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Objective:To analyze the status of neonatal respiratory distress syndrome (RDS) management in 10 hospitals in Northwest China over the past five years and to investigate the strategies for improving the prevention and treatment of RDS.Methods:This retrospective study involved premature infants with RDS who were admitted to the neonatal intensive care units (NICU) of 10 hospitals (six in Shaanxi Province, three in Gansu Province, and one in Xinjiang Uygur Autonomous Region) of the Northwest China Neonatal Collaborative Group within 3 d after birth from January 1 to December 31, 2016, and from January 1 to December 31, 2021. Basic information, perinatal condition, treatment approaches, complications, and prognosis of the patients were compared. T-test, rank sum, and Chi-square tests were used for statistical analysis. Result:(1) This study enrolled 322 premature infants with RDS in 2016 and 349 in 2021. Premature infants at the gestational age of 30 to 33 weeks were mainly affected, and the majority were male [64.3% (207/322) and 57.3% (200/349)]. The average maternal age in 2021 was older than that in 2016 [(30.6±4.8) years vs (28.6±5.4) years, t=24.02, P<0.001], and the proportion of women at advanced maternal age was also higher in 2021 [19.2% (67/349) vs 12.4% (40/322), χ2=4.18, P<0.05]. (2) The proportions of pregnancies conceived with assisted reproductive technologies [11.7% (41/349) vs 1.9% (6/322), χ2=25.12], underwent routine prenatal examinations [58.5% (204/349) vs 30.4% (98/322), χ2=53.33], exposed to steroids [62.2% (217/349) vs 28.6% (92/322), χ2=82.58] and delivered by cesarean section or elective cesarean section [73.6% (257/349) vs 51.6% (166/322), χ2=35.06; 24.1% (84/349) vs 6.5% (21/322), χ2=39.07], as well as the ratio of cesarean scar pregnancy [7.4% (26/349) vs 3.4% (11/322), χ2=5.23] were all higher in 2021 than those in 2016 (all P<0.05). Moreover, the incidence of fetal distress [30.1% (105/349) vs 20.2% (65/322), χ2=8.68], gestational hypertension [24.6% (86/349) vs 13.0% (42/322), χ2=14.59], premature rupture of membranes [16.0% (56/349) vs 10.2% (33/322), χ2=4.89], meconium-stained amniotic fluid [12.6% (44/349) vs 5.6% (18/322), χ2=9.83], placental abruption [10.3% (36/349) vs 5.3% (17/322), χ2=5.84], gestational diabetes mellitus [10.3% (36/349) vs 1.6%(5/322), χ2=22.41], chorioamnionitis [4.6%(16/349) vs 0.9% (3/322), χ2=8.12], thyroid dysfunction [4.3% (15/349) vs 0.6% (2/322), χ2=7.88] and heart disease [4.3% (15/349) vs 0.3% (1/322), χ2=9.17] were higher in 2021 than in 2016 (all P<0.05). (3) In 2021, the rate of pulmonary surfactant (PS) usage, the dosage of porcine PS, and the proportion of bovine PS usage were all significantly higher than those in 2016 [73.6% (257/349) vs 67.1% (216/322), χ2=11.62; (178.5±38.0) mg/kg vs (165.2±42.8) mg/kg, t=7.85; 47.9% (123/257) vs 19.4% (42/216), χ2=41.72; all P<0.01]. No significant difference in the incidence of intubation-surfactant-extubation (INSURE), early PS administration (≤2 h after birth), or the arterial blood gas values before and after PS treatment was found between the cases enrolled in 2021 and 2016. The duration of antibiotic treatment [7.0 d (5.0-14.0 d) vs 5.0 d (1.0-8.0 d), Z=7.55] and assisted ventilation [144 h (81-264 h) vs 73 h (47-134 h), Z=8.20] and the median hospital stay [24 d(14-42 d) vs 16 d (10-25 d), Z=6.74] were significantly longer in 2021 than in 2016 (all P<0.01). More patients required nasal intermittent positive pressure ventilation [29.6% (100/338) vs 1.0% (3/306), χ2=97.81] and conventional ventilation [42.6% (144/338) vs 30.1% (92/306), χ2=10.87] in 2021 as compared with those five