血必净对ALI/ARDS患者呼出气冷凝液中NO和VEGF-A的影响

目的研究急性肺损伤（acute lung injury，ALI）/急性呼吸窘迫综合征（acute respiratory distress syndrome，ARDS）患者使用血必净治疗后呼出气冷凝液（exhaled breath condensate，EBC）中一氧化氮（nitric oxide，NO）和血管内皮生长因子A（vascular endothelial growth factor A，VEGF-A）改变的临床意义及对EBC检测技术效果的评价。方法32例ICU中行机械通气的ALI/ARDS患者，随机分为对照组和血必净治疗组，每组16例。对照组给予针对原发病的常规治疗，血必净治疗组在常规治疗的基础上联用血必净治疗，疗程5天。在诊断ALI/ARDS 24 h内和用药第5天使用改进的EcoScreen冷凝器收集EBC标本。采用EIA法测定EBC和血清中NO和VEGF-A的浓度。观察两组患者治疗前后EBC中NO和VEGF-A的变化。结果与治疗前比较，两组治疗后EBC和血清中NO均有所下降、VEGF-A均有所上升，差异有统计学意义（P<0.05，P<0.01）；治疗后血必净治疗组EBC和血清中NO均低于对照组（P<0.05），EBC中VEGF-A高于对照组（P<0.05），血清中VEGF-A与对照组比较，差异无统计学意义。结论血必净是一种可有效控制ALI/ARDS患者体内炎症反应的药物；采用EBC检测技术测定肺内NO和VEGF-A含量的变化，可判断ALI/ARDS患者肺部的炎症反应程度，有助于治疗效果的评价。

英文摘要:

ObjectiveTo observe the clinical significance of changes of nitric oxide （NO） and vascular endothelial growth factor A （VEGF-A） in exhaled breath condensate （EBC） of patients with acute lung injury/acute respiratory distress syndrome （ALI/ARDS） after they were treated by Xuebijing （XBJ）， and to evaluate the effect of the EBC detection technology. MethodsTotally 32 ALI/ARDS patients receiving mechanical ventilation at intensive care unit （ICU） were randomly assigned to the treatment group and the control group， 16 cases in each group. Patients in the control group were treated by routine therapy， while those in the treatment group were treated by routine therapy+XBJ. The therapeutic course for all was 5 days. The EBC sample was collected by improved EcoScreen condenser within 24 h after confirmed diagnosis of ALI/ARDS and on the fifth day of medication. The levels of NO and VEGF-A were measured by EIA in EBC and serum. The changes of NO and VEGF-A in EBC were observed before and after treatment. ResultsCompared with before treatment， the level of NO in EBC and serum decreased and VEGF-A increased after treatment， showing statistical difference （P<0.05， P<0.01）. After treatment the level of NO in EBC and serum was lower in the treatment group than in the control group （P<0.05）. The VEGF-A in EBC was higher in the treatment group than in the control group （P<0.05）. There was no statistical difference in the serum VEGF-A level between the two groups （P>0.05）. ConclusionsXBJ was an effective therapeutic drug capable to control the in vivo inflammation reaction in patients with ALI/ARDS. The detection of changes of VEGF-A and NO levels by EBC could judge the inflammatory reaction degree in ALI/ARDS patients， and help evaluating the therapeutic effect.

关闭