Xu Yingyi, Lu Bingtai, Zhang Na, Liang Yufeng, Gao Ying, Ye Xiaoxin, Liu Wei
Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
Transl Pediatr. 2020 Dec;9(6):775-783. doi: 10.21037/tp-20-337.
One-lung ventilation (OLV) may cause lung injury and induce pulmonary pro-inflammation; this ventilator-induced lung injury is associated with neutrophil infiltration. The infiltrated neutrophils release neutrophil extracellular traps (NETs), which are associated with tissue damage. It is not known whether NETs are involved in the pathogenesis of one-lung injury and if they could be a potential therapeutic target. In the present study, we quantified NETs in bronchoalveolar lavage fluid from pediatric patients who underwent OLV and assessed their relationship with prognosis.
Eighteen patients with congenital pulmonary cysts or pulmonary sequestration were enrolled in this prospective monocentric study. Myeloperoxidase (MPO) levels, NET markers [i.e., citrullinated histone-3 (CH-3) and free double-stranded DNA (dsDNA)], and inflammatory cytokine levels in bronchoalveolar lavage fluid were assessed. Continuous variables were compared using the paired t-test. The association of NET concentration in bronchoalveolar lavage fluid and clinical parameters was assessed using linear regression analyses.
dsDNA concentration in bronchoalveolar lavage fluid was higher after OLV than before OLV in both the affected lung (0.23±0.30 0.97±1.05, P<0.05) and the healthy lung (0.28±0.19 2.45±2.23, P<0.05). However, there were no significant differences in concentrations of MPO, CH-3, and inflammatory cytokines before and after OLV. Serum interleukin (IL)-6 concentration was higher after OLV than before (t=-3.222, P=0.007). Moreover, no associations between dsDNA concentration in bronchoalveolar lavage fluid and the duration of postoperative mechanical ventilation, postoperative hospital stay, and chest high-resolution computed tomography score were observed. The durations of OLV, anesthesia, and operation, as well as the amount of blood loss, had no significant influence on postoperative dsDNA concentration in bronchoalveolar lavage fluid.
NETs in bronchoalveolar lavage fluid are not involved in patients who undergo OLV.
单肺通气（OLV）可能导致肺损伤并引发肺部促炎反应；这种呼吸机诱导的肺损伤与中性粒细胞浸润有关。浸润的中性粒细胞释放中性粒细胞胞外陷阱（NETs），其与组织损伤相关。目前尚不清楚NETs是否参与单肺损伤的发病机制以及它们是否可能成为潜在的治疗靶点。在本研究中，我们对接受OLV的儿科患者支气管肺泡灌洗（BAL）液中的NETs进行了定量，并评估了它们与预后的关系。
18例先天性肺囊肿或肺隔离症患者纳入了这项前瞻性单中心研究。评估了BAL液中的髓过氧化物酶（MPO）水平、NET标志物[即瓜氨酸化组蛋白-3（CH-3）和游离双链DNA（dsDNA）]以及炎性细胞因子水平。连续变量采用配对t检验进行比较。使用线性回归分析评估BAL液中NET浓度与临床参数之间的关联。
OLV后，患侧肺（0.23±0.30对0.97±1.05，P<0.05）和健侧肺（0.28±0.19对2.45±2.23，P<0.05）的BAL液中dsDNA浓度均高于OLV前。然而，OLV前后MPO、CH-3和炎性细胞因子的浓度没有显著差异。OLV后血清白细胞介素（IL）-6浓度高于术前（t=-3.222，P=0.007）。此外，未观察到BAL液中dsDNA浓度与术后机械通气时间、术后住院时间和胸部高分辨率计算机断层扫描评分之间存在关联。OLV、麻醉和手术时间以及失血量对术后BAL液中dsDNA浓度没有显著影响。
BAL液中的NETs不参与接受OLV的患者的发病过程。
