不同成熟度肺脏冲击伤后肺泡灌洗液中SP-B等相关指标时间点差异与意义探讨
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摘要
目的探索未成熟肺与成熟肺在重度冲击伤后同一时间点肺泡灌洗液中SP-B含量差异,伤后相关指标变化、特点及意义。方法 4周龄幼年健康新西兰白兔[幼年兔组,雌雄不拘40只,体质量(442.10±55.30)g]与24周龄成年健康新西兰白兔[成年兔组,雌雄不拘40只,体质量(2018.15±145.80)g],采用不同驱动压构建实验动物伤情一致的动物模型(驱动压:幼年兔组4.5 MPa,成年兔组4.0 MPa)。在两组伤情一致情况下分别于伤即刻(0 h),2、4、6、12、24、48、72 h检测肺泡灌洗液中SP-B浓度(ELISA法)、观测动物肺大体解剖和光镜病理、测定肺组织含水量和生理指标等。结果两组肺损伤程度较为一致(P>0.05),所有时间点幼年兔组SP-B浓度均低于成年兔组(P<0.05)。幼年兔以肺泡壁断裂和损伤居多,成年兔以肺泡及间质内出血及炎症细胞浸润多见。伤后2 h肺含水率(82.68±0.58 vs 81.06±0.34)、伤后0.5 h血氧饱和度(75.00±18.52 vs 42.20±21.84)均为幼年兔高于成年兔(P<0.05)。伤后6 h(36.92±16.01 vs 60.30±12.09)、12 h(31.42±11.30 vs 46.40±14.15)、24 h(29.48±4.76 vs 35.52±9.77)和48 h(25.70±11.66 vs 37.68±9.11)中性粒细胞百分比则为幼年兔组低于成年兔组(P<0.05)。结论冲击伤后幼年兔未成熟肺与成年兔成熟肺相比肺水肿恢复较快、炎症反应较轻;但SP-B含量较低、合成和分泌功能恢复较慢,可能导致其呼吸功能恢复较慢;从而用以指导不同成熟度肺损伤的临床救治。
Objective To explore the difference of SP-B content in alveolar lavage fluid(ALF) between immature lung and mature lung at the same time point after lung blast injury, and investigate the significance and pathophysiological characteristics of related indexes. Methods The experimental animals(both sexes) included 40 healthy young New Zealand rabbits, weighting 442.10±55.30 g(young rabbit group), and 40 healthy New Zealand rabbits, aged 24 weeks, weighting 2 018.15±145.80 g(adult rabbits group). The experimental model was established under different driving pressures to ensure that the severity of injury was consistent(drive pressure: 4.5 MPa for young rabbit group and 4.0 MPa for adult rabbit group). After injury, the ALF content of SP-B was measured with ELISA at the immediate(0), 2, 4, 6, 12, 24, 48 and 72 h after injury, and the lungs were observed for gross anatomy and pathological changes. The tissue water content and other physiological indicators were determined at the same time. Results The severity of lung injury was consistent between the 2 groups(P>0.05). The SP-B concentration in the young rabbit group was lower than that in the adult rabbit group at all time points(P<0.05); the alveolar wall rupture and injury were more commonly observed in the young rabbits, and the alveolar interstitial hemorrhage and inflammatory cell infiltration were more common in the adult rabbits; the lung water content at 2 h after injury(82.68±0.58 vs 81.06±0.34) and the oxygen saturation at 0.5 h after injury(75.00±18.52 vs 42.20±21.84) were higher in young rabbits group than adult rabbits group(P<0.05). The percentage of neutrophils in the young rabbits group at 6(36.92±16.01 vs 60.30±12.09), 12(31.42±11.30 vs 46.40±14.15), 24(29.48±4.76 vs 35.52±9.77) and 48 h(25.70±11.66 vs 37.68±9.11) after injury were lower than adult rabbits group(P<0.05). Conclusion Compared with mature lungs of adult rabbits after lung blast injury, the immature lungs of young rabbits recover faster and have milder inflammatory reaction, but the SP-B content is lower, the synthesis and secretion function recover slowly, which may lead to the recovery of respiratory function slow. Our results may be used to guide the treatment for injury in immature and mature lungs.
