De Luca Daniele, Baroni Silvia, Vento Giovanni, Piastra Marco, Pietrini Domenico, Romitelli Federica, Capoluongo Ettore, Romagnoli Costantino, Conti Giorgio, Zecca Enrico
Neonatal Intensive Care Unit, Department of Pediatrics, University Hospital "A. Gemelli", Catholic University of the Sacred Heart, L.go A. Gemelli 8, 00168 Rome, Italy.
Intensive Care Med. 2008 Oct;34(10):1858-64. doi: 10.1007/s00134-008-1224-3. Epub 2008 Jul 22.
Secretory phospholipase A2 hydrolyzes phosphoglycerides and it has been shown to be involved in alveolar inflammation and surfactant degradation. It plays an important role in acute lung injury but it has never been studied in newborn infants. We were aimed to investigate the phospholipase A2 activity in neonatal lung injury and its relationship with ventilatory findings.
Third level university hospital NICU.
We measured phospholipase activity in broncho-alveolar lavage fluid of 21 neonates with hyaline membrane disease, 10 with pneumonia or sepsis and 10 controls, ventilated for extrapulmonary reasons. Fluid was obtained before surfactant administration on the first day of life and phospholipase activity was measured using an ultrasensitive enzymatic method. Before lavage, lung mechanics in pressure controlled synchronized intermittent mandatory ventilation was analyzed.
Phospholipase A2 was higher in babies ventilated for sepsis/pneumonia compared to hyaline membrane disease and to control babies. Phospholipase correlated negatively with dynamic compliance, positively with inspired oxygen fraction, mean airway pressure and oxygenation index. These correlations still remained significant after multivariate analysis, adjusting for possible confounding factors. Phospholipase was not correlated with blood and alveolar pH, gestational age, birth weight, blood gases, Apgar score, tidal volume, surfactant need and ventilation time.
These are the first data about phospholipase A2 in neonates. The enzyme plays a role in neonatal lung injury, especially in infection related respiratory failure. It is associated with lung stiffness, higher mean airway pressure and need for oxygen.
分泌型磷脂酶A2可水解磷酸甘油酯，已证明其与肺泡炎症和表面活性剂降解有关。它在急性肺损伤中起重要作用，但从未在新生儿中进行过研究。我们旨在研究新生儿肺损伤中磷脂酶A2的活性及其与通气指标的关系。
三级大学医院新生儿重症监护病房。
我们测量了21例患有透明膜病的新生儿、10例患有肺炎或败血症的新生儿以及10例因肺外原因进行通气的对照组新生儿支气管肺泡灌洗液中的磷脂酶活性。在出生第一天给予表面活性剂之前获取灌洗液，并使用超灵敏酶法测量磷脂酶活性。在灌洗前，分析压力控制同步间歇强制通气时的肺力学。
与患有透明膜病的婴儿和对照组婴儿相比而言，因败血症/肺炎而进行通气的婴儿体内磷脂酶A2水平更高。磷脂酶与动态顺应性呈负相关，与吸入氧分数、平均气道压和氧合指数呈正相关。在对可能的混杂因素进行校正的多变量分析后，这些相关性仍然显著。磷脂酶与血液和肺泡pH值、胎龄、出生体重、血气、阿氏评分、潮气量、表面活性剂需求和通气时间均无相关性。
这些是关于新生儿磷脂酶A2的首批数据。该酶在新生儿肺损伤中起作用，尤其是在与感染相关的呼吸衰竭中。它与肺僵硬、较高的平均气道压和吸氧需求有关。