years ago (both P<0.01). (4) In 2021, the incidence of patent ductus arteriosus [15.5% (54/349) vs 6.2% (20/322), χ2=63.40], bronchopulmonary dysplasia [9.2% (32/349) vs 2.8% (9/322), χ2=12.88], persistent pulmonary hypertension [5.4% (19/349) vs 0.6% (2/322), χ2=12.85], periventricular leukomalacia [4.3% (15/349) vs 1.2% (4/322), χ2=7.52] and pneumothorax [3.4% (12/349) vs 0.3% (1/322), χ2=9.68] increased as compared with those in 2016 (all P<0.05), while the incidence of nosocomial infection decreased significantly [7.4% (26/349) vs 19.6% (63/322), χ2=21.37, P<0.001]. (5) The cure rate of premature infants with RDS was 70.8% (247/349) in 2021, which was significantly higher than that in 2016 [56.2% (181/322), χ2=15.37, P<0.001]. Moreover, the rate of withdrawing treatment and the total mortality rate was lower in 2021 than in 2016 [7.7% (27/349) vs 14.3% (46/322), χ2=7.41; in-hospital: 1.4% (5/349) vs 5.6% (18/322), χ2=8.74; out of hospital: 8.3% (29/349) vs 13.7% (44/322), χ2=4.96; all P<0.05]. Conclusions:The clinical management of RDS in premature infants in the involved hospitals has been improved. However, there is room for improvement in prenatal examinations.
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Objective:To discuss the clinical efficacy of minimally invasive pulmonary surfactant (PS) therapy technology (MIST) in the treatment of neonatal respiratory distress syndrome (NRDS) and analyze the high-risk factors for failure.Methods:A total of 91 NRDS infants treated in the Affiliated Hospital of Jining Medical College from July 2017 to July 2019 were selected as the research objects, and 46 cases were performed minimally MIST (MIST group), 45 cases performed intubate-surfactant-extubate to continuous positive airway pressure (INSURE group), the infants were given 70-100 mg/kg porcine pulmonary phospholipid injection through vascular catheter or endotracheal intubation, respectively. The clinical efficacy of the two groups was compared and the risk factors for failure in the treatment of NRDS by PS were analyzed.Results:The total operating time in the MIST group was longer than that in the INSURE group: (90.06 ± 14.38) min vs. (62.57 ± 11.44) min, there was statistical difference ( P<0.05). The duration of non-invasive auxiliary ventilation, total oxygen uptake time and length of hospitalization time in two groups had no significant differences ( P>0.05). The incidence of bronchopulmonary dysplasia in the MIST group was lower than that in the INSURE group :10.87%(5/46) vs. 31.11%(14/45), there was statistical difference ( χ2 = 5.64, P<0.05). Univariate analysis showed that the male, cesarean section, birth weight <1 500 g, maternal gestational diabetes, arterial partial blood oxygen pressure (PaO 2) <59 mmHg (1 mmHg = 0.133 kPa) before the application of PS, and PaO 2/inhaled oxygen concentration (FiO 2) <185 mmHg and arterial partial pressure of carbon dioxide>55 mmHg were high risk factors for failure ( P<0.05). Conclusions:Although the operation of MIST is difficult, it is safe and feasible. In clinical work, various risk factors should be comprehensively analyzed to select an appropriate early respiratory support model for NRDS children.
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Acute respiratory distress syndrome(ARDS) is a common critical syndrome with high morbidity and mortality.The treatments include respiratory support and drug therapy.In this paper, the latest clinical advances in the treatment of ARDS with glucocorticoids, statins, antioxidants, recombinant human activated protein C, sedatives and muscle relaxants, exogenous alveolar surfactants, mesenchymal stem cells, and vasodilators are reviewed.
