Hutson Alan D, Davidson Bruce A, Raghavendran Krishnan, Chess Patricia R, Tait Alan R, Holm Bruce A, Notter Robert H, Knight Paul R
Department of Biostatistics, State University of New York at Buffalo, Buffalo, New York 14214, USA.
Anesthesiology. 2006 Jan;104(1):73-9. doi: 10.1097/00000542-200601000-00013.
Unwitnessed gastric aspiration can be a diagnostic dilemma, and early discrimination of different forms may help to identify individuals with increased risk of development of severe clinical acute lung injury or acute respiratory distress syndrome. The authors hypothesized that inflammatory mediator profiles could be used to help diagnose different types of gastric aspiration.
Diagnostic modeling using a newly modified receiver operator characteristic approach was applied to recently published data from our laboratory on lavaged inflammatory mediators from rodents given intratracheal normal saline, hydrochloric acid, small nonacidified gastric particles, or a combination of acid and small gastric particles. Multiple animal groups and postaspiration times of injury were analyzed to gauge the applicability of the predictive approach: rats (6 and 24 h), C57/BL6 wild-type mice (5 and 24 h), and transgenic mice on the same background deficient in the gene for monocyte chemoattractant protein 1 (MCP-1 [-/-] mice; 5 and 24 h).
Overall, the four types of aspiration were correctly discriminated in 85 of 96 rats (89%), 72 of 78 wild-type mice (92%), and 59 of 73 MCP-1 (-/-) mice (81%) by models that used a maximum of only two mediators. The severe "two-hit" aspirate of the combination of acid and small gastric particles was correctly predicted in 21 of 24 rats, 23 of 23 wild-type mice, and 21 of 21 MCP-1 (-/-) mice. Specific best-fit mediators or mediator pairs varied with aspirate type, animal type, and time of injury. Cytokines and chemokines that best predicted the combination of acid and small gastric particles were cytokine-induced neutrophil chemoattractant 1 (6 h) and MCP-1 (24 h) in rats, tumor necrosis factor alpha/macrophage inflammatory protein 2 (5 h) and tumor necrosis factor alpha/MCP-1 (24 h) in wild-type mice, and tumor necrosis factor alpha/macrophage inflammatory protein 2 (5 h) and tumor necrosis factor alpha/keratinocyte-derived cytokine (24 h) in MCP-1 (-/-) mice.
These results support the potential feasibility of developing predictive models that use focused measurements of inflammatory mediators to help diagnose severe clinical forms of unwitnessed gastric aspiration, such as the combination of acid and small gastric particles, that may have a high risk of progression to acute lung injury/acute respiratory distress syndrome.
非目击性胃内容物误吸可能是一个诊断难题，早期区分不同形式可能有助于识别发生严重临床急性肺损伤或急性呼吸窘迫综合征风险增加的个体。作者推测炎症介质谱可用于帮助诊断不同类型的胃内容物误吸。
使用一种新改良的受试者工作特征方法进行诊断建模，应用我们实验室最近发表的关于给予气管内生理盐水、盐酸、小的非酸化胃颗粒或酸与小胃颗粒组合的啮齿动物灌洗炎症介质的数据。分析多个动物组和误吸后损伤时间，以评估预测方法的适用性：大鼠（6小时和24小时）、C57/BL6野生型小鼠（5小时和24小时）以及相同背景下单核细胞趋化蛋白1基因缺陷的转基因小鼠（MCP-1[-/-]小鼠；5小时和24小时）。
总体而言，使用最多仅两种介质的模型在96只大鼠中的85只（89%）、78只野生型小鼠中的72只（92%）和73只MCP-1（-/-）小鼠中的59只（81%）中正确区分了四种误吸类型。酸与小胃颗粒组合的严重“二次打击”误吸在24只大鼠中的21只、23只野生型小鼠中的23只和21只MCP-1（-/-）小鼠中的21只中被正确预测。特定的最佳拟合介质或介质对因误吸类型、动物类型和损伤时间而异。最能预测酸与小胃颗粒组合的细胞因子和趋化因子在大鼠中是细胞因子诱导的中性粒细胞趋化因子1（6小时）和MCP-1（24小时），在野生型小鼠中是肿瘤坏死因子α/巨噬细胞炎性蛋白2（5小时）和肿瘤坏死因子α/MCP-1（24小时），在MCP-1（-/-）小鼠中是肿瘤坏死因子α/巨噬细胞炎性蛋白2（5小时）和肿瘤坏死因子α/角质形成细胞衍生细胞因子（24小时）。
这些结果支持开发预测模型的潜在可行性，该模型使用炎症介质的重点测量来帮助诊断非目击性胃内容物误吸的严重临床形式，如酸与小胃颗粒的组合，其可能有进展为急性肺损伤/急性呼吸窘迫综合征的高风险。
