Karagiorga Georgia, Nakos George, Galiatsou Eftychia, Lekka Marilena E
Biochemistry Laboratory, Chemistry Department, University of Ioannina, University Street, 45500 Ioannina, Greece.
Intensive Care Med. 2006 Jan;32(1):116-23. doi: 10.1007/s00134-005-2868-x. Epub 2005 Dec 2.
To identify diagnostic markers distinguishing between acute lung injury/acute respiratory distress syndrome (ALI/ARDS) due to fat embolism syndrome (FES) and that due to other causes, and to investigate whether phospholipase A2 and platelet-activating factor (PAF) play a role in the pathogenesis of ALI due to FES.
A prospective study in a 14-bed ICU.
We studied 13 patients with FES, 11 with ALI/ARDS from other causes (6 without trauma, ALI/ARDS group 1; 7 with trauma, ALI/ARDS group 2) and 5 without cardiopulmonary disease.
We compared broncholveolar lavage (BAL) fluid alterations in the respective groups. Total BAL protein in FES group was significantly higher compared to in ALI/ARDS group 1 and controls but ALI/ARDS group 2. Higher total phospholipids were found than in other groups. The alterations in individual phospholipid classes were similar to those in ALI/ARDS patients. However, total cholesterol, lipid esters, and monoglycerides were significantly higher in FES than in other groups. The level of PAF in FES was significantly higher and there was an inverse correlation between PAF and PAF-acetylhydrolase. Phospholipase A2 activity was significantly higher in both FES and ALI/ARDS groups than in control.
The levels of neutral lipids and especially cholesterol and cholesterol esters in BAL can be used to distinguish patients with FES from ALI/ARDS due to other predisposing factors. Phospholipase A(2) may be involved in the development, and PAF-acetylhydrolase in the downregulation of inflammation in FES.
识别区分脂肪栓塞综合征（FES）所致急性肺损伤/急性呼吸窘迫综合征（ALI/ARDS）与其他原因所致ALI/ARDS的诊断标志物，并研究磷脂酶A2和血小板活化因子（PAF）在FES所致ALI发病机制中是否起作用。
在一个有14张床位的重症监护病房进行的前瞻性研究。
我们研究了13例FES患者、11例其他原因所致ALI/ARDS患者（6例无创伤，ALI/ARDS第1组；7例有创伤，ALI/ARDS第2组）以及5例无心肺疾病的患者。
我们比较了各组支气管肺泡灌洗（BAL）液的变化。FES组的BAL总蛋白显著高于ALI/ARDS第1组和对照组，但与ALI/ARDS第2组相当。发现其总磷脂含量高于其他组。各磷脂类别的变化与ALI/ARDS患者相似。然而，FES组的总胆固醇、脂质酯和甘油单酯显著高于其他组。FES组的PAF水平显著更高，且PAF与PAF-乙酰水解酶之间呈负相关。FES组和ALI/ARDS组的磷脂酶A2活性均显著高于对照组。
BAL中中性脂质尤其是胆固醇和胆固醇酯的水平可用于区分FES患者与其他易感因素所致的ALI/ARDS。磷脂酶A(2)可能参与FES的发展，而PAF-乙酰水解酶参与FES炎症的下调。