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Objective To study the regulatory role of microRNA-16 (miR-16) on human pulmonary surfactant associated protein (SP).Method Human alveolar epithelial A549 cells were transfected by miR-16 analogue,analogue negative control,inhibitor and inhibitor negative control.Blank control group was also set up at the same time.The proliferative abilities of the cells in each group were measured using cell counting kit-8 (CCK8) test.The expressions of miR-16,SP-A,SP-B and SP-C mRNA were examined using reverse transcription polymerase chain reaction (RT-PCR).The protein levels of SP-A,SP-B and SP-C were examined using western blotting method.Result RT-PCR showed that the expression of miR-16 after transfected with miR-16 analogue (34.11± 1.79) was higher than the negative control group (1.65 ± 1.07) and the blank control group (1.07 ±0.50).The expression of miR-16 after transfected with miR-16 inhibitor (0.36±0.05) was lower than the negative control group (0.96±0.13) and the blank control group (1.05±0.20).The differences were significant (all P＜0.05),and indicated that miR-16 over-expression and suppression were successfully achieved.Compared with the blank control group,cell proliferation at different time points in the analogue negative control group and the inhibitor negative control group showed no significant differences (all P＞0.05).Compared with the blank control group (1.02±0.19,1.01±0.09,1.01± 0.12) and the analogue negative control group (1.08±0.24,1.00±0.14,1.00±0.05),miR-16 down-regulated the mRNA expressions of SP-A,SP-B and SP-C (0.58±0.16,0.67±0.05,0.61±0.12).On the other hand,compared with the blank control group (1.02±0.19,1.01±0.09,1.01±0.12) and the inhibitor negative control group (1.05±0.22,0.99±0.13,0.98±0.10),miR-16 up-regulated the mRNA expressions of SP-A,SP-B and SP-C (1.66±0.33,1.29±0.11,1.23±0.12)(all P＜0.05).The trends of protein level of SP-A,SP-B and SP-C were related to their mRNA expression.Conclusion This study indicates that miR-16 inhibits pulmonary surfactant associated protein in A549 cells.
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Objective To investigate the effects of ambroxol hydrochloride injection combined with pulmonary surfactant(PS) on the improvement of arterial blood gas index and the time of mechanical ventilation in neonates with respiratory distress syndrome (NRDS).Methods 82 children with NRDS were selected,and they were randomly divided into two groups according to the digital table ,41 cases in each group.The control group received 100mg/kg PS inhalation,and the study group received intravenous injection of 7.5mg/kg ambroxol hydrochloride +100mg/kg PS inhalation.The changes of arterial blood gas index [PaO2 ,arterial carbon dioxide pressure ( PaCO2 ),pH value], mechanical ventilation time,oxygen supply time and hospitalization time were statistically compared between the two groups.Results The PaO2 [(89.38 ±4.72)mmHg]and pH value (7.40 ±0.02) of the study group were higher than those of the control group [(66.42 ±5.58) mmHg,(7.32 ±0.04)] at 12h after treatment,while PaCO2 [(29.04 ±4.63)mmHg]was lower than that in the control group [(35.38 ±5.67)mmHg],and the differences were statistically significant(t =20.115,11.454,5.545,all P =0.000).The hospitalization time,oxygen supply time and mechanical ventilation time of the study group were lower than those of the control group [(11.10 ±3.47) d vs. (18.61 ±8.72)d,(7.49 ±5.31) d vs.(14.32 ±11.61) d,(56.21 ±11.78)h vs.(78.22 ±18.31)h],and the differences were statistically significant (t =5.123,3.425,6.473,all P =0.000).Conclusion Ambroxol hydrochlo-ride injection combined with PS can improve the arterial blood gas index in children with NRDS and shorten the time of mechanical ventilation,hospitalization and oxygen supply .
