急性呼吸窘迫综合征患儿血清及支气管肺泡灌洗液中胎盘生长因子的变化

Changes of Placenta Growth Factor in Serum and Bronchial Alveolar Lavage Fluid in Children with Acute Respiratory Distress Syndrome

目的:探讨急性呼吸窘迫综合征(ARDS)患儿血清及支气管肺泡灌洗液(BALF)中胎盘生长因子(PLGF)的变化及意义。方法:酶联免疫分析法检测107例ARDS患儿治疗后第1天、第3天和第7天血清和BALF中PLGF水平,根据治疗28 d后临床转归分为生存组和死亡组进行比较分析。结果:(1)在轻度、中度与重度组患儿血清中PLGF水平分别为16.31 pg/m L(P50)、(27.68±8.04)pg/m L、(36.29±11.76)pg/m L,在其BALF中PLGF水平分别为22.75 pg/m L(P50)、(41.57±12.14)pg/m L、54.83 pg/m L(P50),PLGF水平均随着缺氧严重程度增加而上升,三组之间血清和BALF中PLGF水平比较差异均有统计学意义(P均<0.05)。(2)死亡组在治疗后第1天、第3天和第7天血清PLGF水平分别为(48.2±9.3)pg/m L、76.5 pg/m L(P50)、121.6 pg/m L(P50),BALF中PLGF水平分别为(69.4±12.3)pg/m L、(89.4±22.7)pg/m L、96.6 pg/m L(P50),均呈升高趋势,差异均有统计学意义(P<0.05);生存组治疗后第1天、第3天和第7天血清PLGF水平分别为(22.5±7.2)pg/m L、(52.4±17.2)pg/m L、(45.3±10.5)pg/m L,BALF中PLGF水平分别为(31.1±8.6)pg/m L、(67.4±14.1)pg/m L和55.5 pg/m L(P50),差异有统计学意义(P<0.05),但治疗后第7天血清和BALF中PLGF水平显著降低(P<0.05);死亡组治疗后第1天、第3天和第7天血清和BALF中PLGF水平均显著高于存活组(P均<0.05)。(3)死亡组治疗后第7天时PLGF在BALF中水平显著低于血清水平(P<0.05);治疗后第1天、第3天和第7天,存活组和死亡组的PLGF在BALF中水平均显著高于血清水平(P<0.05)。(4)血清和BALF中PLGF均与ARDS患儿的缺氧程度呈正相关(P<0.05);血清和BALF中PLGF与患儿的预后均呈正相关性(P<0.05);存活组血清和BALF的动态变化呈正相关(P<0.05);死亡组血清和BALF的动态变化无相关性(P>0.05)。结论:PLGF与ARDS患儿缺氧的严重程度及病情进展有密切关系,动态检测血清和BALF中PLGF水平可能有助于预测ARDS患儿的预后。

Objective： To observe the change and significance of placenta growth factor （PLGF） in serum and bronchial alveolar lavage fluid （BALF） in children with acute respiratory distress syndrome （ARDS）. Methods： One hundred and seven children with ARDS were divided into mild group, moderate group and severe group according to the degree of hypoxia, PLGF in serum and BALF was measured by ELISA on the 1st day, the 3rd day and the 7th day after therapy. Children with ARDS were divided into death group and survival group according to their outcomes after 28 day＇s treatment and for comparative analysis. Results： （ 1 ） The concentrations of PLGF in serum of the three groups were 16.31 pg/mL （P50）, （27.68 ±8.04） pg/mL, （36.29±11.76 ） pg/mL respectively and in BALF were 22.75 pg/mL （ P50）, （41.57 ± 12.14 ） pg/mL, 54.83 pg/mL （ P50 ） respectively. The concentrations of PLGF were increased with the severity of oxygen, the differences of serum or BALF PLGF among the throe groups have statistical significance （all P〈0.05 ）. （2） Comparison between death group and survival group： PLGF showed a continuing rising trend both in serum （48.2±9.3） pg/mL, 76.5 pg/mL （ P50 ） , 121.6 pg/mL （ P50 ） in death group respectively, （22.5±1. 2 -pg.CmL, （52.4±17.2） pg/mL, （45.3±10. 5） pg/mL in survival group respectively, and BALF （69.4±12.3） pg/mL, （89.4±22.7） pg/mL, 96.6 pg/mL （ Pso ） in death group respectively, （31. 1±8.6） pg/mL, （67.4± 14.1 ） pg/mL, 55.5 pg/mL （ P50 ） in survival group respectively after be admitted to hospital 1 d, 3 d and 7 d, differences were statistically significant （all P〈0.05）. But PLGF was significantly decreased both in serum and BALF on the 7 th day after therapy 7 d （P〈0.05）. PLGF in serum and BALF on the 1st day, the 3rd day, 7th day after therapy in death group were significantly higher than those in the survival group （all P〈0.05 ）. （3） Comparison between PLGF in serum and BALF： PLGF in BALF levels were significantly higher than those in serum of death group and survival group on the 1st day, the 3rd day, 7th day after therapy （all P〈0.05 ） except for PLGF in BALF significantly lower it in serum in death group on the 7th day after therapy 7d （P〈0. 05）. （4） PLGF in serum and BALF were a positive correlation with the degree of hypoxia （ P〈0. 05 ）. PLGF in serum and BALF were a positive correlation with the prognosis of children with ARDS （all P〈0. 05）. The dynamic changes of the serum and BALF had positive correlation in survival group （P〈0. 05）. The dynamic changes of the serum and BALF had no correlation in death group （ P 〉 0. 05 ）. Conclusion： PLGF were closely related to the development of ARDS and the degree of hypoxia. Dynamic detecting PLGF level in serum and BALF may help to predict the prognosis of children with acute respiratory distress syndrome.