(ALI)血浆基质金属蛋白酶2(MMP-2)的水平及其临床意义。方法选择符合ALI诊断标准且机械通气的患儿20例,作为试验组,原发疾病包括胎粪吸入综合征、新生儿窒息、肺炎、肺出血及败血症,采用ELISA方法分别于上呼吸机前1h、上呼吸机后12h、撤呼吸机后72h、治愈出院时测定其血浆MMP-2的浓度,并监测患儿动脉血气。对照组10例抽血一次测血浆MMP-2浓度。结果试验组上机后MMP-2浓度较上机前明显升高(P<0.01),撤机后MMP-2浓度较上机前、后均明显减低(P<0.01),治愈出院时MMP-2浓度较撤机后明显减低(P<0.01),治愈出院时与对照组差异无统计学意义(P>0.05)。各病种间MMP-2浓度差异无统计学意义(P>0.05)。试验组血浆MMP-2浓度与氧合指数呈负相关(r=-0.596,P<0.01);上机前MMP-2浓度与住院天数及辅助通气时间呈正相关(r=0.690、r=0.720);无创呼吸机治疗的患儿血浆MMP-2浓度在上机前后明显低于有创呼吸机治疗的患儿(P<0.05)。结论MMP-2参与ALI的病理生理过程,ALI新生儿血浆MMP-2水平与肺损伤的病情有关,动态监测患儿血浆MMP-2水平有利于判断病情,指导临床诊治。

Objective To study the level and its clinical significance of matrix metalloproteinase-2 （MMP-2） in plasma of newborns with acute lung injury （ALI）. Methods There were 20 neonates admitted to this study that met the diagnostic criteria of ALI and needed mechanical ventilation as experimental group; their primary diseases included meconium aspiration syndrome （MAS）, neonatal asphyxia, pneumonia, pulmonary hemorrhage and septicemia. The plasma MMP-2 levels were measured by ELISA at lh before initiation of mechanical ventilation, 12 h after initiation of mechanical ventilation, 72 h after discontinuation of mechanical ventilation and at time of discharge; the arterial blood gases were measured at the same time when MMP-2 levels were drawn. 10 healthy neonates were admitted to this study as control group and their MMP-2 levels were measured once. Results It was found that the MMP-2 levels of infants in experimental group were significantly higher at 12 h after initiation of mechanical ventilation than those at 1 h before initiation of mechanical ventilation （P 〈0.01 ）, it was significantly lower at 72 h after discontinuation of mechanical ventilation than those before and after initiation of mechanical ventilation （ P 〈 0. 01 ） ; it was also significantly lower at the time of discharge than those at 72 h after discontinuation of mechanical ventilation （P 〈 0. 01 ） , but there was no significant differences between the experimental group and the control group （ P 〉 0. 05 ） at discharge.There was no significant differences among infants with different primary diseases （P 〉 0. 05 ）. The plasma MMP-2 levels showed negative correlation to the oxygen index of infants in the experimental group （ r = - 0. 596, P 〈 0. 01 ） ; the plasma MMP-2 levels at before initiation of mechanical ventilation were positively correlated to the length of hospitalization and the duration of requiring mechanical ventilation （ rd = 0. 690, rh = 0. 720） ; the plasma MMP-2 levels of infants using non-invasive ventilators at before and after initiation of mechanical ventilation were markedly lower than those using invasive ventilators （ P 〈 0. 05 ）. Conclusion MMP-2 is involved in the pathophysiologic process of Aid and its plasma level is related to the severities of ALL It is beneficial to monitor the dynamic changes of plasma MMP-2 levels to evaluate the progress of ALI and to support the diagnosis and treatment of the disease.