Weigelt J A, Chenoweth D E, Borman K R, Norcross J F
Department of Surgery, University of Texas Health Science Center, Dallas 75235.
J Trauma. 1988 Jul;28(7):1013-9. doi: 10.1097/00005373-198807000-00017.
Complement-induced granulocyte aggregation is suspected as a cause of the adult respiratory distress syndrome. Quantifying the lung damage in these patients is difficult, and complement levels combined with clinical parameters of oxygenation might help define the severity of pulmonary deterioration. Forty-five high-risk patients, selected by arterial blood gas criteria, had their pulmonary insult related to C3a and C5a levels. Patients were stratified by pulmonary shunt, alveolar-arterial oxygen gradient, and radiographic findings into two categories of severity: pulmonary dysfunction, a milder insult, and ARDS, a major aberration in pulmonary function. The clinical assignment of a diagnostic category required at least 96 hours of monitoring. During this 96-hour period, multiple complement levels were obtained. These complement levels were then compared in pulmonary dysfunction and ARDS patients. ARDS patients had significantly higher C3a and C5a values after the patients were selected as high risk. These results suggest that the amount of complement activated in patients with incipient respiratory failure correlates with the severity of eventual pulmonary insult. The use of arterial blood gases and C3a and C5a levels should allow better and earlier definition of patients at risk for ARDS.
补体诱导的粒细胞聚集被怀疑是成人呼吸窘迫综合征的一个病因。量化这些患者的肺损伤很困难，补体水平与氧合临床参数相结合可能有助于确定肺部恶化的严重程度。通过动脉血气标准选择的45名高危患者，其肺部损伤与C3a和C5a水平相关。根据肺分流、肺泡-动脉氧梯度和影像学检查结果将患者分为两类严重程度：肺功能障碍，一种较轻的损伤；以及急性呼吸窘迫综合征（ARDS），一种肺功能的严重异常。诊断类别需要至少96小时的监测。在这96小时期间，获取了多个补体水平。然后将这些补体水平在肺功能障碍和ARDS患者中进行比较。在患者被选为高危后，ARDS患者的C3a和C5a值显著更高。这些结果表明，初期呼吸衰竭患者中激活的补体数量与最终肺部损伤的严重程度相关。使用动脉血气以及C3a和C5a水平应能更好、更早地确定ARDS高危患者。
