AECOPD机械通气时呼出气冷凝液H_2O_2和TNF-α水平的监测及意义

Monitoring and its clinical significance of hydrogen peroxide( H_2O_2) and tumor necrosis factor-α( TNF-α) levels in exhaled breath condensate of AECOPD undergoing mechanical ventilation

目的探讨重症监护病房(ICU)慢阻肺急性加重期(AECOPD)机械通气患者气道炎症反应与预后的关系。方法 69例AECOPD机械通气患者按预后分为存活组(36例)和死亡组(33例),采用自行设计的呼出气冷凝液(EBC)收集器收集机械通气1、3、5和7 d呼气端的EBC,用化学荧光法测定EBC中过氧化氢(H2O2)浓度,用放射免疫分析法测定EBC中肿瘤坏死因子(TNF-α)含量。结果 1存活组EBC中H2O2和TNF-α含量逐渐下降,机械通气3、5、7 d较1 d明显降低H2O2(μmol/L):0.12±0.04、0.08±0.02、0.03±0.01比0.22±0.14,TNF-α(ng/L):15.14±3.11、12.24±2.37、9.76±1.89比18.54±2.59,均P<0.05。2死亡组EBC中H2O2:和TNF-α含量逐渐升高,机械通气第五天、第7天EBC中H2O2浓度较1 d明显升高(0.38±0.11、0.44±0.12比0.24±0.03,均P<0.05);机械通气3、5和7 d TNF-α含量较1 d明显升高(18.3±2.56、21.3±2.34、29.7±3.21比15.52±3.14,均P<0.05);7 d时EBC中H2O2和TNF-α含量较3 d、5 d明显升高(均P<0.05)。3存活组和死亡组机械通气患者EBC中H2O2浓度和TNF-α含量与急性生理学与慢性健康状况评分系统(APACHEⅡ、Ⅲ)评分均无相关性(均P>0.05)。结论 EBC中H2O2水平和TNF-α含量的高低与预后有关,故可作为AECOPD机械通气患者气道炎症反应的重要监测指标,并可作为评估其治疗和预后的重要监测指标。

Objective To explore the relationship between inflammatory response of respiratory tract and prognosis of acute exacerbation of chronic obstructive pulmonary diseases（AECOPD） patients undergoing mechanical ventilation （MV） in intensive care unit （ICU）. Methods 69 patients with AECOPD undergoing MV were involved in the study, and they were divided into the survival group （n = 36） and the non-survival group （n = 33）. Exhaled breath condensate （EBC） was collected on Day 1, 3, 5 and 7 after MV. The concentration of hydrogen peroxide （H2 O2 ） in EBC was measured by fluorescence method, and the content of tumor necrosis factor-α （TNF-α） in EBC was measured by enzyme-linked immunosorbent assay （ELISA）. Results ① The levels of H2 O2 and TNF-α de-creased gradually in the survival group undergoing MV, with the H2 O2 value of 0. 12 ± 0. 04, 0. 08 ± 0. 02, 0. 03 ± 0. 01 and 0. 22 ± 0. 14 μmol/ L, and the TNF-α value of 15. 14 ± 3. 11, 12. 24 ± 2. 37, 9. 76 ± 1. 89 and 18. 54 ± 2. 59 ng/ L （P〈0. 05）. ② The levels of H2 O2 and TNF-α increased gradually in the non-survival group, with the H2 O2 value of 0. 38 ± 0. 11, 0. 44 ± 0. 12 and 0. 24 ± 0. 03 respectively on Day 5, 7 and 1, and the TNF-α value of 18. 3 ± 2. 56, 21. 3 ± 2. 34, 29. 7 ± 3. 21 and 15. 52 ± 3. 14 respectively on Day 3, 5, 7 and 1 （P〈0. 05）. ③ The levels of H2 O2 and TNF-α in EBC showed no correlation with acute physiology and chronic health evaluation A-PACHE scores between the two groups （both P〉0. 05）. Conclusion The findings suggest that the levels of H2 O2 and TNF-α in EBC are correlated with prognosis of patients undergoing MV, and it may prove to be useful in monito-ring inflammatory response in the airway after MV as a guidance of therapy and prognosis in AECOPD patients under-going MV.