Hills B A, Masters I B, Vance J C, Hills Y C
Paediatric Respiratory Research Centre, Mater Children's Hospital, Queensland, Australia.
J Paediatr Child Health. 1997 Feb;33(1):61-6. doi: 10.1111/j.1440-1754.1997.tb00993.x.
To determine whether physical abnormalities in lung surfactant, particularly inversion of the hysteresis between surface tension and surface area, are an effective postmortem marker for sudden infant death syndrome (SIDS).
Bronchoalveolar lavage (BAL) was employed to obtain lung rinsings from 55 infants under 24 months of age at autopsy, comprising 34 index cases and 21 controls. Folch reagent was used to extract the lipoid content which was then applied at two surface concentrations, fixed and BAL-determined (BALD), to the pool of a Langmuir trough in which surface tension (gamma) was measured continuously by the Wilhelmy method as surface area (A) was cycled.
The gamma:A loops from SIDS samples were inverted relative to controls (i.e. they were hysteresis reversed, this inversion being quantified by an empirical surface tension: area reversal (STAR) score). There was a wide scatter of STAR scores, but a critical value was found which offered a significant (P = 0.017) separation of SIDS cases from controls for a fixed surface concentration and a highly significant separation (P = 1.0 x 10(-4)) for BALD surface concentrations. Differences in the yields of phospholipid and proteolipid, or their correlation to STAR scores, did not reach statistical significance.
Inversion of the gamma :A loops (i.e. hysteresis inversion) would appear to offer a better postmortem marker of SIDS than any reported previously, the procedure having potential for development as a prospective test indicating the risk of this disease.
确定肺表面活性物质的物理异常，特别是表面张力与表面积之间滞后现象的反转，是否是婴儿猝死综合征（SIDS）有效的死后标志物。
采用支气管肺泡灌洗（BAL）从55例24个月以下婴儿尸检时获取肺冲洗液，其中包括34例索引病例和21例对照。使用Folch试剂提取类脂成分，然后将其以两种表面浓度（固定浓度和BAL测定浓度（BALD））应用于Langmuir槽池中，在该槽池中，当表面积（A）循环时，通过Wilhelmy方法连续测量表面张力（γ）。
与对照相比，SIDS样本的γ:A环反转（即滞后现象反转，这种反转通过经验性表面张力:面积反转（STAR）评分进行量化）。STAR评分存在广泛离散，但发现了一个临界值，对于固定表面浓度，该临界值能显著（P = 0.017）区分SIDS病例与对照，对于BALD表面浓度则有高度显著区分（P = 1.0×10⁻⁴）。磷脂和蛋白脂质产量的差异或它们与STAR评分的相关性未达到统计学显著性。
γ:A环的反转（即滞后现象反转）似乎比先前报道的任何标志物都更适合作为SIDS的死后标志物，该方法有潜力发展成为一种前瞻性检测方法，用于指示患该疾病的风险。
