外源性肺表面活性物质对胎粪吸入综合征肺表面活性物质相关蛋白的影响

The influence of exogenous pulmonary surfactant on pulmonary surfactant-associated proteins in infants with meconium aspiration syndrome

目的探讨肺表面活性物质(PS)对胎粪吸入综合征(MAS)患儿支气管肺泡灌洗液(BALF)中肺表面活性蛋白A(SP-A)、肺表面活性蛋白D(SP-D)及转化生长因子β1(TGF-β1)水平的影响,以及PS对氧合、气体交换的影响。方法需要机械通气辅助呼吸的MAS患儿,按照随机数字法随机分为PS组和对照组,分别在治疗0、24h和48h检测两组患儿BALF中SP-A、SP-D和TGF-β1的含量,并同时记录动脉血气、呼吸机参数,计算氧合指数(oxygenindex,OI)和动脉/肺泡氧分压比值(a/APO2)。结果共入选45例,PS治疗组22例,对照组23例。两组胎龄、出生体质量和入院日龄差异均无统计学意义(P>0.05)。(1)治疗开始时两组患儿BALF中SP-A、SP-D、TGF-β1含量差异无统计学意义(P>0.05)。治疗24、48h后,PS组患儿BALF中SP-A、SP-D含量逐渐升高,明显高于对照组(P<0.05);TGF-β含量PS组明显低于对照组(P<0.05)。(2)PS治疗组机械通气时间和氧暴露时间分别为(71.1±6.1)h、(130.6±20.3)h,明显低于对照组(113.6±21.4)h、(148.6±21.5)h,差异有统计学意义(P<0.05)。(3)PS组气漏发生例数低于对照组,但经统计学处理差异无统计学意义(χ2=1.581,P=0.209);病死率低于对照组,差异有统计学意义(χ2=4.557,P=0.033)。结论外源性PS治疗MAS通过抑制TGF-β1释放,从而抑制肺部炎症反应减轻了肺损伤。同时应用外源性PS治疗MAS,改善了氧合,并缩短了氧暴露和机械通气的时间,降低了病死率。

Objective To investigate the expression of SP-A（surfactant protein A）,SP-D（surfactant protein D）and TGF-β1（transforming growth factor-β1）,and how the exogenous pulmonary surfactant influenced their concentration in bronchoalveolar lavage fluid and the oxygenation.Methods From June 2007 to Jan.2009,45 infants with MAS（Meconium Aspiration Syndrome）in Neonatalogy Department of Hebei Province Children Hospital,were randomly assigned into two groups.The PS（pulmonary surfactant）group（22 cases）were treated with PS 70 mg/kg;the control group（23 cases）were treated in usual method,observing the concentration of SP-A、SP-D and TGF-β1 in bronchoalveolar lavage fluid at 0 h,24 h and 48 h.Results There was no significant difference in gestational age,birth weight,age at admission in hours between the PS group and the control group.（1）At the beginning of the treatment,no significant difference was found in the concentration of SP-A,SP-D and TGF-β1 in bronchoalveolar lavage fluid（BALF）between the PS group and the control group（P〉0.05）.24 h and 48 h later,the concentration of SP-A,SP-D in the BALF of PS group were increased significantly than the control group（P〈0.05）.The concentration of TGF-β1 in the BALF of the PS group decreased significantly than the control group（P〈0.05）.（2）The duration of ventilation time and the need for oxygen supplement of PS group（71.1±6.1 h、130.6±20.3 h）were significantly shorter than control group（113.6±21.4 h,148.6±21.5 h）,（P〈0.05）.The incidence of pulmonary barotauma leakage were not significantly different between the two groups（χ^2=1.581,P=0.209）;The mortality of PS group was significantly lower than the control group（χ^2=4.557,P=0.033）.Conclusion Exogenous PS could stimulate endogenous surfactant secretion,inhibiting the release of transforming growth factor-β1,relieving the inhibition of pulmonary surfactant so as to restrain lung injury.And exogenous PS could effectively improve the oxygenation and shorten the ventilation time and the need for oxygen supplement.