Réanimation Médicale-Détresses Respiratoires Aigües-Infections Sévères, URMITE CNRS-UMR 6236, Hôpital Nord, Assistance Publique, Hôpitaux de Marseille, Chemin des Bourrely, 13015 Marseille, France.
Crit Care. 2011;15(1):R31. doi: 10.1186/cc9978. Epub 2011 Jan 18.
The current study has addressed the presence and the cellular origin of microparticles (MP) isolated from bronchoalveolar lavage (BAL) fluid and from blood samples from patients with acute respiratory distress syndrome (ARDS). Their prognostic interest was also investigated.
Fifty-two patients were included within the first 24 hours of ARDS. They were compared to spontaneous breathing (SB) and ventilated control (VC) groups. Bronchoalveolar lavage (BAL) and blood samples were obtained on Day 1 and Day 3 in an ARDS group. Leukocyte microparticles (LeuMP), neutrophil microparticles (NeuMP), endothelial microparticles (EMP), and platelet microparticles (PMP) were measured in arterial blood and in BAL samples by flow cytometry. Mortality from all causes was recorded at Day 28.
All MP subpopulations were detected in BAL. However, only LeuMP and NeuMP were elevated in ARDS patients compared to the SB group (P = 0.002 for both). Among ARDS patients, higher levels of LeuMP were detected in blood (Day 1) and in BAL (Day 3) in survivors as compared with the non survivors. Circulating LeuMP >60 elements/microliter detectable on Day 1 of ARDS, was associated with a higher survival rate (odds ratio, 5.26; 95% confidence interval, 1.10 to 24.99; P = 0.037).
The identification of the cellular origin of microparticles at the onset of ARDS has identified LeuMP as a biomarker of prognostic significance. The higher levels of LeuMP in survivors could be associated with a protective role of this MP subpopulation. This hypothesis needs further investigations.
本研究探讨了急性呼吸窘迫综合征（ARDS）患者支气管肺泡灌洗液（BAL）和血液样本中分离的微颗粒（MP）的存在及其细胞来源。还研究了它们的预后意义。
ARDS 发病后 24 小时内纳入 52 例患者，并与自主呼吸（SB）和通气控制（VC）组进行比较。ARDS 组于第 1 天和第 3 天分别采集支气管肺泡灌洗（BAL）和血液样本。通过流式细胞术在动脉血和 BAL 样本中测量白细胞微颗粒（LeuMP）、中性粒细胞微颗粒（NeuMP）、内皮微颗粒（EMP）和血小板微颗粒（PMP）。记录第 28 天的所有原因死亡率。
所有 MP 亚群均在 BAL 中检测到。然而，与 SB 组相比，ARDS 患者的 LeuMP 和 NeuMP 水平升高（均 P = 0.002）。在 ARDS 患者中，与非幸存者相比，幸存者的血液（第 1 天）和 BAL（第 3 天）中 LeuMP 水平更高。ARDS 发病第 1 天可检测到的循环 LeuMP>60 个/微升，与生存率较高相关（优势比，5.26；95%置信区间，1.10 至 24.99；P = 0.037）。
在 ARDS 发病时确定微颗粒的细胞来源，确定 LeuMP 为具有预后意义的生物标志物。幸存者中 LeuMP 水平较高可能与该微颗粒亚群的保护作用有关。这一假说需要进一步研究。
