术前肺保护对肺组织肺表面活性蛋白A含量的影响

The effect of preoperative pulmonary protection on surfactant protein A content in lung tissue

目的探讨术前肺保护治疗对肺组织肺表面活性蛋白A(SP-A)含量及术后并发症的影响。方法入组2015年1月—2016年6月在天津市胸科医院行手术治疗的非小细胞肺癌(NSCLC)合并慢性阻塞性肺疾病(COPD)患者60例,其中对照组30例,肺保护组30例。对照组常规术前准备,肺保护组在常规术前准备基础上给予1周肺保护治疗。收集入院时及术前呼出气冷凝液(EBC)并复查肺功能,酶联免疫吸附测定(ELISA)法检测EBC中SP-A含量。术中收集肺组织标本,免疫印迹法测定肺组织SP-A水平。结果肺保护组中肺组织SP-A水平高于对照组(1.05±0.21 vs.0.93±0.16,P<0.05)。肺保护组术前EBC中SP-A含量较入院时提高[(5.51±1.48)ng/L vs.(4.99±1.32)ng/L,P<0.01]。经肺保护治疗后,术前肺功能指标较入院时提高,差异有统计学意义(P<0.01)。2组术后肺部并发症的发生率差异无统计学意义(43.3%vs.23.3%),肺保护组术后平均住院日较对照组短[(9.2±3.1)d vs.(11.6±4.8)d,P<0.05]。结论术前肺保护不但能够改善肺功能和缩短术后住院时间,也能提高肺组织中SP-A含量。

Objective To explore the effect of preoperative pulmonary protection therapy on surfactant protein A(SP–A) content in lung tissue and postoperative complications. Methods Sixty patients with non- small cell lung cancer(NSCLC) complicated with chronic obstructive pulmonary disease(COPD) who underwent surgical treatment in Tianjin Chest Hospital from January 2015 to June 2016 were enrolled in this study. Thirty patients were included in the control group and 30 patients in the pulmonary protection group. The control group was given routine preoperative preparation, while the pulmonary protection group was given 1 week pulmonary protection therapy on the basis of routine preoperative preparation.The exhaled breath condensate (EBC) was collected and pulmonary function was re-checked after admission and before surgery. The content of SP-A in EBC was detected by ELISA. The lung tissue samples were collected during surgery, and the SP-A level was measured by Western blotting. Results The SP-A level of the pulmonary protection group was significantly higher than that of the control group (1.05±0.21 vs. 0.93±0.16, P<0.05). The SP-A content in the preoperative EBC of the pulmonary protection group was significantly higher than that after admission[(5.51±1.48) ng/L vs. (4.99±1.32) ng/L, P<0.01]. After pulmonary protection treatment, the preoperative pulmonary function index was significantly higher than that after admission (P<0.01). There was no significant difference in the incidence of postoperative pulmonary complications between two groups (23.3% vs. 43.3%, P>0.05). The average postoperative hospital stay was statistically significant shorter in the pulmonary protection group than that in the control group[(9.2±3.1) d vs. (11.6±4.8) d, P<0.05]. Conclusion Preoperative pulmonary protection therapy can not only improve pulmonary function and shorten postoperative hospital stay,but also improve SP-A content in lung tissue