急性肺损伤/急性呼吸窘迫综合征患者呼出气冷凝液和血清一氧化氮及内皮素检测的意义

The clinical significance of nitric oxide and endothelin-1 in exhaled breath condensate and serum of patients with acute lung injury/acute respiratory distress syndrome

目的:研究急性肺损伤/急性呼吸窘迫综合征(acute lung injury/acute respiratory distress syndrome,ALI/ARDS)患者呼出气冷凝液(exhaled breath condensate,EBC)和血清中一氧化氮(nitric oxide,NO)和内皮素(endothelin-1,ET-1)改变与病情变化及预后的关系。方法:研究组为南通大学第二附属医院重症监护病房(intensive care unit,ICU)行机械通气的52例ALI/ARDS患者,根据预后分为存活组和病死组;健康对照组为30例健康体检者。采用Ecoscreen呼出气冷凝液收集器收集健康对照组和ALI/ARDS患者在住院第1天及第5天EBC标本。健康对照组和ALI/ARDS患者均同步抽取静脉血标本。以ELISA法测定EBC和血清中的NO、ET-1浓度。结果:(1)ALI/ARDS患者EBC和血清中NO及ET-1均高于健康对照组(均P<0.05)。(2)ALI/ARDS患者治疗后EBC和血清中NO及ET-1均低于治疗前,均P<0.05。(3)治疗后存活组EBC和血清中NO低于病死组(P均<0.05)。治疗后存活组血清中ET-1低于病死组(P<0.05)。结论:检测EBC及血清中NO和ET-1的水平的变化,可反映ALI/ARDS患者肺部存在氧化应激、炎症反应。其水平的改变与病情变化相关,并可评估疾病的预后。

Objective To observe the level of the nitric oxide （NO） and endothelin-1 （ET-1） in the exhaled breath condensate（EBC）and serum of the patients with ALI /ARDS, and investigate its clinical significance. Methods The study group included 52 mechanical ventilation patients with ALI/ARDS in ICU , which were divided into the survival and death group, while 30 healthy volunteers were recruited as healthy control. EBC samples of the healthy control and the study group on the 1st day and 5st day were collected by EcoScreen condenser with the synchronous collection of the venous blood. The concentrations of NO and ET-1 in the EBC and serum were measured by EIA. Results The levels of NO and ET-1 in EBC and serum of the patients with ALI /ARDS were all significantly higher than those of the healthy control. After treatment , the levels of NO and ET-1 in EBC and serum of the patients all decreased significantly compared with before treatment. After treatment , The levels of NO in EBC and serum of the survival group were significantly lower than those of the death group. After treatment , the levels of ET-1 in serum of the survival group was significantly lower than that of the death group. Conclusions Detecting the levels of NO and ET-1 in the EBC and serum can reflect oxidative stress , inflammatory reaction and endothelial injury in lung of patients with ALI/ARDS.