血清肺泡表面活性物质蛋白D水平与小儿急性肺损伤评分的关系研究

摘要

目的 探讨血清肺泡表面活性物质蛋白D(SP-D)水平与小儿急性肺损伤评分的关系,为小儿急性肺损伤提供理论依据.方法 ELISA法检测30例健康儿童(对照组)和67例急性肺损伤患儿(急性肺损伤组)的入院当日及入院1d、3d、5d、7d与14d的血清SP-D水平,同时对急性肺损伤患儿进行急性肺损伤评分;患儿按病情程度分为ALI不伴有多脏器功能衰竭(MOF)组与ALI伴有MOF组;按预后分为生存组和死亡组.结果 入院当日血清SP-D:急性肺损伤组血清SP-D的浓度较对照组显著升高(P<0.05);ALI不伴有MOF组与ALI伴有MOF组血清中SP-D水平与小儿急性肺损伤评分差异均有统计学意义(P<0.05);生存组与死亡组血清中SP-D水平与小儿急性肺损伤评分差异均具有显著性(P<0.05).动态血清SP-D:急性肺损伤患儿血清SP-D 5d达峰后降低;急性肺损伤评分入院1 d达峰后降低.不同病情程度与不同预后患儿的患儿入院当日血清SP-D与急性肺损伤评分均呈正相关性(P<0.05);患儿入院不同时间段血清SP-D与急性肺损伤评分无相关性(P>0.05).结论 急性肺损伤后患儿血清SP-D水平升高,SP-D的升高程度可以反映早期肺损伤的程度,与小儿急性肺损伤评分具有一定的关系.%Objective To investigate the correlation between serum levels of alveolar surface active substance protein-D (SP-D) and acute lung injury score in children patients with acute lung injury (ALI) in order to provide basis for the prognosis of patients with ALI.Methods The 30 healthy children (control group)and 67 children patients with ALI (ALI group) were enrolled in the study. The serum levels of SP-D on admission and on 1d,3d,5d,7d,14d after hospitalization were detected by ELISA,at the same time,acute lung injury score was performed for children with ALI.Moreover the patients with ALI were redivided into ALI without MOF group(ALI without multiple organ failure) and ALI with MOF group(ALI with MOF) according to the severity of ALI. In addition the patients with ALI were divided into survival case group and death case group according to the prognosis of patients.Results As compared with those in control group, the serum levels of SP-D on admission in ALI group were significantly increased (P<0.05).There were significant differences in serum levels of SP-D and acute lung injury score between ALI without MOF group and ALI with MOF group and between survival case group and death case group (P<0.05). Moreover the dynamic changes of serum levels of SP-D and the serum levels of SP-D reached peak on 5d after hospitalization,however acute lung injury score reached peak on 1d after hospitalization,then which were gradually decreased. In addition the serum levels of SP-D in different disease severity degrees and different prognoses of patients on adlission were positively correlated with acute lung injury scores(P<0.05),however,the serum levels of SP-D in different time points were not correlated with acute lung injury scores(P>0.05).Conclusion The serum levels of SP-D are increased after acute lung injury in children,moreover,the increase degree of SP-D levels can reflect the severity of early lung injury,and the serum levels of SP-D are correlated with acute lung injury scores at some extent.