SP-A在手足口病危重症急性肺损伤早期诊断中的价值

The early diagnosis value of the serum surfactant protein a in critically ill acute lung injury of HFMD

目的探讨血清肺表面活性蛋白A(SP-A)水平的变化对手足口病危重症急性肺损伤(ALI)早期判断的临床指导价值。方法选取2010年8月至2011年12月该院儿科收治的手足口病患儿60例,分为普通组20例,重症组28例,危重组12例(4例死亡),根据ALI诊断标准中的氧合指数(PaO2/FiO2),把危重组中3例PaO2/FiO2>300mm Hg归为无肺损伤组,9例PaO2/FiO2≤300mm Hg归为肺损伤组。选取同期体检健康儿童15例作为对照组,采用ELISA定量法分别于诊断后24、72h检测患儿血清SP-A水平。结果普通组、重症组24、72h血清SP-A水平分别与对照组比较,差异均无统计学意义(P>0.05),危重症组24h血清SP-A水平明显高于对照组、普通组及重症组(P<0.05);72h时,危重症组血清SP-A水平较24h有明显下降,并低于普通组及重症组,差异均有统计学意义(P<0.05)。无肺损伤组24h血清SP-A水平与对照组比较,差异无统计学意义(P>0.05);而肺损伤组24h血清SP-A水平与无肺损伤组和对照组比较有明显升高(P<0.05)。结论检测血清SP-A对手足口病危重症ALI早期判断有临床指导价值,可以指导临床治疗,降低病死率,减少后遗症,并有助于判断病情的严重程度及预后。

Objective To explore the early diagnosis clinical value of the serum surfactant protein-A （SP-A） against acute lung injury on HFMD （hand ,foot and mouth disease） in critically ill .Methods 60 cases of HFMD were selected in Xingtai People′s Hospital from August 2010 to December 2011 ,and they were divided into three groups .20 were ordinary cases ,28 were severe cases and 12 were critical cases（4 cases dead） .According to PaO2/FiO2 of ALI ,3 of critical cases （PaO2/FiO2 〉300 mm Hg） were put into the non lung injury group and 9 （PaO2/FiO2 ≤300 mm Hg） were put into the lung injury group .Besides ,15 cases of healthy children were selected as the control group .The changes of the serum SP-A levels in these children were detected through ELISA methods after 24 h and 72 h .Results Contrasting the serum SP-A levels in the ordinary and severe groups separately with the ones in control group ,there was no statistical significance（P〉0 .05） and so was contrasting the serum SP-A levels in the ordinary group with the ones in the severe group ,and the serum SP-A levels in the critical group after 24 h was significantly higher than the ordina-ry and severe groups （P0 .05） ,con-trasting with ones in the control group ;but the serum SP-A levels in the lung injury group after 24 h were significantly higher than ones in the control group and in the non lung injury group （P〈0 .05） .Conclusion Detection of the serum SP A has clinical value of the early diagnosis of acute lung injury on HFMD in critically ill ,which is beneficial to guide the clinical treatment .Meanwhile , it can reduce the mortality rate and the sequela ,and help to diagnose the condition of acute lung injury and treat it .