Objective To explore the difference of SP-B content in alveolar lavage fluid(ALF) between immature lung and mature lung at the same time point after lung blast injury, and investigate the significance and pathophysiological characteristics of related indexes. Methods The experimental animals(both sexes) included 40 healthy young New Zealand rabbits, weighting 442.10±55.30 g(young rabbit group), and 40 healthy New Zealand rabbits, aged 24 weeks, weighting 2 018.15±145.80 g(adult rabbits group). The experimental model was established under different driving pressures to ensure that the severity of injury was consistent(drive pressure: 4.5 MPa for young rabbit group and 4.0 MPa for adult rabbit group). After injury, the ALF content of SP-B was measured with ELISA at the immediate(0), 2, 4, 6, 12, 24, 48 and 72 h after injury, and the lungs were observed for gross anatomy and pathological changes. The tissue water content and other physiological indicators were determined at the same time. Results The severity of lung injury was consistent between the 2 groups(P>0.05). The SP-B concentration in the young rabbit group was lower than that in the adult rabbit group at all time points(P<0.05); the alveolar wall rupture and injury were more commonly observed in the young rabbits, and the alveolar interstitial hemorrhage and inflammatory cell infiltration were more common in the adult rabbits; the lung water content at 2 h after injury(82.68±0.58 vs 81.06±0.34) and the oxygen saturation at 0.5 h after injury(75.00±18.52 vs 42.20±21.84) were higher in young rabbits group than adult rabbits group(P<0.05). The percentage of neutrophils in the young rabbits group at 6(36.92±16.01 vs 60.30±12.09), 12(31.42±11.30 vs 46.40±14.15), 24(29.48±4.76 vs 35.52±9.77) and 48 h(25.70±11.66 vs 37.68±9.11) after injury were lower than adult rabbits group(P<0.05). Conclusion Compared with mature lungs of adult rabbits after lung blast injury, the immature lungs of young rabbits recover faster and have milder inflammatory reaction, but the SP-B content is lower, the synthesis and secretion function recover slowly, which may lead to the recovery of respiratory function slow. Our results may be used to guide the treatment for injury in immature and mature lungs.
引文
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[10] 周继红、刘宝华、许明辉,等.创伤评分学[M].北京:科学出版社,2018:88-92. ZHOU J H, LIU B H, XU M H, et al.Trauma Scoreology[M]. Beijing: Science Press, 2018:88-92.
[11] 钱桂生.急性肺损伤和急性呼吸窘迫综合征研究现状与展望[J]. 解放军医学杂志, 2003,28(2):97-101.10.3321/j.issn:0577-7402.2003.02.001. QIAN G S. The status quo and pospect of acute lung injury and acute respiratory distress syndrome[J]. Med J Chin PLA, 2003, 28(2):97-101.10.3321/j.issn:0577-7402.2003.02.001.
[12] 黄跃生,粟永萍,周继红.中华战创伤学(第8卷):特殊致伤原因战创伤[M].郑州:郑州大学出版社,2016:88-89. HUANG Y S, SU Y P, ZHOU J H. Chinese War Traumatology (Volume Eight)[M]. Zhengzhou:Zhengzhou University Press, 2016:88-89.
[13] MAZELA J, MERRITT TA, GADZINOWSKI J, et al. Evolution of pulmonary surfactants for the treatment of neonatal respiratory distress syndrome and pediatric lung diseases[J]. Acta Pediatrica, 2006,95(9):1036-1048. DOI:10.1080/08035250600615168.
[14] 王鹏,王万能,吕婧, 等.疏水性肺表面活性蛋白SP-B结构类似物的研究进展[J].华西药学杂志,2013,(6):636-639. DOI:10.13375/j.cnki.wcjps.2013.06.039 WANG P, WANG W L, LYU J, et al. Progress in the study of hydrophobic pulmonary surfactant protein SP-B structural analogues[J].West China J Pharm Sci, 2013,(6):636-639. DOI:10.13375/j.cnki.wcjps.2013.06.039.
[2] BURNHAM G, LAFTA R, DOOCY S, et al. Mortality after the 2003 invasion of Iraq: a cross-sectional cluster sample survey[J]. Lancet, 2006, 368(9545): 1421-1428. DOI:10.1016/s0140-6736(06)69491-9.
