Sato H, Callister M E J, Mumby S, Quinlan G J, Welsh K I, duBois R M, Evans T W
Interstitial Lung Disease Unit, National Heart and Lung Institute, Imperial College, Royal Brompton Hospital, London, SW3 6NP, UK.
Eur Respir J. 2004 Jan;23(1):142-5. doi: 10.1183/09031936.03.00070303.
The acute respiratory distress syndrome (ARDS) is an extreme form of lung injury characterised by disruption to the alveolar epithelium. KL-6 is a mucin-like glycoprotein expressed on type II pneumocytes. Circulating levels of KL-6 have diagnostic and prognostic significance in a number of interstitial lung diseases, and when elevated are thought to indicate disruption of the alveolar epithelial lining. In this study, the authors sought to determine whether plasma KL-6 levels were elevated in patients with ARDS and whether these were associated with aetiology, disease severity, outcome or ventilatory strategy. Plasma samples were collected from 28 patients with ARDS, nine ventilated controls of matched illness severity and 10 healthy individuals. KL-6 concentrations were measured by enzyme-linked immunosorbent assay. Patients with ARDS had higher plasma levels of KL-6 (median 537 U x mL(-1), interquartile range (IQR) 383-1,119), as compared to ventilated controls (median 255 U x mL(-1), IQR 83-338) and normal individuals (median 215 U x mL(-1), IQR 149-307). In patients with ARDS, plasma KL-6 levels were higher in nonsurvivors than survivors, and correlated positively with oxygenation index and negatively with arterial oxygen tension:inspiratory oxygen fraction ratio. There were also significant positive correlations with mean and peak airway pressures. Elevated levels of plasma KL-6 may provide a useful marker for acute respiratory distress syndrome in ventilated patients and have possible prognostic significance. Alveolar epithelial cell damage may be influenced by the nature of mechanical ventilatory support.
急性呼吸窘迫综合征（ARDS）是肺损伤的一种极端形式，其特征是肺泡上皮受到破坏。KL-6是一种在II型肺泡上皮细胞上表达的黏蛋白样糖蛋白。KL-6的循环水平在多种间质性肺疾病中具有诊断和预后意义，当其升高时被认为提示肺泡上皮屏障的破坏。在本研究中，作者试图确定ARDS患者血浆KL-6水平是否升高，以及这些水平是否与病因、疾病严重程度、预后或通气策略相关。从28例ARDS患者、9例病情严重程度匹配的机械通气对照患者和10名健康个体中采集血浆样本。采用酶联免疫吸附测定法测量KL-6浓度。与机械通气对照患者（中位数255 U/mL，四分位间距（IQR）83 - 338）和正常个体（中位数215 U/mL，IQR 149 - 307）相比，ARDS患者血浆KL-6水平更高（中位数537 U/mL，IQR 383 - 1119）。在ARDS患者中，非存活者的血浆KL-6水平高于存活者，且与氧合指数呈正相关，与动脉氧分压：吸入氧分数比呈负相关。血浆KL-6水平还与平均气道压和气道峰压显著正相关。血浆KL-6水平升高可能为机械通气患者的急性呼吸窘迫综合征提供一个有用的标志物，并具有潜在的预后意义。肺泡上皮细胞损伤可能受机械通气支持方式的影响。
