急性肺损伤时人中性粒细胞明胶酶相关脂质运载蛋白与血管外肺水指数的相关性分析

The correlation between the human neutrophil gelatinase-associated lipocalin and the extravascular lung water index being analysised in patients with acute lung injury

目的研究脓毒性休克患者并发急性肺损伤（acutelunginjury，ALI）时肺泡灌洗液中人中性粒细胞明胶酶相关脂质运载蛋白（neutrophilgelatinase．associatedlipocalin，NGAL）含量与血管外肺水指数（extravascularlungwaterindex，EVLWI）之间是否存在相关性。方法前瞻性收集天津市第一中心医院ICU科2013年12月至2015年6月110例脓毒性休克患者，依据指南6h内完成初始的液体复苏，按是否并发ALl分为两组：非ALI组为A组（n=61），ALI组为B组（n=49）。收集两组患者入住重症监护室（ICU）时的基线指标，经肺热稀释技术和脉搏波型轮廓分析技术（PICCO）监测两组患者血流动力学指标及EVLWI，完成初始补液后床旁纤维支气管镜检查留取肺泡灌洗液酶联免疫吸附实验（ELISA）法检测NGAL含量，并同时记录EVLWI值。结果两组患者基线水平统计差异无统计学意义（P〉0．05）。对影响脓毒性休克患者EVLWI增高的危险因素：液体平衡量、NGAL、心脏指数（CI）、全心舒张末期容量指数（GEDI）、人血白蛋白（ALB）、球蛋白（GLO）等进行多元线性回归分析，结果EVLWI与NGAL、GEDI存在直线回归关系。回归方程依次为：Y（NGAL）=2．017＋0．035X与Y㈣DI）=-0．671＋0．004X。进一步行相关分析：EVLwI与NGAL之间的r=0．835，P〈0．01；EVLWI与GEDI之间的r=0．504，P〈0．01；NGAL与GEDI之间的r=0．489，P〈0．01，均具有统计学意义，即有正相关关系，在固定GEDI因素的影响后，EVLWI与NGAL之间的r=0．381，P=0．060，差异无统计学意义，即没有相关关系。结论脓毒性休克患者早期液体复苏，在补液量相对过多的情况下，肺泡灌洗液中NGAL含量与EVLWI存在正相关性。

Objective To study whether there is a correlation between the content of neutrophil gelatinase-asociated lipoealin （NGAL） and extravaseular lung water index （EVLWI） in patients with acute lung injury （ALI） induced by septic shock . Methods We prospectively collected 110 patients with septic shock from December 2013 to June 2015, who had already completed the initial fluid resuscitation within 6 hours according to the guide. In accordance with whether combined with ALI, patients were divided into two groups： nonALI group was A group （n =61）, and ALI group was B group （n =49） . Baseline information, EVLWI and other indexes of hemodynamic monitored by PICCO of each group was collected prior to admission in intensive care unit. EVWI and the content of NGAL in alveolar lavage fluid, which detected by ELISA, were gathered after the initial fluid resuscitation. Results There were no significant differences at the baseline level between the two groups （ P 〉 0. 05 ） . The risk factors of EVLWI in patients with septic shock were analyzed by multivariate linear regression analysis. The risk factors contained fluidbalance, NGAL, cardiac index （CI）, Global end diastolic volume index （GEDI）, human albumin （ALB） , globulin （GLO） . The results showed that EVLWI had linear regression with NGAL and GEDI. The equation of linear regression were Y（NGAL） = 2. 017 ＋ 0. 035X, and Y（GEDI） = 0. 671 ＋ 0. 004X, respectively. Correlation analysis indicated that there was significandy positive correlation between EVLWI andGEDI （r=0.835, P=0.000）andbetweenNGALandGEDI （r=0.489, P=0.000） . In contrast, after immobilization of GEDI, we did not find any significant correlation between EVLWI and NGAL （ r = 0. 381, P =0. 060） . Conclusions In case of fluid infusion volume is relatively too much , there is a strong correlation between NGAL it, alveolar lavage fluid and EVLWI levels ibr early fluid resuscitation in patients with sepetic shock.