[3] OLMEDA B, GARCLA-áLVARE B, GóMEZ M J, et al. A model for the structure and mechanism of action of pulmonary surfactant protein B[J]. Faseb J, 2015, 29(10). DOI:10.1096/fj.15-27345.
[4] 闫亚敏, 王志红, 卢健. 肺表面活性蛋白B(SP-B)在肺损伤中的研究进展[J]. 临床肺科杂志,2010,15(6):849-851.DOI:10.3969/j.issn.1009-6663.2010.06.051. YAN Y M, WANG Z H, LU J. Progress in research of pulmonary surfactant protein B (SP-B) in lung injury[J]. J Clin Pulm Med, 2010,15(6):849-851.DOI:10.3969/j.issn.1009-6663.2010.06.051.
[5] REUTER S, MOSER C, BAACK M. Respiratory distress in the newborn[J]. Pediatr Rev, 2014, 35(10):417-429. DOI:10.1542/pir.35-10-417.
[6] 梁毅,代维,麻超,等. 幼兔重度肺冲击伤动物模型的建立[J].局解手术学杂志,2016,25(5):318-322.DOI: 10.11659 /jjssx.03E016015. LIANG Y, DAI W, MA C, et al. Establishment of animal model of severe lung injury in young rabbits[J].J Region Anat Oper Surg, 2016,25(5):318-322.DOI: 10.11659 /jjssx.03E016015.
[7] MOORE E E, MALANGONI M A, COGBILL T H ,et al. Organ injury scaling. IV: Thoracic vascular, lung, cardiac, and diaphragm[J]. J Trauma, 1994, 36(3): 299-300. DOI:10.1097/00005373-199403000-00002.
[8] 梁毅, 邱俊, 袁丹凤,等. 脏器损伤分级及应用评价[J]. 伤害医学(电子版), 2015, 4(3):44-47.DOI:1 0.3868/j.issn.2095-1 566.201 5.03.009. LIANG Y, QIU J, YUAN D F, et al. Organ damage classification and application evaluation[J]. Injury Med (Electr Ver), 2015, 4(3):44-47.DOI:1 0.3868/j.issn.2095-1 566.201 5.03.009.
[9] 孙海晨, 朱佩芳. 脏器损伤分级[J]. 中华创伤杂志, 1998, 14(3):143-147. SUN H C, ZHU P F. Organ damage classification[J]. Chin J Trauma, 1998, 14(3):143-147.
[10] 周继红、刘宝华、许明辉,等.创伤评分学[M].北京:科学出版社,2018:88-92. ZHOU J H, LIU B H, XU M H, et al.Trauma Scoreology[M]. Beijing: Science Press, 2018:88-92.
[11] 钱桂生.急性肺损伤和急性呼吸窘迫综合征研究现状与展望[J]. 解放军医学杂志, 2003,28(2):97-101.10.3321/j.issn:0577-7402.2003.02.001. QIAN G S. The status quo and pospect of acute lung injury and acute respiratory distress syndrome[J]. Med J Chin PLA, 2003, 28(2):97-101.10.3321/j.issn:0577-7402.2003.02.001.
[12] 黄跃生,粟永萍,周继红.中华战创伤学(第8卷):特殊致伤原因战创伤[M].郑州:郑州大学出版社,2016:88-89. HUANG Y S, SU Y P, ZHOU J H. Chinese War Traumatology (Volume Eight)[M]. Zhengzhou:Zhengzhou University Press, 2016:88-89.
[13] MAZELA J, MERRITT TA, GADZINOWSKI J, et al. Evolution of pulmonary surfactants for the treatment of neonatal respiratory distress syndrome and pediatric lung diseases[J]. Acta Pediatrica, 2006,95(9):1036-1048. DOI:10.1080/08035250600615168.
[14] 王鹏,王万能,吕婧, 等.疏水性肺表面活性蛋白SP-B结构类似物的研究进展[J].华西药学杂志,2013,(6):636-639. DOI:10.13375/j.cnki.wcjps.2013.06.039 WANG P, WANG W L, LYU J, et al. Progress in the study of hydrophobic pulmonary surfactant protein SP-B structural analogues[J].West China J Pharm Sci, 2013,(6):636-639. DOI:10.13375/j.cnki.wcjps.2013.06.039.