呼吸机相关性肺炎新生儿血清及支气管肺泡灌洗液中炎症因子和氧化指标的动态变化及其临床意义-东南大学学报医学版

呼吸机相关性肺炎新生儿血清及支气管肺泡灌洗液中炎症因子和氧化指标的动态变化及其临床意义

单位：1. 桂林医学院第二附属医院新生儿科, 广西桂林 541001;
2. 桂林医学院附属医院儿科, 广西桂林 541001

分类号：R722.135

出版年·卷·期（页码）：2017·36·第四期（603-608）

摘要：

目的：探讨呼吸机相关性肺炎（ventilator associatel peneumonia，VAP）新生儿血清和支气管肺泡灌洗液（bronchial pulmonary dysplasia，BALF）中白介素1（interleukin-1，IL-1）、白介素2（interleukin-2，IL-2）、白介素6（interleukin-6，IL-6）、白介素8（interleukin-8，IL-8）和肿瘤坏死因子-α（tumor necrosis factor alpha，TNF-α）等炎症因子以及超氧化歧化酶（superoxide dimutase，SOD）、丙二醛（malondialdehyde，MDA）和髓过氧化物酶（Myeloperoxidase，MPO）等氧化指标动态变化及临床意义。方法：对80例接受机械通气的新生儿进行临床分析，分别在气管插管后24、48、96 h采集外周血和BALF，测定IL-1、IL-2、IL-6、IL-8、TNF-α、SOD、MDA和MPO水平。将新生儿根据是否发生VAP分为VAP组和NVAP组，其中VAP组40例，NVAP组40例。结果：两组气管插管后24 h血清和BALF中炎症因子和氧化指标均无显著性差异（P>0.05）。气管插管后48、96 h两组血清和BALF中IL-1、IL-6、IL-8、TNF-α、MDA和MPO水平明显增高（P<0.05），IL-2和SOD水平明显降低（P<0.05）；与NVAP组比，VAP组血清和BALF中IL-1、IL-6、IL-8、TNF-α、MDA和MPO水平明显增高（P<0.05），IL-2和SOD水平明显降低（P<0.05）。结论：随着机械通气时间的延长，VAP组血清及BALF中IL-1、IL-6、IL-8和TNF-α促炎因子水平升高，IL-2抗炎因子水平降低，促炎和抗炎平衡打破；MDA和MPO水平增高，SOD抗氧能力降低，氧化还原系统平衡打破。临床中在诊断和评估VAP病情时，尤其应关注血清及BALF中IL-8的变化。

Objective:To study the serum and bronchoalveolar lavage fluid (BALF) of interleukin -1 (IL-1), interleukin -2 (IL-2), interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor-α (TNF-α) and superoxide dismutase(SOD), malondialdehyde(MDA) and myeloperoxidase(MPO) in neonatal ventilator-associated pneumonia (VAP). Methods:80 patients receiving mechanical ventilation neonate were collected and IL-1, IL-2, IL-6, IL-8, TNF-α, SOD, MDA and MPO in blood and BALF after intubation 24 h, 48 h and 96 h were collected. 80 patients were divided into 2 groups:40 cases in the VAP group and 40 cases in the NVAP group. Results:24 h after intubation, IL-1, IL-2, IL-6, IL-8, TNF-α, SOD, MDA and MPO in serum and BALF of the two groups had no significant differences (P>0.05). After intubation 48 h and 96 h, IL-1, IL-6, IL-8, TNF-α, MDA and MPO in serum and BALF had increased, IL-2 and SOD had decreased in the two groups (P<0.05). Compared with the NVAP group, IL-1, IL-6, IL-8, TNF-α, MDA and MPO in serum and BALF had increased, IL-2 and SOD had decreased in the VAP group(P<0.05). Conclusion:With the prolonging of the mechanical ventilation, the VAP patients' IL-1, IL-6, IL-8, TNF-α, MDA and MPO in BALF and srum have increased, IL-2 and SOD have decreased, which measns cytokine and redox play important roles in the development of VAP. IL-8 in serum and BALF should be paid more attention in VAP development.

参考文献：

[1] TAN B,XIAN-YANG X,ZHANG X,et al.Epidemiology of pathogens and drug resistance of ventilator-associated pneumonia in Chinese neonatal intensive care units:a meta-analysis[J].Am J Infect Control,2014,42(8):902-910.
[2] SMITH M A,HIBINO M,FALCIONE B A,et al.Immunosuppressive aspects of analgesics and sedatives used mechanically ventilated patients:an underappreciated risk factor for the development of ventilator-associated pneumonia in critically ill patients[J].Ann Pharmacother,2014,48(1):77-85.
[3] MATIN-LOECHES I,PAPIOL E,ALMANSA R,et al.Intubated patients developing tracheobronchitis or pneumonia have distinctive complement system gene expression signatures in the pre-infection period:a pilot study[J].Med Intensiva,2012,36(4):257-263.
[4] 李征瀛,金未来,章乐,等.sTREM-1在新生儿肺炎诊断和治疗中的意义[J].现代医学,2014,42(11):1278-1280.
[5] CHASTRE M P,KALI A,EASOW J M,et al.Ventilator-associated pneumonia[J].Australas Med J,2014,7(8):334-344.
[6] MORRIS A C,KEFALA K,SIMPSON A J,et al.Evaluation of the effect of diagnostic methodology on the reported incidence of ventilator-associated pneumonia[J].Thorax,2009,64(6):516-522.
[7] 焦洋,黄怡.《2014NICE临床指南:成人社区和医院获得性肺炎诊断和管理》解读[J].中国实用内科杂志,2015,5:411-413.
[8] TSAY T B,JIANG Y Z,HSU C M,et al.Pseudomonas aeruginosa colonization enhances ventilator-associated pneumonia-induced lung injury[J].Respir Res,2016,17(1):101.
[9] BARBAR S D,PAUCHARD L A,BRUYÉRE R,et al.Mechanical ventilation alters the development of staphylococcus aureus pneumonia in rabbit[J].PLoS One,2016,11(7):e0158799.
[10] JIANG M,SONG J J,GUO X L,et al.Airway humidification reduces the inflammatory response during mechanical ventilation[J].Respir Care,2015,60(12):1720-1728.
[11] 柳湘洁,刘旭华,陈佳,等.不同剂量氨茶碱联合肺康复治疗对老年COPD患者肺功能及相关炎症介质表达的影响[J].现代医学,2016,44(2):205-208.
[12] 忽新刚.右旋美托咪啶对呼吸机所致肺损伤的保护作用及其机制研究[D].广州:广州医学院,2011.
[13] 王洁.凝溶胶蛋白在急性放射性肺损伤中的作用[D].苏州:苏州大学,2014.
[14] SILVESTRI L,van SAENE H K,ZANDSTRA D F,et al.SDD,SOD,or oropharyngeal chlorhexidine to prevent pneumonia and to reduce mortality in ventilated patients:which manoeuvre is evidence-based?[J].Intensive Care, 2010,36(8):1436-1437.
[15] TOUFEKOULA C,PAPADAKIS V,TSAGANOS T.Compartmentalization of lipid peroxidation in sepsis by multidrug-resistant gram-negative bacteria:experimental and clinical evidence[J].Crit Care,2013,17(1):R6.
[16] MATHY-HARTERT M,DAMAS P,NYS M.Nitrated proteins in bronchoalveolar lavage fluid of patients at risk of ventilator-associated bronchopneumonia[J].Eur Respir J,2000,16(2):296-301.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录