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急性呼吸窘迫综合征中支气管肺泡灌洗液体细胞因子评估肺复张手法的潜力

Potential for Lung Recruitment Maneuvers Estimated by the Cytokines in Bronchoalveolar Lavage Fluid in Acute Respiratory Distress Syndrome.

作者信息

Shen Minjin, Huai Jiaping

机构信息

Department of Gastroenterology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang, China.

Department of Critical Care, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang, China.

出版信息

Emerg Med Int. 2025 Feb 10;2025:5442038. doi: 10.1155/emmi/5442038. eCollection 2025.

Abstract

Lung recruitment maneuvers (RMs) is an important treatment for acute respiratory distress syndrome (ARDS) patients; however, assessing lung recruitability is imperative to avoid biotrauma and hemodynamic instability. This study aims to investigate whether the cytokine levels in the bronchoalveolar lavage fluid (BALF) of ARDS patients can serve as an indicator of their lung recruitability. This study included ARDS patients who received mechanical ventilation for over 24 h. Patients were categorized into lung recruitment maneuver effective (RM-E) group and lung recruitment maneuver noneffective (RM-N) group. Interleukin-6 (IL-6), interleukin-8 (IL-8) and interleukin-10 (IL-10) in BALF, lung ultrasound (LUS) scores, and the oxygenation index (P/F) were measured. The differences in cytokine levels between the two groups were compared, and correlations between changes in cytokine levels (ΔIL-6, ΔIL-8, and ΔIL-10), ΔLUS, and ΔP/F were analyzed. Sixty-two patients were included in this study (38 in the RM-E group and 24 in the RM-N group). After the RM, compared with the RM-N group, an increase was observed in ΔIL-6 (=0.013), ΔIL-8 (=0.045), ΔIL-10 (=0.039), and ΔLUS (=0.045) in the RM-E group. A positive linear correlation was found between ΔIL-6 and ΔLUS ( = 0.504, < 0.001). The area under the lung recruitment potential curve (AUC) predicted by ΔIL-6 was 0.794, the sensitivity was 94.7%, and the specificity was 70.8%. A positive linear correlation was found between ΔIL-6 and ΔLUS ( = 0.504, < 0.001). The lung recruitment potential curve's AUC predicted by ΔIL-6 was 0.794, with a sensitivity of 94.7% and specificity of 70.8%. Lower levels of cytokines in BALF were observed in the RM-E group. It is possible that the cytokines in BALF, especially IL-6, could be used to determine the need for RM on the basis of lung recruitability.

摘要

肺复张手法(RMs)是急性呼吸窘迫综合征(ARDS)患者的重要治疗方法;然而,评估肺复张能力对于避免生物创伤和血流动力学不稳定至关重要。本研究旨在探讨ARDS患者支气管肺泡灌洗液(BALF)中的细胞因子水平是否可作为其肺复张能力的指标。本研究纳入了接受机械通气超过24小时的ARDS患者。患者被分为肺复张手法有效(RM-E)组和肺复张手法无效(RM-N)组。测量了BALF中的白细胞介素-6(IL-6)、白细胞介素-8(IL-8)和白细胞介素-10(IL-10)、肺部超声(LUS)评分以及氧合指数(P/F)。比较了两组之间细胞因子水平的差异,并分析了细胞因子水平变化(ΔIL-6、ΔIL-8和ΔIL-10)、ΔLUS和ΔP/F之间的相关性。本研究共纳入62例患者(RM-E组38例,RM-N组24例)。肺复张手法后,与RM-N组相比,RM-E组的ΔIL-6(=0.013)、ΔIL-8(=0.045)、ΔIL-10(=0.039)和ΔLUS(=0.045)均有所升高。发现ΔIL-6与ΔLUS之间存在正线性相关性(=0.504,<0.001)。由ΔIL-6预测的肺复张潜力曲线下面积(AUC)为0.794,敏感性为94.7%,特异性为70.8%。发现ΔIL-6与ΔLUS之间存在正线性相关性(=0.504,<0.001)。由ΔIL-6预测的肺复张潜力曲线的AUC为0.794,敏感性为94.7%,特异性为70.8%。RM-E组BALF中的细胞因子水平较低。BALF中的细胞因子,尤其是IL-6,有可能基于肺复张能力来确定是否需要进行肺复张手法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c578/11832253/29a182580037/EMI2025-5442038.001.jpg

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