乌司他丁对急性肺损伤患者血小板活化因子表达影响.doc

乌司他丁对急性肺损伤患者血小板活化因子表达影响 　 作者：赵仁国 林海 张鸣华 慈晓 刘凌云 【摘要】 目的 探讨急性肺损伤（ALI）患者血清中血小板活化因子（PAF）的表达以及乌司他丁（UTI）对PAF表达和临床症状的影响。 方法 ALI 37例，随机分为对照组和治疗组，分别于治疗前及治疗5d后评价生命体征和临床症状，测定血清PAF水平和血气分析。 结果 两组患者治疗后氧合改善、PAF水平下降、临床症状改善，治疗组变化较对照组均更为明显（Plt;0.05或Plt;0.01）；治疗组呼吸支持时间明显缩短（Plt;0.05），但两组间病死率无明显差异(Pgt;0.05)。 结论 UTI能够减少ALI患者PAF的表达，从而作为非特异性PAF抑制剂能减轻ALI患者症状、缩短病程，为临床早期治疗ALI提供了新的方法。 【关键词】 急性肺损伤 血小板活化因子 乌司他丁 　　【Abstract】Objective To investigate the expression of platelet-activating factor (PAF) in serum of acute lung injury patients (ALI) and the effects of ulinastatin on PAF expression and clinical symptom. Methods 37 patients of ALI were randomly divided into two groups, control and treatment groups. The vital signs and clinical symptoms were assessed before treatment and 5 days after treatment, respectively. Serum PAF level and blood gas analysis were also measured . Results Compared with those before treatment, the clinical symptom and blood gas analysis were improved and PAF level decreased in both groups These changes were more significant in treatment group（Plt;0.05 or Plt;0.01）. The respiration support duration was significantly shortened in treatment group（Plt;0.05）. However, the case fatality ratio between two groups had no significant difference（Pgt;0.05）. Conclusions Ulinastatin could decrease the expression of sera PAF in ALI patients as a non-specific PAF inhibitor. It could also relieve symptom of ALI, shorten the course of disease. So, it could be a new approach for early clinical treatment of ALI. 　　【Key words】Acute lung injury(ALI) Platelet-activating factor Ulinastatin 　　急性肺损伤（acute lung injury，ALI）是由心源性以外的各种原因引起的严重肺部炎性反应，临床上以呼吸窘迫和顽固性低氧血症为主要特点。炎性介质的过度释放在ALI的发生发展过程中起着重要作用。血小板活化因子（platelet-activating factor，PAF）是一种重要的内源性磷脂类炎性介质，是迄今为止所发现的最强的血小板聚集诱导剂，在ALI的发生发展过程中起着重要的作用。本文旨在研究探讨ALI患者血清中PAF的表达，以及乌司他丁（ulinastatin，UTI）对PAF表达和临床症状的影响。 　　1 临床资料 　　1.1 研究对象 　　2005年6月至2006年3月，本院收治ALI 37例，均符合中华医学会呼吸病学分会制订的ALI诊断标准［１］，其中男29例，女8例，年龄17～73岁(平均42.62岁)。原发病：呼吸道感染15例，严重外伤11例，严重烧伤3例，急性胰腺炎、败血症、海