Departamento de Biología Funcional, Instituto Universitario de Oncología del Principado de Asturias (IUOPA), Universidad de Oviedo, Oviedo, Spain.
Intensive Care Med. 2012 Feb;38(2):240-7. doi: 10.1007/s00134-011-2403-1. Epub 2011 Nov 23.
Lung tissue may exhibit a biochemical response to excessive deformation. Since strain has been proposed as a marker of such deformation, we studied the relationships between strain and matrix remodeling and inflammation markers in mechanically ventilated patients with and without acute lung injury (ALI).
Twenty-two ventilated patients were studied (16 with ALI, 6 controls). Clinical data, gas exchange and respiratory mechanics were recorded, and end-expiratory lung volume (EELV) was measured by oxygen washin/washout. Extracellular matrix remodeling markers (procollagen, matrix metalloproteinases -2 and -9, TIMP-1) and inflammation markers (IL-6, IL-8, IL-10, IFNγ, IL-17A, and VEGF) were measured in bronchoalveolar lavage fluid (BALF). Strain was computed as the ratio between tidal volume and EELV. Patients with ALI were divided into two subgroups according to the median strain value (0.27).
Patients in the ALI group exhibited higher airway pressures, lower EELV and higher strain than the control group. There were no significant differences in gas exchange, respiratory mechanics, or the matrix remodeling markers between ALI patients with normal and high strain. The subgroup of patients with high strain showed a fourfold increase of IL-6 and IL-8 concentrations in BALF, compared with patients with ALI and normal strain or patients without ALI. In the whole sample, IL-6 and IL-8 concentrations in BALF were correlated with strain (Spearman's ρ = 0.67 and 0.77, respectively).
Increased strain is associated with a proinflammatory lung response in patients with ALI.
肺部组织可能会对过度变形产生生化反应。由于应变已被提出作为这种变形的标志物，因此我们研究了机械通气患者中应变与基质重塑和炎症标志物之间的关系，这些患者有无急性肺损伤（ALI）。
研究了 22 名接受通气的患者（16 名患有 ALI，6 名对照）。记录临床数据、气体交换和呼吸力学，并通过氧洗出/洗入测量呼气末肺容积（EELV）。测量支气管肺泡灌洗液（BALF）中的细胞外基质重塑标志物（前胶原、基质金属蛋白酶-2 和 -9、TIMP-1）和炎症标志物（IL-6、IL-8、IL-10、IFNγ、IL-17A 和 VEGF）。应变作为潮气量与 EELV 的比值计算。根据应变中位数（0.27）将 ALI 患者分为两组。
ALI 组患者的气道压力较高，EELV 较低，应变较高。在正常和高应变的 ALI 患者之间，气体交换、呼吸力学或基质重塑标志物均无显著差异。高应变亚组的 BALF 中 IL-6 和 IL-8 浓度增加了四倍，与 ALI 患者和正常应变患者或无 ALI 患者相比。在整个样本中，BALF 中的 IL-6 和 IL-8 浓度与应变相关（Spearman's ρ 分别为 0.67 和 0.77）。
在 ALI 患者中，应变增加与肺部炎症反应有关。
