Division of Pediatrics and Neonatal Critical Care, "Antoine Béclère" Medical Centre, Paris Saclay University Hospitals, APHP, Paris, France.
Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, Paris, France.
Am J Physiol Lung Cell Mol Physiol. 2023 Oct 1;325(4):L411-L418. doi: 10.1152/ajplung.00079.2023. Epub 2023 Jul 25.
Surfactant protein-D (SP-D) is a hydrophilic protein with multiple crucial anti-inflammatory and immunological functions. It might play a role in the development and course of pulmonary infections, acute respiratory distress syndrome, and other respiratory disorders. Only few small neonatal studies have investigated SP-D: we aimed to investigate the links between this protein, measured in the first hours of life in extremely preterm neonates, and clinical outcomes, as well its relationship with pulmonary secretory phospholipase A2 (sPLA2). Bronchoalveolar lavage fluids were obtained within the first 3 h of life. SP-D and sPLA2 were measured with ELISA and radioactive method, respectively; epithelial lining fluid concentrations were estimated with urea ratio. Clinical data were prospectively collected. One hundred extremely preterm neonates were nonconsecutively studied. SP-D was significantly raised with increasing gestational age (24-26 wk: 68 [0-1,694], 27 or 28 wk: 286 [0-1,328], 29 or 30 wk: 1,401 [405-2,429] ng/mL, overall = 0.03). SP-D was significantly higher in cases with clinical chorioamnionitis with fetal involvement (1,138 [68-3,336]) than in those without clinical chorioamnionitis with fetal involvement (0 [0-900] ng/mL, < 0.001). SP-D was lower in infants with bronchopulmonary dysplasia (BPD) (251 [0-1,550 ng/mL]) compared with those without bronchopulmonary dysplasia (BPD) or who died before its diagnosis (977 [124-5,534 ng/mL], = 0.05) and this was also significant upon multivariate analysis [odds ration (OR): 0.997 (0.994-0.999), = 0.024], particularly in neonates between 27- and 28-wk gestation. SP-D significantly correlated with the duration of hospital stay (ρ = -0.283, = 0.002), invasive ventilation (ρ = -0.544, = 0.001), and total sPLA2 activity (ρ = 0.528, = 0.008). These findings help understanding the role of SP-D early in life and support further investigation about the role of SP-D in developing BPD. Surfactant protein-D increases with gestational age and is inversely associated with BPD development. These results have been obtained in the first hours of life of extremely preterm neonates with optimal perinatal care.
表面活性蛋白-D（SP-D）是一种具有多种关键抗炎和免疫功能的亲水性蛋白。它可能在肺部感染、急性呼吸窘迫综合征和其他呼吸障碍的发展和过程中发挥作用。只有少数新生儿的小型研究调查了 SP-D：我们旨在研究在极早产儿生命的最初几个小时内测量的这种蛋白质与临床结果之间的联系，以及它与肺分泌型磷脂酶 A2（sPLA2）的关系。在生命的头 3 小时内获得支气管肺泡灌洗液。分别用 ELISA 和放射性方法测量 SP-D 和 sPLA2；上皮衬里液浓度用尿素比估计。临床数据是前瞻性收集的。100 名极早产儿进行了非连续研究。SP-D 随着胎龄的增加而显著升高（24-26 周：68 [0-1,694]，27 或 28 周：286 [0-1,328]，29 或 30 周：1,401 [405-2,429]ng/ml，总体 = 0.03）。伴有胎儿受累的临床绒毛膜羊膜炎的病例中 SP-D 显著升高（1,138 [68-3,336]ng/ml），而无胎儿受累的临床绒毛膜羊膜炎病例中 SP-D 显著降低（0 [0-900]ng/ml，< 0.001）。支气管肺发育不良（BPD）患儿的 SP-D 较低（251 [0-1,550]ng/ml），与无 BPD 或在诊断前死亡的患儿相比（977 [124-5,534]ng/ml，= 0.05），多变量分析也有显著意义[比值比（OR）：0.997（0.994-0.999），= 0.024]，特别是在 27-28 周胎龄的新生儿中。SP-D 与住院时间（ρ=-0.283，= 0.002）、有创通气（ρ=-0.544，= 0.001）和总 sPLA2 活性（ρ=0.528，= 0.008）呈显著负相关。这些发现有助于了解 SP-D 在生命早期的作用，并支持进一步研究 SP-D 在发育中的作用BPD。表面活性蛋白-D（SP-D）随胎龄增加而增加，与 BPD 发育呈负相关。这些结果是在接受最佳围产期护理的极早产儿生命的最初几个小时内获得的。
