Lloyd J, Todd D A, John E
Department of Neonatal Medicine, Westmead Hospital, NSW, Australia.
Early Hum Dev. 1999 Mar;54(2):157-68. doi: 10.1016/s0378-3782(98)00086-3.
The initial clinical response to synthetic or natural surfactant is different and long-term complications from meta-analysis suggest that bronchopulmonary dysplasia and retinopathy of prematurity may be increased in infants given synthetic surfactant. It is possible that this is due to differences in the phospholipid composition of lung fluid following administration of these surfactants. Infants less than 32 weeks gestation with respiratory distress syndrome (RDS) were randomly assigned to receive either Exosurf, an artificial surfactant, or Survanta, a natural surfactant. Endotracheal or hypopharyngeal aspirates were obtained from these infants and from control infants who had normal lungs. The aspirates were taken prior to and up to 28 days following surfactant administration. The different phospholipids were separated by thin layer chromatography and expressed as a percent of total phospholipid measured. Infants with normal lungs had a higher proportion of phosphatidylcholine than those with RDS prior to treatment. The infants with normal lungs had a greater proportion of phosphatidylinositol in their lung aspirates than both treatment groups at 24 h. Infants in the Survanta group had a higher proportion of phosphatidylglycerol at 48 h than the group with normal lungs. No other differences were found in phospholipid composition up to 28 days. There were no major differences in the phospholipid profile in infants with RDS treated with either Exosurf or Survanta. In conclusion, neither the clinical differences initially seen between infants treated with either Exosurf or Survanta, nor the long-term outcome could be explained by the phospholipid composition of serial samples of lung aspirates.
合成表面活性剂或天然表面活性剂的初始临床反应有所不同，荟萃分析显示，使用合成表面活性剂的婴儿发生支气管肺发育不良和早产儿视网膜病变的长期并发症可能会增加。这可能是由于使用这些表面活性剂后肺液中磷脂成分存在差异。将孕周小于32周的呼吸窘迫综合征（RDS）婴儿随机分为两组，分别接受人工合成表面活性剂Exosurf或天然表面活性剂Survanta治疗。从这些婴儿以及肺部正常的对照婴儿中获取气管内或下咽吸出物。在给予表面活性剂之前以及给药后长达28天内采集吸出物。通过薄层色谱法分离不同的磷脂，并以所测总磷脂的百分比表示。治疗前，肺部正常的婴儿比患有RDS的婴儿含有更高比例的磷脂酰胆碱。在24小时时，肺部正常的婴儿肺吸出物中磷脂酰肌醇的比例高于两个治疗组。Survanta组婴儿在48小时时磷脂酰甘油的比例高于肺部正常组。在长达28天的时间内，未发现磷脂成分有其他差异。接受Exosurf或Survanta治疗的RDS婴儿的磷脂谱没有重大差异。总之，无论是最初在接受Exosurf或Survanta治疗的婴儿之间观察到的临床差异，还是长期结局，都无法用肺吸出物系列样本的磷脂成分来解释。
