严重机械通气患者肺损伤评估中表面活性蛋白 D 和 KL-6 的血浆水平。
Plasma levels of surfactant protein D and KL-6 for evaluation of lung injury in critically ill mechanically ventilated patients.
机构信息
Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, The Netherlands.
出版信息
BMC Pulm Med. 2010 Feb 16;10:6. doi: 10.1186/1471-2466-10-6.
BACKGROUND
Preventing ventilator-associated lung injury (VALI) has become pivotal in mechanical ventilation of patients with acute lung injury (ALI) or its more severe form, acute respiratory distress syndrome (ARDS). In the present study we investigated whether plasma levels of lung-specific biological markers can be used to evaluate lung injury in patients with ALI/ARDS and patients without lung injury at onset of mechanical ventilation.
METHODS
Plasma levels of surfactant protein D (SP-D), Clara Cell protein (CC16), KL-6 and soluble receptor for advanced glycation end-products (sRAGE) were measured in plasma samples obtained from 36 patients - 16 patients who were intubated and mechanically ventilated because of ALI/ARDS and 20 patients without lung injury at the onset of mechanical ventilation and during conduct of the study. Patients were ventilated with either a lung-protective strategy using lower tidal volumes or a potentially injurious strategy using conventional tidal volumes. Levels of biological markers were measured retrospectively at baseline and after 2 days of mechanical ventilation.
RESULTS
Plasma levels of CC16 and KL-6 were higher in ALI/ARDS patients at baseline as compared to patients without lung injury. SP-D and sRAGE levels were not significantly different between these patients. In ALI/ARDS patients, SP-D and KL-6 levels increased over time, which was attenuated by lung-protective mechanical ventilation using lower tidal volumes (P = 0.02 for both biological markers). In these patients, with either ventilation strategy no changes over time were observed for plasma levels of CC16 and sRAGE. In patients without lung injury, no changes of plasma levels of any of the measured biological markers were observed.
CONCLUSION
Plasma levels of SP-D and KL-6 rise with potentially injurious ventilator settings, and thus may serve as biological markers of VALI in patients with ALI/ARDS.
背景
预防呼吸机相关性肺损伤（VALI）已成为急性肺损伤（ALI）或其更严重形式急性呼吸窘迫综合征（ARDS）患者机械通气的关键。本研究旨在探讨肺特异性生物标志物的血浆水平是否可用于评估机械通气开始时患有 ALI/ARDS 患者和无肺损伤患者的肺损伤。
方法
在本研究中，我们测量了来自 36 名患者的血浆样本中表面活性蛋白 D（SP-D）、克拉拉细胞蛋白（CC16）、KL-6 和可溶性晚期糖基化终产物受体（sRAGE）的血浆水平，这些患者包括 16 名因 ALI/ARDS 而插管和机械通气的患者，以及 20 名机械通气开始时无肺损伤的患者。患者使用保护性肺通气策略（使用较低潮气量）或传统潮气量的潜在损伤性通气策略进行通气。在基线和机械通气 2 天后，回顾性测量生物标志物水平。
结果
与无肺损伤患者相比，基线时 ALI/ARDS 患者的 CC16 和 KL-6 血浆水平更高。SP-D 和 sRAGE 水平在这些患者之间没有显著差异。在 ALI/ARDS 患者中，SP-D 和 KL-6 水平随时间推移而增加，使用较低潮气量的保护性机械通气可减弱这种增加（两种生物标志物的 P 值均为 0.02）。在这些患者中，无论采用哪种通气策略，CC16 和 sRAGE 的血浆水平均未随时间发生变化。在无肺损伤患者中，未观察到任何测量的生物标志物的血浆水平发生变化。
结论
SP-D 和 KL-6 的血浆水平随潜在损伤性通气设置而升高，因此可能作为 ALI/ARDS 患者 VALI 的生物标志物。
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