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Objective To determine the levels and significance of Krebs von den lungen-6(KL-6), pulmonary surfactant protein A (SP-A), SP-D and interleukin (IL)-6 in patients with connective tissue disease interstitial lung disease (CTD-ILD). Methods The serum KL-6, SP-A, SP-D and IL-6 in all subjects were detected and the imaging and pulmonary function were recorded t test, χ2 test, non-parametric test, ANOVA and correlation analysis were used for data analysis. Results ① The levels of serum KL-6, SP-A, SP-D, IL-6 in the CTD-ILD group [551.4 (428.2, 883.5) U/ml, 938.4(435.2, 2324.7) pg/ml, 90.7 (80.7, 100.3) ng/ml and 30.4 (22.9, 41.7) pg/ml; P all<0.05] was significantly higher than that in the CTD group [192.9 (139.2, 266.2) U/ml; 458.0 (372.6, 529.0) pg/ml; 80.0 (71.2, 98.3) ng/ml; 18.6 (4.9, 31.0) pg/ml, Z=-5.383, -3.76, -2.123,-3.903, P all <0.05]; and higher than healthy controls (n=30) [183.2(141.9, 216.6) U/ml; 229.0(162.0, 248.0) pg/ml;50.8(26.1, 96.4) ng/ml;7.1(3.7, 8.7) pg/ml, Z=-5.801,-8.13, 2.272, 3.266;P all<0.05].②The levels of KL-6 in pulmonary HRCT for active ILD group was significantly higher than the non-active ILD group [998.5 (640.3, 1293.3) U/ml vs 565.0(434.0, 799.5) U/ml, Z=2.182, P=0.023], there was no statistical difference in the levels of SP-A, SP-D, IL-6 between the 2 groups. ③ Spearman correlation analysis showed that KL-6 was negatively correlated with forced vital capacity (FVC%);SP-D, IL-6 and diffusing capacity of carbon monoxide (DLCO %). ④ Logistic multiple regression analysis showed that KL-6 [OR=1.017, P=0.002, 95%CI (1.006, 1.028)], SP-A [OR=1.023, P=0.009, 95%CI (1.006, 1.041)], SP-D [OR=1.175, P=0.009, 95%CI (1.075, 1.264)], IL-6[OR=1.213, P=0.001, 95%CI(1.088, 1.354)] were the risk factors for ILD. Conclusion Serum KL-6, SP-A, SP-D and IL-6 are significantly increased and correlate with CTD-ILD. KL-6 is related to the pulmonary inflammatory disease and vital capacity, while SP-D and IL-6 are related to diffusion function.
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Objective@#To investigate the clinical manifestations of surfactant protein C gene (SFTPC) exon-2 c. 115G>G/T (p.V39L).@*Method@#Patients were screened for the entire coding sequence of SFTPC. Three cases from three children′s hospital with mutation in p. V39L were reported.@*Result@#All the three cases were females. The age of onset ranged from 2 months to 7 years. Two cases had recurrent lower respiratory tract infection and failed to thrive. One had chronic anoxia and clubbing fingers. Chest computed tomography (CT) showed diffused ground glass pattern, localized emphysema and intralobular septal thickening. In one case, early sign of cyst formation was also shown on CT. Two were lost to follow-up after alleviation of acute respiratory infection. One was treated with oral low-dose azithromycin and nebulized budesonide and terbutaline. She had recurrent lower respiratory tract infection in more than one year of follow-up.@*Conclusion@#Mutations in SFTPC p. V39L cause interstitial lung diseases. Clinical manifestations included recurrent respiratory tract infections, chronic lung disease. Chest CT showing diffused ground glass pattern, localized emphysema, intralobular septal thickening and early sign of cyst formation. The treatment and prognosis need further study.
