
新生儿呼吸窘迫综合征合并呼吸机相关肺炎患儿气道灌洗液IL-4和IL-13水平监测
夏耀方, 刘翠青, 时会菊, 马莉
中国当代儿科杂志 ›› 2009, Vol. 11 ›› Issue (08) : 645-648.
新生儿呼吸窘迫综合征合并呼吸机相关肺炎患儿气道灌洗液IL-4和IL-13水平监测
Interleukin-4 and interleukin-13 concentrations in bronchoalveolar lavage fluid in neonates with respiratory distress syndrome and concurrent ventilator-associated pneumonia
目的:通过监测新生儿呼吸窘迫综合征(RDS)患儿呼吸机相关肺炎(VAP)气道灌洗液中IL-4和IL-13含量,了解发生VAP时免疫调节功能。方法:68名机械通气>48 h的RDS新生儿作为研究对象,其中发生VAP的患儿37名,未发生VAP的31名。用ELISA法测定机械通气后1 h,72 h及96 h支气管肺泡灌洗液中IL-4和IL-13 水平。结果:机械通气后96 h VAP组支气管肺泡灌洗液中IL-4水平显著高于非VAP组(35.34±1.78 ng/L vs 13.69±2.47 ng/L; P<0.05); IL-13水平亦显著高于非VAP组(33.74±2.74 ng/L vs 13.50±3.81 ng/L; P<0.05)。随着上机时间的延长,VAP组支气管肺泡灌洗液中IL-4及IL-13含量逐渐增加,上机后96 h与1 h比较差异均有显著性(P<0.05)。结论:新生儿RDS患儿在合并VAP时支气管灌洗液中IL-4及IL-13浓度增高,提示IL-4及IL-13参与了体内免疫反应的调节。[中国当代儿科杂志,2009,11(8):645-648]
OBJECTIVE: To study the concentrations of IL-4 and IL-13 in bronchoalveolar lavage fluid (BALF) in neonates with respiratory distress syndrome (RDS) and concurrent ventilator-associated pneumonia (VAP). METHODS: Sixty-eight neonates with RDS undergoing mechanical ventilation for over 48 hrs were enrolled. IL-4 and IL-13 levels in BALF were measured using ELISA 1, 72 and 96 hrs after mechanical ventilation. The results were compared between the neonates with concurrent VAP (n=37) and without (n=31). RESULTS: The levels of BALF IL-4 96 hrs after ventilation in the VAP group (35.34±1.78 ng/mL) were significantly higher than those in the non-VAP group (13.69±2.47ng/mL, P<0.05). The levels of BALF IL-13 96 hrs after ventilation in the VAP group (33.74±2.74 ng/mL) also increased significantly compared with those in the non-VAP group (13.50±3.81 ng/mL) (P<0.05). There were significant differences in BALF IL-4 and IL-13 levels between 1 hr and 96 hrs in the VAP group (P<0.05).ConclusionsBALF IL-4 and IL-13 levels increase in neonates with RDS and concurrent VAP. IL-4 and IL-13 may involve in the regulation of the inflammatory immue response.[Chin J Contemp Pediatr, 2009, 11 (8):645-648]
呼吸窘迫综合征 / 呼吸机相关肺炎 / IL-4;IL-13 / 支气管肺泡灌洗液 / 新生儿
Respiratory distress syndrome / Ventilation associated pneumonia / IL-4 / IL-13 / Bronchoalveolar lavage fluid / Neonate
[1]Iwamura C, Kimura MY, Shinoda K, Endo Y, Hasegawa A, Yamashita M, et al. Schnurri-2 regulates Th2-dependent airway inflammation and airway hyperresponsiveness[J].Int Immunol, 2007, 19(6):755-762.
[2]金汉珍,黄德珉,官希吉.实用新生儿学[M].第3版. 北京:人民卫生出版社, 2005, 421-427.
[3]李文静,刘翠青,马莉.新生儿呼吸机相关性肺炎病原菌分析.中国新生儿科杂志,2006,21(1):36-38.
[4]Petdachai W.Ventilator-associated pneumonia in a newborn intensive care unit[J].Southeast Asian J Trop Med Public Health, 2004, 35(3):724-729.
[5]Noor A, Hussain SF. Risk factors associated with development of ventilator associated pneumonia[J]. J Coll Physicians Surg Pak, 2005, 15(2):92-95.
[6]刘翠青,曹蕾,郑华成,贾系群,康利民,李兰凤,等.肺泡巨噬细胞核转录因子κB和核转录因子抑制物κB-α在肺透明膜病中的表达[J].中华儿科杂志, 2006, 46(8):602-606.
[7]Liu Q, Liu Z, Rozo CT, Hamed HA, Alem F, Urban JF Jr, et al. The role of B cells in the development of CD4 effector T cells during a polarized Th2 immune response[J].J Immunol, 2007, 179(6):3821-3830.
[8]Kay AB. The role of T lymphocytes in asthma[J]. Chem Immunol Allergy, 2006, 91:59-75.
[9]Kimura MY, Iwamura C, Suzuki A, Miki T, Hasegawa A, Sugaya K, et al. Schnurri-2 controls memory Th1 and Th2 cell numbers in vivo[J]. J Immunol, 2007, 178(8):4926-4936.
[10]Kimura MY, Hosokawa H, Yamashita M, Hasegawa A, Iwamura C, Watarai H, et al. Regulation of T helper type 2 cell differentiation by murine Schnurri-2[J]. J Exp Med, 2005, 201(3):397-408.
[11]Kellner J, Gamarra F, Welsch U, Jorres RA, Huber RM, Bergner A, et al. IL-13Ralpha2 reverses the effects of IL-13 and IL-4 on bronchial reactivity and acetylcholine-induced Ca+ signaling[J]. Int Arch Allergy Immunol, 2007, 142(3):199-210.
[12]Salahuddin N, Zafar A, Sukhyani L, Rahim S, Noor MF, Hussain K, et al. Reducing ventilator-associated pneumonia rates through a staff education programme[J]. J Hosp Infect, 2004, 57(3):223-227.
[13]朱绪亮,赵玲,杨嘉琛,陈晓,吴星恒.新生儿呼吸机相关性肺炎的病原学和高危因素分析[J].中国当代儿科杂志,2007,9(6):549-552.