急性肺损伤/急性呼吸窘迫综合征患者呼出气冷凝液中TNF-α检测的临床意义

Clinical significance of TNF-αin exhaled breath condensate of patients with ALI/ARDS

目的:研究急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)患者呼出气冷凝液(EBC)中肿瘤坏死因子-α(TNF-α)检测的临床意义。方法:选择33例ICU中行机械通气的ALI/ARDS患者,用改进的德国JAEGER公司Ecoscreen呼出气冷凝液收集器收集EBC标本,同时收集血清标本;并选取20例健康体检者为对照组。采用ELISA法测定两组EBC和血清中TNF-α的浓度,分析患者EBC和血清中TNF-α水平与临床指标的相关性。结果:1ALI/ARDS患者EBC及血清中TNF-α水平高于健康对照组[(38.24±3.54)pg/ml vs.(11.52±9.71)pg/ml,(105.52±24.91)pg/ml vs.(32.71±9.11)pg/ml,P<0.01]。2第1天、第3天及第7天ARDS组患者EBC中TNF-α水平均高于ALI组,P<0.05。3ALI组EBC及血清中TNF-α水平:第1天与第3天相比、第3天与第7天相比,EBC及血清中TNF-α水平存在差异(P<0.01);ARDS组EBC及血清中TNF-α水平:第1天与第3天相比、第3天与第7天相比,EBC及血清中TNF-α水平存在差异(P<0.01)。4病死组EBC中TNF-α水平在第1天和第7天高于生存组(分别为P<0.05和P<0.01)。5病死组EBC、血清中TNF-α水平于第1天和第3天及第3天和第7天相比,P<0.01;生存组EBC、血清中TNF-α水平于第1天与第3天及第3天与第7天相比,P<0.01。6EBC中TNF-α水平与PaO2/FiO2(P<0.01)、PaO2(P<0.01)及APACHEⅡ评分(P<0.05)呈正相关,与AaDO2/PaO2呈负相关。结论:TNF-α的变化可以作为评估ALI/ARDS患者病情严重程度及预后的指标之一;用EBC检测ALI/ARDS患者TNF-α的变化较血清灵敏。

Objective：To observe the level of Tumor Necrosis Faetor-α （TNF-e） in exhaled breath condensate （EBC） of patients with acute lung injury/acute respiratory distress syndrome （ALI/ARDS）,and to investigate its clinical significance. Method：We collected 33 patients with ALI/ARDS by mechanical ventilation in intensive care unit （ICU） and 20 normal control subjects which were healthy. EBC were collected by improved EcoScreen con- denser which made by JAEGER company in German, and the venous serum samples were collected at the same time. The level of TNF-α was measured by ELISA in EBC and serum. Observe the levels of TNF-α in EBC and ser- um of patients,and the correlation was analyzed between the level of TNF-α and clinical indicators. Result： （1）The level of TNF-α in EBC and serum were higher in patients with ALI/ARDS than that of control subjects [-（38.24±3.54） pg/ml vs. （11.52±9.71） pg/ml,（105. 52±24.91） pg/ml vs. （32.71±9.11） pg/ml,P〈0. 01]. （2） At the first day, the third day and the seventh day,the level of TNF-a in EBC was higher in the ARDS group than that of ALI group（P〈0.01）. （3）Comparing the level of TNF-α in EBC and serum in ALl group and ARDS group：at the first day and the third day, the level of TNF-α was higher in ARDS group than that in ALI group, so as to the third day and the seventh day（P〈0.01）. （4）The TNF-α in EBC of death group were higher than that of surviving group at the first day（P〈0.05） and the seventh day（P〈0.01）. （5）Comparing the surviving group to the death group：at the first day and the third day,the third day and the seventh day,the differences of TNF-α in EBC and serum were statistically significant（P〈0.01）. （6）The level of TNF-α in EBC were positively correlated with PaO2/FiO2, A- PACHE Ⅱ score and PaO2, but negatively correlated with A-aDO2/PaO2 （respectively, P〈0. 05）. The level of TNF-α in serum had no correlation with APACHE Ⅱ score, AaDO2/PaO2, PaO2/FiO2 , or PaO2 （all P〉0.05）. Con- clusion：（1）The changes of TNF-α in EBC of patients with ALI/ARDS may serve as an indicator for severity and prognosis evaluation;compared to serum,EBC is more sensitive in detecting the level of TNF-α in ALI/ARDS.