目的 探讨难治性支原体肺炎(RMPP)患儿支气管肺泡灌洗液(BALF)中表面活性物质相关蛋白-A(SP-A)的表达与肺功能的相关性.方法 选择2015年1月至2016年12月鹤壁市人民医院收治的RMPP患儿30例,分别于急性期和恢复期检测患儿动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、第1秒用力呼气量(FEV1)和用力肺活量(FVC),并行支气管肺泡灌洗,收集BALF,采用酶联免疫吸附试验检测BALF中SP-A水平.结果 RMPP患儿急性期和恢复期BALF中SP-A水平分别为(3.63±0.09)、(5.86±0.17)mg· L-1,RMPP患儿急性期BALF中SP-A水平显著低于恢复期(t=-63.499,P＜0.05).RMPP患儿急性期PaO2和PaCO2分别为(49.25 ±7.32)、(47.16±6.48)mmHg,恢复期PaO2和PaCO2分别为(76.54 ±6.48)、(36.20±5.61) mmHg;RMPP患儿急性期PaO2显著低于恢复期(t=-15.289,P＜0.05),急性期PaCO2显著高于恢复期(=7.004,P＜0.05).RMPP患儿急性期FEV1、FVC和FEV1/FVC分别为(1.36 ±0.67)、(1.68±0.31)L和69.85±8.34,恢复期FEV1、FVC和FEV1/FVC分别为(1.89±0.58)、(1.99±0.53)L和87.32±9.52;RMPP患儿急性期FEV1、FVC和FEV1/FVC显著低于恢复期(t=-3.276、-2.765、-7.560,P＜0.05).RMPP患儿BALF中SP-A水平与PaO2呈正相关(r=0.921 6,P＜0.05),与PaCO2无显著相关(r=1.211 4,P＜0.05);BALF中SP-A水平与FEV1、FVC和FEV1/FVC均呈正相关(r=0.831、0.905、0.803,P＜0.05).结论 RMPP患儿BALF中SP-A水平与呼吸功能呈正相关,检测患儿BALF中SP-A水平有助于评估患儿肺功能,判断患儿病情.%Objective To investigate the relationship between surfactant associated protein-A(SP-A) in bronchoalveolar lavage fluid(BLAF) and lung function in children with refractory mycoplasma pneumoniae pneumonia(RMPP).Methods Thirty children with RMPP were selected from January 2015 to December 2016 in the People's Hospital of Hebi City.The partial pressure of oxygen in artery (PaO2),partial pressure of carbon dioxide in artery (PaCO2),forced expiratory volume in one second(FEV1) and forced vital capacity (FVC) of the children were detected at acute and convalescent periods.The BALF was collected by bronchoalveolar lavage,and the level of SP-A in BALF was detected by enzyme linked immunosorbent assay.Results The level of SP-A in BALF of children with RMPP at ac ute and convalescent period was (3.63 ± 0.09) and (5.86 ± 0.17)mg · L-1 respectively,the level of SP-A in BALF of children with RMPP at acute phase was significantly lower than that at convalescent period(t =-63.499,P ＜ 0.05).The PaO2 and PaCO2 in children with RMPP at acute phase were (49.25 ±7.32) and (47.16 ±6.48)mmHg respectively,and they were (76.54 ±6.48) and (36.20 ± 5.61)mmHg respectively at convalescent period;the PaO2 in children with RMPP at acute phase was significantly lower than that at convalescent period (t =-15.289,P ＜ 0.05),and the PaO2 in children with RMPP at acute phase was significantly higher than that at convalescent period(t =7.004,P ＜ 0.05).The FEV1,FVC and FEV1/FVC in RMPP children at acute phase were (1.36 ±0.67),(1.68 ± 0.31) L and 69.85 ± 8.34 respectively;and they were (1.89 ± 0.58),(1.99 ± 0.53) L and 87.32 ± 9.52 respectively at convalescent period;the FEV1,FVC and FEV1/FVC in RMPP children at acute phase were significantly lower than those at convalescent period(t =-3.276,-2.765,-7.560;P ＜ 0.05).The level of SP-A in BALF of children with RMPP was positively correlated with PaO2 (r =0.921 6,P ＜ 0.05),but there was no significant correlation between SP-A level and PaCO2 (r =1.211 4,P ＜ 0.05).The level of SP-A in BALF was positively correlated with FEV1,FVC and FEV1/FVC (r =0.831,0.905,0.803;P ＜ 0.05).Conclusion The level of SP-A in BALF was positively correlated with lung function of children with RMPP.The detection of SP-A level in BALF is helpful to assess the lung function and pathogenetic condition of children with RMPP.
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