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目的探讨新生儿常见肺部疾病支气管肺泡灌洗液肺表面活性蛋白A(BALSPA)水平及其与临床的关系。方法收集2000年1月至2003年2月在广州市儿童医院新生儿重症监护室住院的需行机械通气治疗的新生儿重症肺炎、胎粪吸入综合征(MAS)、急性呼吸窘迫综合征(ARDS)以及新生儿呼吸窘迫综合征(RDS)患儿共57例。测定其BALSPA水平,监测血气、PaO2/FiO2水平。结果重症肺炎组与MAS组患儿BALSPA水平无明显差异,但MAS组患儿PaO2、PaCO2及PaO2/FiO2水平较重症肺炎组明显降低(P值<0.01,<0.05,<0.05);ARDS及RDS组患儿BALSPA水平均较上述两组低(P值均<0.001),而RDS组患儿BALSPA水平较ARDS组低(P<0.001),但ARDS组患儿PaO2水平较RDS组患儿低(P<0.05)。PS治疗组患儿的病死率较非PS治疗组明显降低(P=0.049),其PaO2/FiO2与BALSPA水平密切相关(r=0.741,P=0.000)。结论与重症肺炎患儿比较胎粪吸入综合征患儿BALSPA水平无明显降低;ARDS及RDS患儿BALSPA水平明显降低;BALSPA水平能反映新生儿肺损伤的严重程度,对于新生儿肺部疾病预后的判断有一定意义。
Objective To investigate the expression of pulmonary surfactant protein A (BALP) in bronchoalveolar lavage fluid (BALF), a common lung disease in neonates, and its clinical significance. Methods From January 2000 to February 2003, neonates with severe pneumonia, meconium aspiration syndrome (MAS), acute respiratory distress syndrome (ARDS) hospitalized in neonatal intensive care unit of Guangzhou Children’s Hospital undergoing mechanical ventilation were enrolled. ) And neonatal respiratory distress syndrome (RDS) in children a total of 57 cases. The level of BALSPA was measured and blood gas and PaO2 / FiO2 levels were monitored. Results There was no significant difference in BALSPA levels between severe pneumonia group and MAS group, but the levels of PaO2, PaCO2 and PaO2 / FiO2 in MAS group were significantly lower than those in severe pneumonia group (P <0.01, <0.05, <0.05) BALSPA levels were lower in both groups than those in the above two groups (P <0.001), while BALSPA levels in RDS group were lower than those in ARDS group (P <0.001) P <0.05). The mortality of PS group was significantly lower than that of non-PS group (P = 0.049). PaO2 / FiO2 was closely related to BALSPA level (r = 0.741, P = 0.000). Conclusion Compared with children with severe pneumonia, the level of BALSPA in children with meconium aspiration syndrome has no significant difference. The level of BALSPA in children with ARDS and RDS is significantly lower. The level of BALSPA can reflect the severity of neonatal lung injury. Judgment has some significance.