Davis J M, Meyer J D, Barie P S, Yurt R W, Duhaney R, Dineen P, Shires G T
Department of Surgery, Cornell University Medical College, New York, New York.
Surg Gynecol Obstet. 1990 Jun;170(6):495-500.
Leukotriene B4, a potent neutrophil chemotactic factor, is also made by the neutrophil. Neutrophil function was studied in 12 patients at risk for the development of adult respiratory distress syndrome (ARDS) after admission to the surgical intensive care unit (ICU) to test the hypothesis that increased generation by the neutrophil generation of this mediator precedes the development of pulmonary failure. Peripheral blood neutrophils were tested for chemotaxis to f-met-leu-phe (fMLP) and leukotriene B4 (LTB4) and the generation of LTB4. Plasma was collected simultaneously for assay of C3a desArg levels. Five patients had ARDS a mean of 2.2 +/- 0.25 days after admission to the ICU. Neutrophil generation of LTB4 was significantly enhanced on ICU day 1 in these patients as compared with patients at risk for ARDS but not developing the syndrome (119.4 +/- 6.1 versus 101.0 +/- 5.1, per cent control, p less than 0.05). Chemotaxis to fMLP and LTB4 was significantly reduced in both groups of patients. However, neutrophil chemotaxis improved in patients who did not have pulmonary failure during the time in the ICU, whereas neutrophil chemotactic responsiveness worsened in patients who did have pulmonary failure. Plasma C3a desArg levels were significantly elevated over normal laboratory values on ICU day 1 in the ARDS patients (317.2 +/- 74.0 versus 132.0 +/- 16.0 milligrams per milliliter, p less than 0.01). These data indicate that LTB4 production by the neutrophil occurs concomitantly with complement activation, is a predictor of subsequent ARDS and may play a significant role in the development of pulmonary failure in critically ill surgical patients.
白三烯B4是一种有效的中性粒细胞趋化因子，也由中性粒细胞产生。对12例入住外科重症监护病房（ICU）后有发生成人呼吸窘迫综合征（ARDS）风险的患者的中性粒细胞功能进行了研究，以检验中性粒细胞产生这种介质增加先于肺功能衰竭发生这一假说。检测外周血中性粒细胞对f-甲硫-亮-苯丙氨酸（fMLP）和白三烯B4（LTB4）的趋化性以及LTB4的产生。同时采集血浆检测C3a去精氨酸水平。5例患者在入住ICU后平均2.2±0.25天发生ARDS。与有ARDS风险但未发生该综合征的患者相比，这些患者在ICU第1天中性粒细胞产生LTB4显著增强（对照百分比分别为119.4±6.1和101.0±5.1，p<0.05）。两组患者对fMLP和LTB4的趋化性均显著降低。然而，在ICU期间未发生肺功能衰竭的患者中性粒细胞趋化性改善，而发生肺功能衰竭的患者中性粒细胞趋化反应性恶化。ARDS患者在ICU第1天血浆C3a去精氨酸水平显著高于正常实验室值（分别为317.2±74.0和132.0±16.0毫克/毫升，p<0.01）。这些数据表明，中性粒细胞产生LTB4与补体激活同时发生，是随后发生ARDS的一个预测指标，可能在外科重症患者肺功能衰竭的发生中起重要作用。
