人肺泡Ⅱ型上皮细胞表面抗原在急性呼吸窘迫综合征患者中的变化及地塞米松的保护作用

摘要

目的 研究血清人肺泡Ⅱ型上皮细胞表面抗原(KL-6)在急性呼吸窘迫综合征(ARDS)患者中的变化,及地塞米松的保护作用.方法 采用回顾性研究方法,选择40例ARDS患者,按是否应用地塞米松分为常规治疗组(20例)和地塞米松治疗组(20例);于ARDS确诊后1、2、3 d检测血清KL-6水平(酶联免疫吸附试验)和氧合指数(PaO2/FiO2)变化.设健康对照组20例.结果 健康对照组血清KL-6 [(243±121)kU/L]和PaO2/FiO2 [(452.78±35.86) mm Hg,1 mm Hg=0.133 kPa]水平均在正常范围内.常规治疗组和地塞米松治疗组随病情进展血清KL-6(kU/L)、PaO2/FiO2(mm Hg)进行性升高.与健康对照组比较,两组1、2、3 d血清KL-6明显升高(常规治疗组:980±132、1121±151、1320±143,地塞米松治疗组:697±132、832±125、957±136),PaO2/FiO2明显下降(常规治疗组:125.73±33.26、172.33±22.18、228.32±41.72,地塞米松治疗组:159.92±30.21、230.18±32.78、352.64±48.72),差异均有统计学意义(均P＜0.01);且地塞米松治疗组血清KL-6较常规治疗组明显下降,PaO2/FiO2较常规治疗组明显升高,差异有统计学意义(均P＜0.05).结论 ARDS患者血清KL-6表达升高,早期应用地塞米松可降低KL-6水平,减轻肺组织损伤.%Objective To discuss the changes of krebs von cieri lungen-6 (KL-6) in the patients with acute respiratory distress syndrome ( ARDS) and the protective effects of dexamelhasone. Methods A retrospective study was used to investigate 40 patients with ARDS, and they were divided into conventional therapeutic group (20 cases) and dexamethasone therapeutic group (20 cases). The changes in serum KL-6 (by enzyme linked irnmunosorbent assay) and oxygenation index (PaO2/FiO3) were detected in patients with ARDS after diagnosis for 1, 2, and 3 days. Twenty healthy cases were assigned as the healthy control group. Results In the healthy control group, the serum KL-6 levels L(243 ±121)kU/L ] and PaO2/FiO2 ((452.78 + 35.86) mm Hg, 1 mm Hg=.0.133 kPa ]were in the normal range. The levels of serum KL-6 (kU/L) and PaO2/FiO2( mm Hg) in conventional therapeutic group and dexamethasone therapeutic group were significantly higher than those in control group as the disease progressed. The serum KL-6 levels were significantly increased at 1, 2, and 3 days after ARDS diagnosis (in the conventional therapeutic group ; 980±132, 1121±151,1320 ± 143; in the dexamethasone therapeutic group ; 697±132, 832±125, 957±136). and the levels of PaO2/FiO2 were significantly decreased (in the conventional therapeutic group; 125.73 ± 33.26,172.33 ± 22.18, 228.32±41.72; in the dexamethasone therapeutic group: 159.92 ± 30.21, 230.18±32.78, 352.64±48.72), compared with the control group all the differences being statistically significant (all P＜0.01). Compared with conventional therapeutic group, serum KL-6 levels were significantly decreased, and the levels of PaO2/FiO2 were significantly increased in the dexamethasone therapeutic group (all P＜0.05). Conclusion In ARDS patients, the expression of serum KL-6 is increased, and the early application of dexamethasone can decrease the KL-6 level and ameliorate the lung injury.