Hashimoto Satoru, Okayama Yoko, Shime Nobuaki, Kimura Akio, Funakoshi Yosuke, Kawabata Kazuhito, Ishizaka Akitoshi, Amaya Fumimasa
Department of Anaesthesiology and Intensive Care, Kyoto Prefectural School of Medicine, Kyoto, Japan.
Respirology. 2008 Jun;13(4):581-4. doi: 10.1111/j.1440-1843.2008.01283.x. Epub 2008 Apr 10.
Neutrophil elastase (NE) may play a key role in the development of acute lung injury (ALI) or ARDS. NE activity (NEA) was measured in patients with ALI treated with a selective NE inhibitor.
NEA and NE-alpha1-antitrypsin (NE-AT) complex were measured in plasma before, during and after the administration of the selective NE inhibitor, sivelestat, in 32 patients with a diagnosis of ALI or ARDS. NEA index (NEAI) was calculated as NEA/NE-AT. The sequential organ failure assessment (SOFA) score and the ratio PaO(2)/fraction of inspired oxygen (FiO(2)) were measured.
NEA and NE-AT was raised in all patients. Sivelestat reduced NEAI and NEA (P < 0.01 for both) but not NE-AT and NEA, and NEAI returned to pretreatment levels. NEA correlated closely with NE-AT before, but not after treatment. No relationship was observed between these indices and SOFA score or PaO(2)/FiO(2) ratio.
Sivelestat reduced NEA and NEAI in patients with ALI or ARDS suggesting NE inhibition. A larger study is needed to determine the relationship of NEA, NE-AT and NEAI with the outcome of ALI/ARDS.
中性粒细胞弹性蛋白酶（NE）可能在急性肺损伤（ALI）或急性呼吸窘迫综合征（ARDS）的发生发展中起关键作用。本研究对接受选择性NE抑制剂治疗的ALI患者的NE活性（NEA）进行了检测。
对32例诊断为ALI或ARDS的患者，在给予选择性NE抑制剂西维来司他之前、期间及之后，检测其血浆中的NEA及NE-α1抗胰蛋白酶（NE-AT）复合物。NEA指数（NEAI）计算为NEA/NE-AT。同时测量序贯器官衰竭评估（SOFA）评分及动脉血氧分压（PaO₂）/吸入氧分数（FiO₂）比值。
所有患者的NEA及NE-AT均升高。西维来司他降低了NEAI及NEA（两者P均<0.01），但未降低NE-AT，且NEAI恢复至治疗前水平。治疗前NEA与NE-AT密切相关，治疗后则无相关性。未观察到这些指标与SOFA评分或PaO₂/FiO₂比值之间存在关联。
西维来司他降低了ALI或ARDS患者的NEA及NEAI，提示其对NE有抑制作用。需要开展更大规模的研究以确定NEA、NE-AT及NEAI与ALI/ARDS预后之间的关系。
