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[Blue Journal最新论文]:ARDS患者远端气道无创采样的新方法
2018年05月10日 时讯速递, 进展交流 评论数 1

Novel Method for Noninvasive Sampling of the Distal Airspace in Acute Respiratory Distress Syndrome

J. Brennan McNeil , Ciara M. Shaver , V. Eric Kerchberger , et al

Am J Respir Crit Care Med 2018; 197: 1027-1035

Rationale: 背景

A major barrier to a more complete understanding of acute respiratory distress syndrome (ARDS) pathophysiology is the inability to sample the distal airspace of patients with ARDS. The heat moisture exchanger (HME) filter is an inline bacteriostatic sponge that collects exhaled moisture from the lungs of mechanically ventilated patients.

对于全面了解ARDS的病理生理学而言,主要障碍之一是无法取得ARDS患者远端气道标本。湿热交换器(HME)的滤器放置在管路中,除抑菌作用外,还能够收集来自机械通气患者肺部的呼出气。

Objectives: 目的

To test the hypothesis that HME filter fluid (HMEF) represents the distal airspace fluid in patients with ARDS.

检验假设,即HME液体(HMEF)代表了ARDS患者远端气道内的液体。

Methods: 方法

Samples of HMEF were collected from 37 patients with acute pulmonary edema (either from ARDS or hydrostatic causes [HYDRO; control subjects]). Concurrent undiluted pulmonary edema fluid (EF) and HMEF were collected from six patients. HMEF from 11 patients (8 ARDS and 3 HYDRO) were analyzed by liquid chromatography–coupled tandem mass spectometry. Total protein (bicinchoninic acid assay), MMP-9 (matrix metalloproteinase-9), and MPO (myeloperoxidase) (ELISA) were measured in 29 subjects with ARDS and 5 subjects with HYDRO. SP-D (surfactant protein-D), RAGE (receptor for advanced glycation end-products) (ELISA), and cytokines (IL-1β, IL-6, IL-8, and tumor necrosis factor-α) (electrochemiluminescent assays) were measured in six concurrent HMEF and EF samples.

我们收集了37名急性肺水肿(ARDS或静水压升高导致[HYDRO,对照组])的HMEF标本。对6名患者同时收集未经稀释的肺水肿液(EF)及HMEF。通过液相色谱串联质谱法分析11名患者(8名ARDS患者,3名HYDRO患者)的HMEF。对29名ARDS患者及5名HYDRO患者测定总蛋白(二喹啉甲酸分析)、MMP-9(基质金属蛋白酶-9)和MPO(髓过氧化物酶)(ELISA)。6名患者同时测定HMEF和EF标本的SP-D(表面活性蛋白-D)、RAGE(糖基化终产物受体)(ELISA)和细胞因子 (IL-1β, IL-6, IL-8, 和TNF-α)(电化学发光法)。

Measurements and Main Results: 测定指标与主要结果

Liquid chromatography–coupled tandem mass spectrometry on concurrent EF and HMEF samples from four patients revealed similar base peak intensities and m/z values indicating similar protein composition. There were 21 significantly elevated proteins in HMEF from patients with ARDS versus HYDRO. Eight proteins measured in concurrent EF and HMEF from six patients were highly correlated. In HMEF, total protein and MMP-9 were significantly higher in ARDS than in HYDRO.

4名患者的EF和HMEF标本通过液相色谱串联质谱法检测显示相同的基峰强度及m/z数值,提示蛋白组成相似。与HYDRO患者相比,ARDS患者HMEF中有21种明显升高的蛋白。6名患者同时留取的EF和HMEF中检测的8种蛋白高度相关。ARDS患者HMEF的总蛋白与MMP-9水平显著高于HYDRO患者。

Conclusions: 结论

These data suggest that HMEF is a novel, noninvasive method to accurately sample the distal airspace in patients with ARDS.

这些数据提示HMEF是准确采取ARDS患者远端气道标本的一种新的无创方法。

目前有 1 条留言 其中:访客:1 条, 博主:0 条

  1. snowcedar : 2018年05月12日23:37:17  -49楼

    个人觉得很难确定这是致病菌还是另一个条件培养基上的优势菌

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