Arnon S, Grigg J, Silverman M
Department of Paediatrics and Neonatal Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, London.
Arch Dis Child. 1993 Jul;69(1 Spec No):44-8. doi: 10.1136/adc.69.1_spec_no.44.
The aim of this study was to determine the effect of surfactant treatment on the number and distribution of inflammatory cells in bronchoalveolar lavage fluid (BALF) from mechanically ventilated preterm infants over the first week of life in relation to the subsequent development of chronic lung disease (CLD). The study included 25 babies who received surfactant on clinical grounds and 29 babies of similar severity who did not. BALF was collected on days 1, 3, 5, and 7 after birth. Cell counts were performed and differentials were calculated on 300 cells. CLD was equally common in both treatment groups. Of the 54 infants, 29 (53%) who developed CLD had a higher incidence of patent ductus arteriosus and air leak and needed a higher concentration of inspired oxygen on the fifth and seventh days of life. Babies who developed CLD had more polymorphonuclear leucocytes and fewer macrophages on days 5 and 7 than those who recovered. Surfactant treatment was associated with a higher total white cell count on day 3. Between days 3 and 7, macrophage numbers were higher in surfactant treated babies, whatever the pulmonary outcome. This data suggests that CLD was associated with persistence of high numbers of polymorphonuclear leucocytes in BALF at the end of the first week. Surfactant treatment caused a persistent increase in macrophage numbers. The association between persistent neutrophilia and CLD was unaffected by surfactant treatment.
本研究的目的是确定表面活性剂治疗对机械通气早产儿出生后第一周支气管肺泡灌洗液（BALF）中炎症细胞数量和分布的影响，以及与随后慢性肺病（CLD）发展的关系。该研究纳入了25名因临床原因接受表面活性剂治疗的婴儿和29名病情严重程度相似但未接受治疗的婴儿。在出生后第1、3、5和7天收集BALF。进行细胞计数并计算300个细胞的分类。CLD在两个治疗组中同样常见。在54名婴儿中，29名（53%）患CLD的婴儿动脉导管未闭和气漏的发生率更高，且在出生后第5天和第7天需要更高浓度的吸入氧。与康复的婴儿相比，患CLD的婴儿在第5天和第7天有更多的多形核白细胞和更少的巨噬细胞。表面活性剂治疗与第3天更高的白细胞总数相关。在第3天至第7天之间，无论肺部结局如何，接受表面活性剂治疗的婴儿巨噬细胞数量更高。这些数据表明，CLD与第一周结束时BALF中大量多形核白细胞的持续存在有关。表面活性剂治疗导致巨噬细胞数量持续增加。持续性中性粒细胞增多与CLD之间的关联不受表面活性剂治疗的影响。
