摘要
目的 通过检测急性肺损伤/急性呼吸窘迫综合征（ALI/ARDS）时支气管肺泡灌洗液（BALF）中血管内皮生长因子（VEGF）的变化,针对凝血纤溶途径进行干预,探索ALI/ARDS的有效治疗方案.方法 （1）选择成年雄性大鼠96只,按随机数字表法分为油酸组、丹参组、尿激酶组和盐水组,每组24只.除盐水组外,其余各组均建立ALI模型.油酸组按0.2 ml/kg注射油酸后不做其他处理;丹参组在给予油酸同时,推注丹参多酚酸盐（质量分数0.06％丹参注射液10 ml/kg,尾静脉推入）;尿激酶组给予油酸同时,应用尿激酶（尿激酶5 000 U/kg溶于2ml等渗盐水中,全部经尾静脉推入）;盐水组只给予与油酸同等量的等渗盐水.检测各组BALF中VEGF含量,比较早期应用丹参、尿激酶后VEGF含量变化,观察凝血纤溶对BALF中VEGF的影响;（2）收集ALI/ARDS患者（ALI/ARDS组,根据患者生存情况ALI/ARDS组又分为生存亚组和死亡亚组）,进行急性生理学和慢性健康状况评分Ⅱ（APACHEⅡ）、多器官功能障碍综合征（MODS）评分.同时设立健康对照组,检测ALI/ARDS组与对照组BALF中VEGF含量的变化.结果 在油酸造模的大鼠ALI模型中,早期应用丹参或尿激酶均可升高BALF中VEGF水平（P＜0.05）,减轻ALI程度.ALI/ARDS组BALF中VEGF含量为（45.9±5.7）pg/ml,较对照组的（60.6±4.5） pg/ml明显降低（P＜0.01）;BALF中VEGF含量与APACHEⅡ、MODS评分均呈负相关（r=-0.542,-0.659,P＜0.01）;死亡亚组较生存亚组BALF中VEGF含量低（t=2.68,P＜0.05）.结论 BALF中VEGF在一定程度上可作为临床判断患者病情及预后的指标,在ALI/ARDS患者中早期应用抗凝或溶栓药物可能对患者预后产生积极作用.
Objective To test the levels of vascular endothelial growth factor （VEGF） in bronchoalveolar lavage fluid （BALF） during acute lung injury （ALI）/acute respiratory distress syndome （ARDS） after the interference with anticoagulation and fibrinolytic in an attempt to find a possible treatment plan for ALI/ARDS.Methods Oleic acid-induced ALI models were used in this study.A total of 96 rats were randomly assigned oleic acid group,salvianolate group,urokinase group,and saline group according to the random number table,with 24 animals per group.In oleic acid group,oleic acid （0.2 ml/kg,caudally） was administered alone.In addition to the oleic acid,the rats in salvianolate and urokinase groups received caudal injection with 10 ml/kg of 0.06% salvianolate and 5,000 U/kg of urokinase respectively.In saline group,saline solution with an equal volume of oleic acid was caudally administered alone.Effect of the early use of salvianolate and urokinase on levels of VEGF in BALF was measured.Clinically,patients with ALI/ARDS composing survivor and death groups were enrolled and assessed by acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） score and multiple organ dysfunction syndrome （MODS） score.Besides,healthy population was included as the controls to comparatively analyze the levels of VEGF in BALF in ALI/ARDS group.Results Of the rat models of ALI,early use of salvianolate or urokinase was associated with elevated level of VEGF in BALF （P 〈0.05）,which subsequently attenuated the lung injury.In the clinical research,it was found that the level of VEGF in BALF in ALI/ARDS group was much lower than that in control group [（45.9 ± 5.7） pg/ml vs （60.6 ± 4.5） pg/ml] （P 〈 0.01）.The level of VEGF in BALF was negatively correlated with APACHE Ⅱor MODS scores （r =-0.542,-0.659,P 〈 0.01）.Moreover,patients in death group appeared lower VEGF level in BALF than those in survivor group（t =2.68,P 〈 0.05）.Conclusion VEGF level in BALF can be taken as an indicator of
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2015年第7期655-659,共5页
Chinese Journal of Trauma
基金
天津市卫生局科技基金资助项目（09KZ29）
关键词
急性肺损伤
血管内皮生长因子类
丹参
尿激酶
Acute lung injury
Vascular endothelial growth factors
Salvia miltiorrhiza
Urokinase
