Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, PR China; Department of Thoracic Surgery, Wuxi People's Hospital, Nanjing Medical University, Wuxi, 214000, PR China.
Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, PR China.
Int J Surg. 2017 May;41:136-142. doi: 10.1016/j.ijsu.2017.03.084. Epub 2017 Apr 3.
Surfactant Protein D (SP-D) as a lung-derived biomarker for inflammatory lung disease is being studied in depth. Meanwhile, the Pre-operative Rehabilitation Program (PRP) has been proposed as an effective treatment to reduce the incidence of Post-operative Pulmonary Complications (PPCs) and further improve quality of life. However, the relationship between serum SP-D levels and PRP remains unclear. This study aimed to explore the correlation between these two phenomena and validate the feasibility of using preoperative serum SP-D levels to predict or assess the effectiveness of PRP.
A prospective study with a total of 80 lung cancer patients with risk factors for PPCs was conducted; subjects were randomly divided into an Intervention Group (IG, n = 36) and a Control Group (CG, n = 44). The IG was treated with one week of PRP, and the CG was treated for the same duration with routine preoperative preparation before the lobectomy. Peripheral venous blood samples were collected at five time points and serum SP-D levels were measured by enzyme-linked immunosorbent assay (ELISA). We analysed the serum level changes of SP-D as well as the PPCs occurred between the two groups.
Both groups were comparable at baseline. The average levels of SP-D in both groups showed a decline trend with time, and levels before the day of surgery revealed a significant decline range in the IG compared with the CG (6.56 ± 5.30 vs. 1.05 ± 2.79 ng/ml, P < 0.001). The incidence of PPCs in the IG was significantly lower than in the CG (2/36 vs. 10/44, p = 0.032), as were the PPC person-times occurring from postoperative days 1-4 (POD 1-4) (5/36 vs. 15/44, p = 0.038) and the total person-times (5/36 vs. 19/44, p = 0.004). The overall SP-D levels on the day before surgery in patients with PPCs were significantly higher than those without PPCs (34.07 ± 4.32 vs. 30.30 ± 6.52 ng/ml, p = 0.005); furthermore, the overall SP-D levels on admission day in CG patients with PPCs were also significantly higher than those without PPCs (34.93 ± 4.15 vs. 29.81 ± 7.47 ng/ml, p = 0.045).
The Preoperative Intensity Rehabilitation Program could positively decrease the serum SP-D levels in lung cancer patients with PPC risk factors, and higher preoperative serum SP-D levels may related to a higher incidence of PPCs. Serum SP-D may be a potential predictor for evaluating the efficiency of PRPs and the risk of PPC occurrence.
表面活性蛋白 D（SP-D）作为一种肺部来源的炎症性肺部疾病生物标志物，正在被深入研究。同时，术前康复计划（PRP）已被提出作为一种有效的治疗方法，以降低术后肺部并发症（PPCs）的发生率，并进一步提高生活质量。然而，血清 SP-D 水平与 PRP 之间的关系尚不清楚。本研究旨在探讨这两种现象之间的相关性，并验证使用术前血清 SP-D 水平预测或评估 PRP 效果的可行性。
进行了一项前瞻性研究，共纳入 80 例有 PPCs 风险因素的肺癌患者；患者被随机分为干预组（IG，n=36）和对照组（CG，n=44）。IG 接受一周的 PRP 治疗，CG 在肺叶切除术前接受相同时间的常规术前准备。在五个时间点采集外周静脉血样，并通过酶联免疫吸附试验（ELISA）测量血清 SP-D 水平。我们分析了两组之间 SP-D 的血清水平变化和 PPCs 的发生情况。
两组在基线时具有可比性。两组的 SP-D 平均水平随时间呈下降趋势，IG 组手术前一天的水平与 CG 组相比有明显的下降范围（6.56±5.30 vs. 1.05±2.79ng/ml，P<0.001）。IG 组的 PPCs 发生率明显低于 CG 组（2/36 vs. 10/44，p=0.032），术后第 1-4 天（POD 1-4）的 PPC 人次（5/36 vs. 15/44，p=0.038）和总人次（5/36 vs. 19/44，p=0.004）也明显减少。患有 PPCs 的患者手术前一天的整体 SP-D 水平明显高于无 PPCs 的患者（34.07±4.32 vs. 30.30±6.52ng/ml，p=0.005）；此外，CG 组患有 PPCs 的患者入院当天的整体 SP-D 水平也明显高于无 PPCs 的患者（34.93±4.15 vs. 29.81±7.47ng/ml，p=0.045）。
术前强化康复方案可降低 PPC 高危肺癌患者的血清 SP-D 水平，术前血清 SP-D 水平升高可能与 PPC 发生率增加有关。血清 SP-D 可能是评估 PRP 效果和 PPC 发生风险的潜在预测因子。
