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目的观察急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)患者呼出气冷凝液(EBC)中血管内皮生长因子A(VEGF-A)的水平,并探讨其临床价值。方法纳入23例ICU中行机械通气的ALI/ARDS患者,使用改进的EcoScreen冷凝器收集EBC标本。17名健康体检者为对照组,自主呼吸收集EBC标本。采用EIA法测定EBC和血清中VEGF-A的浓度。观察不同肺损伤分级患者EBC中VEGF-A的差异,并与临床指标作相关性分析。结果 EBC中VEGF-A水平在ALI/ARDS患者低于正常对照组[(49.88±6.32)ng/L比(56.50±6.23)ng/L,P<0.01],ALI组高于ARDS组[(53.56±5.56)ng/L比(45.86±4.45)ng/L,P<0.01),存活组高于病死组[(51.92±6.28)ng/L比(46.05±4.58)ng/L,P<0.05)。EBC中VEGF-A水平与肺损伤评分(LIS)、A-aDO2/PaO2呈负相关(r值分别为-0.426和-0.510,P<0.05),与PaO2/FiO2、PaO2呈正相关(r值分别为0.626和0.655,P<0.05)。血清VEGF-A水平在ALI/ARDS患者与正常对照组、ALI组与ARDS组、存活组与死亡组之间比较,差异均无统计学意义(P均>0.05)。血清VEGF-A水平与LIS评分、A-aDO2/PaO2、PaO2/FiO2、PaO2均无显著相关性(P均>0.05)。结论 ALI/ARDS患者EBC中VEGF-A的变化可以作为肺损伤病情严重程度判断和预后评估的辅助指标。
Objective To investigate the level of vascular endothelial growth factor A (VEGF-A) in exhaled breath condensate (EBC) in patients with acute lung injury / acute respiratory distress syndrome (ALI / ARDS) and to investigate its clinical value. Methods Twenty-three ICU patients with mechanically ventilated ALI / ARDS were enrolled. EBC specimens were collected using a modified EcoScreen condenser. 17 healthy people as control group, spontaneous breathing collection of EBC specimens. EIA and serum VEGF-A concentrations were measured by EIA. To observe the difference of VEGF-A in EBC of different lung injury grading patients, and to make correlation analysis with clinical indexes. Results The level of VEGF-A in EBC was lower in ALI / ARDS group than in control group [(49.88 ± 6.32) ng / L vs (56.50 ± 6.23) ng / L, P <0.01] (51.82 ± 6.28) ng / L vs (45.86 ± 4.45) ng / L, P <0.01). The survival rate was significantly higher in the survival group than in the control group [(51.92 ± 6.28) ng / L vs . The levels of VEGF-A in EBC were negatively correlated with LIS and A-aDO2 / PaO2 (r values were -0.426 and -0.510, respectively, P <0.05), and were positively correlated with PaO2 / FiO2 and PaO2 0.626 and 0.655, P <0.05). Serum VEGF-A levels in ALI / ARDS patients and normal control group, ALI group and ARDS group, survival group and death group, the difference was not statistically significant (P all> 0.05). There was no significant correlation between serum VEGF-A level and LIS scores, A-aDO2 / PaO2, PaO2 / FiO2 and PaO2 (all P> 0.05). Conclusion The changes of VEGF-A in EBC of patients with ALI / ARDS may be used as an auxiliary index to judge the severity of lung injury and prognosis.