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PURPOSE: Pulmonary surfactants for preterm infants contain mostly animal-derived surfactant proteins (SPs), which are essential for lowering surface tension. We prepared artificial pulmonary surfactants using synthetic human SP analogs and performed in vitro and in vivo experiments. MATERIALS AND METHODS: We synthesized peptide analogues that resemble human SP-B (RMLPQLVCRLVLRCSMD) and SP-C (CPVHLKRLLLLLLLLLLLLLLLL). Dipalmitoylphosphatidylcholine (DPPC), phosphatidylglycerol (PG), and palmitic acid (PA) were added and mixed in lyophilized to render powdered surfactant. Synsurf-1 was composed of DPPC:PG:PA:SP-B (75:25:10:3, w/w); Synsurf-2 was composed of DPPC:PG:PA:SP-C (75:25:10:3, w/w); and Synsurf-3 was composed of DPPC:PG:PA:SP-B:SP-C (75:25:10:3:3, w/w). We performed in vitro study to compare the physical characteristics using pulsating bubble surfactometer and modified Wilhelmy balance test. Surface spreading and adsorption test of the surfactant preparations were measured. In vivo test was performed using term and preterm rabbit pups. Pressure-volume curves were generated during the deflation phase. Histologic findings were examined. RESULTS: Pulsating bubble surfactometer readings revealed following minimum and maximum surface tension (mN/m) at 5 minutes: Surfacten® (5.5±0.4, 32.8±1.6), Synsurf-1 (16.7±0.6, 28.7±1.5), Synsurf-2 (7.9±1.0, 33.1±1.6), and Synsurf-3 (7.1±0.8, 34.5±1.0). Surface spreading rates were as follows: Surfacten® (27 mN/m), Synsurf-1 (43 mN/m), Synsurf-2 (27 mN/m), and Synsurf-3 (27 mN/m). Surface adsorption rate results were as follows: Surfacten® (28 mN/m), Synsurf-1 (35 mN/m), Synsurf-2 (29 mN/m), and Synsurf-3 (27 mN/m). The deflation curves were best for Synsurf-3; those for Synsurf-2 were better than those for Surfacten®. Synsurf-1 was the worst surfactant preparation. Microscopic examination showed the largest aerated area of the alveoli in the Synsurf-3 group, followed by Synsurf-1 and Surfacten®; Synsurf-2 was the smallest. CONCLUSION: Synsurf-3 containing both SP-B and SP-C synthetic analogs showed comparable and better efficacy than commercially used Surfacten® in lowering surface tension, pressure-volume curves, and tissue aerated area of the alveoli.
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Animals , Humans , Infant, Newborn , 1,2-Dipalmitoylphosphatidylcholine , Adsorption , Animal Experimentation , In Vitro Techniques , Infant, Premature , Palmitic Acid , Pulmonary Surfactant-Associated Proteins , Pulmonary Surfactants , Reading , Surface TensionABSTRACT
Objective To investigate the clinical effect of three kinds of dose of pulmonary surfactant (PS) in neonatal respiratory distress syndrome (NRDS), and to determine the optimal dose. Methods One hundred and seventy-four cases of NRDS were divided into A group (59 cases), B group (57 cases) and C group (58 cases) according random digits table. Based on the conventional treatment, children in A group were given large dose of poractant alfa injection 250 mg/kg, children in B group were given 200 mg/kg, and children in C group were given 100 mg/kg. After treatment for 1, 6, 12 and 24 h, the arterial oxygen saturation (SaO2), inspired oxygen concentration (FiO2), arterial oxygen tension (PaO2), oxygenation index (OI), arterial/alveolar oxygen tension ratio (a/APO 2), ventilator using and oxygen using time and the incidence of complication were compared. Results After treatment for 12,and 24 h, the levels of SaO 2 in A group and B group were significantly higher than those in C group: 0.936 ± 0.018, 0.935 ±0.019 vs. 0.857 ±0.027;0.941 ±0.017, 0.946 ±0.015 vs. 0.847 ±0.053, and there were significant differences (P0.05). After treatment for 1, 6, 12, and 24 h, the levels of FiO 2 and OI in A group and B group were significantly lower than those in C group, and the levels of PaO 2 and a/APO2 in A group and B group were significantly higher than those in C group. There were significant differences (P0.05). The ventilator using time in A, B and C group were (108.6±23.5) , (119.6±32.8), (156.3±27.3) h, and there were significant differences (P0.05). The oxygen using time in C group was significantly longer than that in A and B group: (186.5 ± 52.8) h vs. (148.7 ±24.4), (154.6±28.2), P0.05).The incidence of complication in C group was significantly higher than that in A and B group:29.31%(17/58) vs. 13.56%(8/59), 12.28%(7/57), P<0.05. Conclusions Poractant alfa injection 200 mg/kg is optimal dosage for poractant alfa injection in the treatment of NRDS, and it can effectively improve oxygenation and ventilation function, reduce the incidence of complication, shorten the course of disease and improve the prognosis and increase the cure rate. Excessive dose is waste, and little dose can not get effective treatment.
