摘要
目的探讨肺表面活性物质蛋白(surfactant protein,SP)-B缺陷与足月儿新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)的相关性。方法2019年7月至2023年6月,在解放军总医院第七医学中心等4家医院开展研究。NRDS组纳入因患NRDS死亡的足月新生儿60例;对照组纳入同期因其他原因手术后死亡的足月、非NRDS患儿60例。采集胸部X线片结果。新生儿死亡后30 min内进行支气管肺泡灌洗、肺组织取材,采用蛋白质印迹法检测SP-B表达。统计学方法采用χ^(2)检验。结果NRDS组患儿生后出现严重高碳酸血症和低氧血症,采用外源性肺表面活性物质、有创高频振荡通气呼吸支持、一氧化氮治疗降低肺动脉高压等综合治疗措施,10例接受体外膜肺氧合治疗,均治疗无效死亡。NRDS组的X线胸片均显示白肺。NRDS组患儿支气管肺泡灌洗液中SP-B单体(分子质量8 ku)及二聚体(分子质量16~18 ku)表达阳性的比例均明显低于对照组[8 ku:75.0%(45/60)与100.0%(60/60),χ^(2)=17.143;16~18 ku:73.3%(44/60)与100.0%(60/60),χ^(2)=18.462;P值均<0.001];NRDS组肺组织中SP-B分子质量8 ku及16~18 ku表达阳性的比例也明显低于对照组[8 ku:75.0%(45/60)与100.0%(60/60),χ^(2)=17.143;16~18 ku:70.0%(42/60)与100.0%(60/60),χ^(2)=21.176;P值均<0.001]。NRDS组筛出SP-B缺陷个体15例,对照组仅1例,NRDS组SP-B缺陷的比例高于对照组[25.0%(15/60)与1.7%(1/60),χ^(2)=14.135,P<0.001]。结论SP-B缺陷与足月儿NRDS发病存在一定的相关性。
Objective To explore the correlation between pulmonary surfactant protein(SP)-B deficiency and neonatal respiratory distress syndrome(NRDS)in full-term newborns.Method From July 2019 to June 2023,research was conducted in the Seventh Medical Center of PLA General Hospital and the other three hospitals.60 full-term newborns who died with NRDS were included in the NRDS group.The control group included 60 full-term newborns with non-NRDS who died after surgery due to other reasons during the same period.Chest X-ray results were collected.Within 30 min after the newborns died,bronchoalveolar lavage and lung tissue sampling were performed.SP-B expression was detected using Western blotting.Chisquare test was used for statistical methods.Result Newborns in the NRDS group experienced severe hypercapnia and hypoxemia after birth.Adopting comprehensive treatment measures such as exogenous pulmonary surfactant,invasive high-frequency oscillatory ventilation respiratory support,nitric oxide therapy to reduce pulmonary arterial hypertension,etc.Ten cases received extracorporeal membrane oxygenation(ECMO).However,all of them died.Chest X-rays in the NRDS group all showed white lungs.The proportion of positive expression of SP-B monomers(molecular weight 8 ku)and dimers(molecular weight 16-18 ku)in bronchoalveolar lavage fluid of newborns in the NRDS group was significantly lower than that in the control group[8 ku:75.0%(45/60)vs 100.0%(60/60),χ^(2)=17.143;16-18 ku:73.3%(44/60)vs 100.0%(60/60),χ^(2)=18.462;P<0.001].The proportion of positive expression of SP-B monomers and dimers in lung tissue of the NRDS group was significantly lower than that of the control group[8 ku:75.0%(45/60)vs 100.0%(60/60),χ^(2)=17.143;16-18 ku:70.0%(42/60)vs 100.0%(60/60),χ^(2)=21.176;P<0.001].Fifteen newborns with SP-B deficiency were detected in the NRDS group,while one with SP-B deficiency was detected in the control group.The proportion of SP-B deficiency in the NRDS group was significantly higher than that in the control group[25.0%(15/60)vs 1.7%(1/60),χ^(2)=14.135,P<0.001].Conclusion SP-B deficiency is corrected with NRDS in full-term newborns to some extent.
作者
尹晓娟
李明霞
史源
梅花
张晓媛
朱艳萍
霍梦月
封志纯
Yin Xiaojuan;Li Mingxia;Shi Yuan;Mei Hua;Zhang Xiaoyuan;Zhu Yanping;Huo Mengyue;Feng Zhichun(Beijing Key Laboratory of Pediatric Organ Failure,National Engineering Laboratory for Birth Defects Prevention and Control of Key Technology,Institute of Pediatrics,the Seventh Medical Center of PLA General Hospital,Faculty of Pediatrics,the Chinese PLA General Hospital,Beijing 100700,China;Department of Neonatology,the First Affiliated Hospital of Xinjiang Medical University,Xinjiang,Urumqi 830054,China;Department of Neonatology,Children’s Hospital of Chongqing Medical University,Chongqing 401122,China;Department of Neonatology,the Affiliated Hospital of Inner Mongolia Medical University,Inner Mongolia,Huhhot 010050,China)
出处
《发育医学电子杂志》
2024年第1期25-29,共5页
Journal of Developmental Medicine (Electronic Version)
基金
国家自然科学基金(30871397)。
