Nakos G, Kitsiouli E I, Tsangaris I, Lekka M E
Intensive Care Unit, University Hospital of Ioannina, Greece.
Intensive Care Med. 1998 Apr;24(4):296-303. doi: 10.1007/s001340050571.
To determine the concentration of proteins and phospholipids, markers of inflammatory reaction such as platelet-activating factor (PAF), and cell alterations in bronchoalveolar lavage (BAL) fluid during the evolution of the acute respiratory distress syndrome (ARDS).
Prospective controlled study.
14-bed medical-surgical intensive care unit in a 750-bed university teaching hospital.
19 mechanically ventilated patients, 9 patients with ARDS and 10 patients without cardiopulmonary disease (controls), were eligible for this study.
BAL was performed during the early, intermediate, and late phases of ARDS.
Total phospholipids and individual phospholipid classes of the surfactant, proteins, PAF, and cells were measured. High levels of PAF, an increase in neutrophils and proteins, and quantitative as well as qualitative alterations in phospholipids in BAL fluid were observed in ARDS patients compared to the control group. PAF, proteins, and neutrophils were higher in early ARDS than in intermediate or late ARDS. The surfactant pool increased in the early phase and decreased in the intermediate or late phase of the syndrome. The qualitative alterations of surfactant consist of reduced phospholipid content in the surfactant structures with good surface properties; moreover, there was a considerable decrease in the percentage of phosphatidylcholine and phosphatidylglycerol, followed by an increase in phosphatidylethanolamine, phosphatidylserine, phosphatidylinositol, and sphingomyelin in all three phases of ARDS compared to the control group. Lysophosphatidylcholine was detectable only in late ARDS.
Total surfactant phospholipids, surfactant components, and inflammatory markers such as PAF, cells, and proteins were affected in patients with ARDS. These factors, undergoing quantitative alterations during the course of ARDS, could have a significant role in the pathogenesis and evolution of ARDS.
确定急性呼吸窘迫综合征（ARDS）进展过程中支气管肺泡灌洗（BAL）液中蛋白质和磷脂的浓度、炎症反应标志物如血小板活化因子（PAF）以及细胞变化。
前瞻性对照研究。
一所拥有750张床位的大学教学医院中的14张床位的内科-外科重症监护病房。
19例机械通气患者，9例ARDS患者和10例无心肺疾病的患者（对照组）符合本研究条件。
在ARDS的早期、中期和晚期进行BAL。
测量了表面活性剂的总磷脂和各个磷脂类别、蛋白质、PAF和细胞。与对照组相比，ARDS患者的BAL液中PAF水平升高、中性粒细胞和蛋白质增加，以及磷脂的定量和定性改变。早期ARDS患者的PAF、蛋白质和中性粒细胞高于中期或晚期ARDS患者。该综合征早期表面活性剂池增加，中期或晚期减少。表面活性剂的定性改变包括具有良好表面性质的表面活性剂结构中磷脂含量降低；此外，与对照组相比，ARDS所有三个阶段的磷脂酰胆碱和磷脂酰甘油百分比均显著降低，随后磷脂酰乙醇胺、磷脂酰丝氨酸、磷脂酰肌醇和鞘磷脂增加。溶血磷脂酰胆碱仅在晚期ARDS中可检测到。
ARDS患者的总表面活性剂磷脂、表面活性剂成分以及炎症标志物如PAF、细胞和蛋白质均受到影响。这些因素在ARDS病程中发生定量改变，可能在ARDS的发病机制和进展中起重要作用。