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Objective To observe the effect of pulmonary surfactant-associated proteins ( Kelisu) combined with ambroxol in the treatment of 180 congenital alveolar dysplasia children with neonatal respiratory distress syndrome ( NRDS) .Methods According to random number table ,180 congenital alveolar dysplasia children with NRDS were randomly divided into the observation group and control group , 90 cases in each group .In addition to conventional therapy,the control group was given ambroxol hydrochloride treatment ,the observation group was given Kelisu on thebasis of treatment of the control group.The treatment effect was compared between the two groups .Results Comparedwith the control group,after treatment the values of PaO2 and pH were significantly increased,PaCO2 significantly decreasedin the observation group(t =5.91,13.16,29.89,2.98,5.11,8.13,all P <0.05).The duration of mechanicalventilation,length of hospital stay were (45.30 ±5.35)h,(10.01 ±2.24)d in the observation group,respectively,which were significantly better than[(68.27 ±6.13)h,(17.24 ±2.39)d]in the control group(t =26.78,20.94,all P <0.05).Conclusion Kelisu combined with hydrochloride ambroxol can significantly improve hypoxia symp -toms in NRDS children,reduce the duration of mechanical ventilation and length of hospital stay ,improve the prognosis.
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Respiratory distress syndrome (RDS) among preterm infants is typically due to a quantitative deficiency of pulmonary surfactant. Aside from the degree of prematurity, diverse environmental and genetic factors can affect the development of RDS. The variance of the risk of RDS in various races/ethnicities or monozygotic/dizygotic twins has suggested genetic influences on this disorder. So far, several specific mutations in genes encoding surfactant-associated molecules have confirmed this. Specific genetic variants contributing to the regulation of pulmonary development, its structure and function, or the inflammatory response could be candidate risk factors for the development of RDS. This review summarizes the background that suggests the genetic predisposition of RDS, the identified mutations, and candidate genetic polymorphisms of pulmonary surfactant proteins associated with RDS.
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Humans , Infant, Newborn , Genetic Predisposition to Disease , Infant, Premature , Polymorphism, Genetic , Pulmonary Surfactant-Associated Proteins , Pulmonary Surfactants , Risk Factors , TwinsABSTRACT
Objective To compare the effect of noninvasive ventilation (nasal continuous positive airway pressure ventilation,-NCPAP) and nasal intermittent positive pressure ventilation,-NIPPV) and invasive ventilation (i.e.,mechanical ventilation,CMV) combined with pulmonary surfactant (PS) in the treatment of Ⅰ ～ Ⅲ level in premature infants with respiratory distress syndrome (NRDS).Methods 81 cases with Ⅰ ～ Ⅲ level in NRDS were selected.40 cases in invasive group was given CMV combined with PS therapy.41 cases in noninvasive group was given noninvasive ventilation combined with PS therapy.The changes of blood gas,cure rate,complications,duration of oxygen therapy,hospitalization expenses and time were compared between the two groups.Results 1 hour after treatment,clinical symptoms were obviously improved in the two groups.6 hours,12 hours,weaning of blood gas analysis of two groups to maintain arterial oxygen partial pressure (PaO2) better and showed an upward trend,arterial partial pressure of carbon dioxide (PaCO2) was decreased,while the two groups before and after treatment had no significant differences (P ＞ 0.05).The cure rate of noninvasive group was 95.0％,that in invasive group was 92.5 ％,the difference between the two groups was not significant (P ＞ 0.05).Compared with the invasive group,the infection rate of lung,the incidence rate of chronic lung disease in noninvasive group were significantly lower (22.0％ vs 65.0％、14.6％ vs 37.5 ％,x2 =6.243,6.021,all P ＜ 0.01),the duration of oxygen therapy,time of hospitalization in the noninvasive group were significantly shorter (t =3.092,3.070,P ＜ 0.05),and the hospital costs was relatively low (t =3.791,P ＜ 0.05).Conclusion Noninvasive ventilation combined with PS in the treatment of Ⅰ ～ Ⅲ level NRDS is safe,efficient,relative economic,it is worthy of popularization,especially in primary hospital.
