首页|肺表面活性物质蛋白-B缺陷与足月新生儿呼吸窘迫综合征的相关性研究

肺表面活性物质蛋白-B缺陷与足月新生儿呼吸窘迫综合征的相关性研究

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目的 探讨肺表面活性物质蛋白(surfactant protein,SP)-B缺陷与足月儿新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)的相关性.方法 2019 年 7 月至 2023 年 6 月,在解放军总医院第七医学中心等4家医院开展研究.NRDS组纳入因患NRDS死亡的足月新生儿60例;对照组纳入同期因其他原因手术后死亡的足月、非NRDS患儿 60 例.采集胸部X线片结果.新生儿死亡后 30 min内进行支气管肺泡灌洗、肺组织取材,采用蛋白质印迹法检测SP-B表达.统计学方法采用χ2 检验.结果 NRDS组患儿生后出现严重高碳酸血症和低氧血症,采用外源性肺表面活性物质、有创高频振荡通气呼吸支持、一氧化氮治疗降低肺动脉高压等综合治疗措施,10 例接受体外膜肺氧合治疗,均治疗无效死亡.NRDS组的X线胸片均显示白肺.NRDS组患儿支气管肺泡灌洗液中SP-B单体(分子质量 8 ku)及二聚体(分子质量 16~18 ku)表达阳性的比例均明显低于对照组[8 ku:75.0%(45/60)与 100.0%(60/60),χ2=17.143;16~18 ku:73.3%(44/60)与 100.0%(60/60),χ2=18.462;P值均<0.001];NRDS组肺组织中SP-B分子质量 8 ku及 16~18 ku表达阳性的比例也明显低于对照组[8 ku:75.0%(45/60)与 100.0%(60/60),χ2=17.143;16~18 ku:70.0%(42/60)与 100.0%(60/60),χ2=21.176;P值均<0.001].NRDS组筛出SP-B缺陷个体 15 例,对照组仅 1 例,NRDS组SP-B缺陷的比例高于对照组[25.0%(15/60)与 1.7%(1/60),χ2=14.135,P<0.001].结论 SP-B缺陷与足月儿NRDS发病存在一定的相关性.
Research on the correlation between pulmonary surfactant protein B deficiency and neonatal respiratory distress syndrome in full-term newborns
Objective To explore the correlation between pulmonary surfactant protein(SP)-B deficiency and neonatal respiratory distress syndrome(NRDS)in full-term newborns.Method From July 2019 to June 2023,research was conducted in the Seventh Medical Center of PLA General Hospital and the other three hospitals.60 full-term newborns who died with NRDS were included in the NRDS group.The control group included 60 full-term newborns with non-NRDS who died after surgery due to other reasons during the same period.Chest X-ray results were collected.Within 30 min after the newborns died,bronchoalveolar lavage and lung tissue sampling were performed.SP-B expression was detected using Western blotting.Chi-square test was used for statistical methods.Result Newborns in the NRDS group experienced severe hypercapnia and hypoxemia after birth.Adopting comprehensive treatment measures such as exogenous pulmonary surfactant,invasive high-frequency oscillatory ventilation respiratory support,nitric oxide therapy to reduce pulmonary arterial hypertension,etc.Ten cases received extracorporeal membrane oxygenation(ECMO).However,all of them died.Chest X-rays in the NRDS group all showed white lungs.The proportion of positive expression of SP-B monomers(molecular weight 8 ku)and dimers(molecular weight 16-18 ku)in bronchoalveolar lavage fluid of newborns in the NRDS group was significantly lower than that in the control group[8 ku:75.0%(45/60)vs 100.0%(60/60),χ2=17.143;16-18 ku:73.3%(44/60)vs 100.0%(60/60),χ2=18.462;P<0.001].The proportion of positive expression of SP-B monomers and dimers in lung tissue of the NRDS group was significantly lower than that of the control group[8 ku:75.0%(45/60)vs 100.0%(60/60),χ2=17.143;16-18 ku:70.0%(42/60)vs 100.0%(60/60),χ2=21.176;P<0.001].Fifteen newborns with SP-B deficiency were detected in the NRDS group,while one with SP-B deficiency was detected in the control group.The proportion of SP-B deficiency in the NRDS group was significantly higher than that in the control group[25.0%(15/60)vs 1.7%(1/60),χ2=14.135,P<0.001].Conclusion SP-B deficiency is corrected with NRDS in full-term newborns to some extent.

Full-term newbornRespiratory distress syndromeSurfactant protein BDeficiencyInheritance

尹晓娟、李明霞、史源、梅花、张晓媛、朱艳萍、霍梦月、封志纯

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解放军总医院儿科医学部 解放军总医院第七医学中心儿科研究所 出生缺陷防控关键技术国家工程实验室 儿童器官功能衰竭北京市重点实验室,北京 100700

新疆医科大学第一附属医院 新生儿科,新疆 乌鲁木齐 830054

重庆医科大学附属儿童医院 新生儿科,重庆 401122

内蒙古医科大学附属医院 新生儿科,内蒙古 呼和浩特 010050

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足月新生儿 呼吸窘迫综合征 肺表面活性物质蛋白-B 缺陷 遗传

国家自然科学基金

30871397

2024

发育医学电子杂志
人民卫生出版社

发育医学电子杂志

CSTPCD
影响因子:0.212
ISSN:2095-5340
年,卷(期):2024.12(1)
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