支气管肺发育不良新生儿肺泡灌洗液中VEGF、SP-A和TGF-β1水平的变化及临床意义

Changes of VEGF, SP-A, and TGF-β1 levels in alveolar lavage fluid of neonates with bronchopulmonary dysplasia and its clinical significance

目的探讨支气管肺发育不良(BPD)新生儿肺泡灌洗液中血管内皮生长因子(VEGF)、肺表面活性物质蛋白A(SP-A)和转化生长因子-β1(TGF-β1)水平的变化及其临床意义,为新生儿BPD的防治提供理论依据。方法选取2016年5月至2019年5月西安市中心医院新生儿科诊治的67例BPD新生儿作为研究组,根据患儿病情严重程度分为研究A组(轻度,37例)和研究B组(中重度,30例),并选取同期67例非支气管肺发育不良新生儿作为对照组。检测并比较三组新生儿出生后1周、2周肺泡灌洗液中的VEGF、SP-A和TGF-β1水平。结果研究组患儿出生后1周的VEGF、TGF-β1水平分别为(0.42±0.15)μg/L、(36.71±3.92)μg/mL,明显高于对照组的(0.33±0.14)μg/L、(30.18±3.87)μg/mL,出生后2周的VEGF、TGF-β1水平分别为(1.86±0.23)μg/L、(45.26±5.12)μg/mL,明显高于对照组的(0.62±0.20)μg/L、(32.27±3.93)μg/mL,差异均有统计学意义(P<0.05);研究组患儿出生后1周的SP-A水平为(15.52±1.10)μg/mL,明显低于对照组的(16.80±1.06)μg/mL,出生后2周的SP-A水平为(15.52±1.10)μg/mL,明显低于对照组的(16.62±1.15)μg/mL,差异均有统计学意义(P<0.05);研究B组患儿出生后1周的VEGF、TGF-β1水平分别为(0.67±0.15)μg/L、(37.92±1.75)μg/mL,明显高于研究A组的(0.54±0.12)μg/L、(33.90±1.91)μg/mL,出生后2周的VEGF、TGF-β1水平分别为(2.05±0.65)μg/L、(46.42±3.95)μg/mL,明显高于研究A组的(1.34±0.43)μg/L、(38.8±3.10)μg/mL,差异均有统计学意义(P<0.05);研究B组患儿出生后1周和2周的SP-A水平分别为(14.71±1.03)μg/mL、(10.10±0.92)μg/mL,明显低于研究A组的(15.89±1.00)μg/mL、(11.4±0.92)μg/mL,差异均有统计学意义(P<0.05)。结论BPD新生儿肺泡灌洗液中VEGF和TGF-1水平明显升高,而SP-A水平明显下降;检测新生儿肺泡灌洗液中VEGF、TGF-1和SP-A水平有助于诊断支气管肺发育及病情程度。

Objective To investigate the changes of vascular endothelial growth factor(VEGF),pulmonary surface active substance protein A(SP-A),and transformed growth factor-beta 1(TGF-β1)levels in bronchoalveolar lavage fluid of newborns with tracheal pulmonary dysplasia(BPD)and their clinical significance,to provide a theoretical basis for the prevention and treatment of neonatal BPD.Methods Sixty-seven BPD neonates diagnosed and treated by the Department of Neonatology,Xi'an Central Hospital from May 2016 to May 2019 were selected as the study group.According to the severity of the disease,the patients were divided into study group A(mild,37 cases)and study group B(moderate and severe,30 cases),and 67 newborns with non-bronchial lung dysplasia were selected as the control group.The levels of VEGF,SP-A,and TGF-β1 in the alveolar lavage fluid of the three groups of newborns 1 week and 2 weeks after birth were detected and compared.Results The levels of VEGF and TGF-β1 in the study group were(0.42±0.15)μg/L,(36.71±3.92)μg/mL at 1 week after birth,which were significantly higher than(0.33±0.14)μg/L,(30.18±3.87)μg/mL of the control group,and the levels at 2 weeks after birth were(1.86±0.23)μg/L,(45.26±5.12)μg/mL,which were significantly higher than(0.62±0.20)μg/L,(32.27±3.93)μg/mL in the control group(P<0.05).The SP-A level in the study group at 1 week after birth was(15.52±1.10)μg/mL,which was significantly lower than(16.80±1.06)mg/mL of the control group,and the level at 2 weeks after birth was(15.52±1.10)μg/mL,which was significantly lower than(16.62±1.15)μg/mL of the control group(P<0.05).The level of VEGF and TGF-β1 in the study group B at 1 week after birth were(0.67±0.15)μg/L,(37.92±1.75)μg/mL,which were significantly higher than(0.54±0.12)μg/L,(33.90±1.91)μg/mL in the study group A,and the levels in the study group B at 2 weeks after birth were(2.05±0.65)μg/L,(46.42±3.95)μg/mL,which were significantly higher than(1.34±0.43)μg/L,(38.8±3.10)μg/mL in the study group A,with statistically significant difference(P<0.05).The SP-A level in the study group B was(14.71±1.03)μg/mL at 1 week and(10.10±0.92)μg/mL at 2 weeks after birth,which were significantly lower than(15.89±1.00)μg/mL,(11.4±0.92)μg/mL in the study group A(P<0.05).Conclusion The levels of VEGF and TGF-1 in BPD neonatal alveolar lavage fluid were significantly increased,while SP-A levels were significantly decreased.Detection of VEGF,TGF-1,and SP-A levels in neonatal alveolar lavage fluid was helpful in diagnosing bronchopulmonary development and disease severity.