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Objective To measure serum surfactant protein (SP) A and D levels in patients with interstitial lung disease associated with rheumatoid arthritis (RA).Methods Serum SP-A and SP-D levels of RA,RA-ILD patients and healthy controls were assessed using a sensitive enzyme-linked immunosorbent assay (ELISA).The relationship between SP-A and SP-D and RA-ILD was analyzed.The serum SP-A and SP-Dpositive rate was calculated for the three groups.The correlation between SP-A and SP-D with RF,anti-CCP,antinuclear antibody,antikeratin antibody,anti-perinuclear factor,C-reactive protein,erythrocyte sedimentation rate,were analyzed.Mean value of groups were compared with variance analysis,Spearmam rank correlation test was used for correlation analysis.Results The levels of serum SP-A in RA-ILD patients and RA patients as well as in healthy controls were [ (51.2±9.2),(25.9±2.6),( 15A±0.3 ) μg/L] respectively.The level of serum SP-D of the three groups was [ ( 42.5 ±8.1 ),(20.8 ± 1.5 ),( 16.6±0.8 ) μg/L ] respectively.The levels of serum SP-A and SP-D in patients with RA complicated with ILD were higher than those simple RA patients and healthy controls (P＜0.05).The levels of serum SP-A and SP-D in patients with RA were not significantly higher than those in healthy controls (P＞0.05).The positive rate of serum SP-A and SP-D in RA-ILD patients were significantly higher than those in simple RA patients and healthy controls.The positive rate of serum SP-D of RA-ILD patients was higher than that of SP-A.The levels of serum SP-A and SP-D in patients with RA complicated with ILD were correlated positively with age,C-reactive protein.The level of serum SP-D was correlated positively with RF,anti-CCP,antikeratin antibody.There was no correlation between the level of serum SP-A and SP-D with RA-ILD and antinuclear antibody,antiperinuclear factor,erythrocyte sedimentation rate.Conclusion The levels of serum SP-A and SP-D are correlated with RA-ILD and may be useful markers for ILD in patients with RA.These two paramenters may be helpful to early diagnosis of RA-ILD.The Serum SP-D levels are more sensitive in predicting the development of RA-ILD than other parameters and can help in assessing the severity of lung damage.
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Objective To study the effects of vascular endothelial growth factor(VEGF)on production of pulmonary surfactants.Method Fetal rat lungs were obtained at 19-day gestation.Primary culture of typeⅡalveolar epithelial cells(AECⅡ)was performed using IgG panning technique.The rats was divided into groups: VEGF,Dexamethasone,VEGF plus Dexamethasone and a control.Total phospholipids,phosphatidylcholine (PC),phosphatidyl glycerol(PG)and sphingornyelin(SM)were determined.Results expressed as mean?SEM. Comparison between groups were made with LSD-t test and one -way ANOVA.Result VEGF,Dexamethasone and VEGF plus Dexamethasone groups showed increased amount of total phospholipids and its compositions on the first day of culture.Conclusions VEGF-165 promotes the production and secretion of pulmonary surfactant. VEGF and Dexamethason may go through different mechanism for enhancement of synthesis of pulmonary surfactant,thereby improve biological function of AECⅡ.
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Objective To explore effect of hyperoxia and amygdalin on surfactant associated protein messenger RNA levels of alveolar epithelial cells of premature rat lung. Methods Type Ⅱ alveolar epithelial cells (AECⅡ) were gained by primary culture from 19-days fetal rat lung. After purified,AECⅡ were randomly assigned to four groups and exposed to air or hyperoxia: air group (group Ⅰ),hyperoxia group (group Ⅱ),air plus amygdalin group (group Ⅲ),hyperoxia plus amygdalin group (group Ⅳ),Groups Ⅱ、Ⅳ were flushed the flake with 95% oxygen-5% CO 2 at 3 L/min for 10 min,then sealed and cultured for 24 hours. Groups Ⅲ,Ⅳ were added 200 ?mol/L of amygdalin at the same time. All groups were in CO 2 culture chamber (37 ℃,5% CO 2) for 24 hours,cells were harvested and extracted for total RNA by Trizol reagent. mRNA levels of SP were measured by reverse transcription polymerase chain reaction (RT-PCR). Results SP mRNA levels were significantly decreased in groupⅡ compared to groupⅠ( P