The Clinical Significance Of Plasma Surfactant Protein-D Surfactant Protein-A And Clara Cell Secretory Protein In Patients With Septic ALI/ARDS

Objective:To discuss the importance of plasma Surfactant protein-D(SP-D), Surfactant protein-A(SP-A), Clara cell secretory protein(CC16) in septic Acute lung injury(ALI)/Acute Respiratory Distress Syndrome(ARDS) patient. To elect the most reliable biomarkers to the progression and severity of septic ALI/ARDS.Methods:50patients admitted in ICU of Beijing Friendship Hospital between Jan2012to Oct2012were enrolled to this trial. All patients were divided into three groups: sepsis group, ALI group and ARDS group. Record information about age, gender, diagnosis on admission, and record every-day body temperature, blood pressure, heart rate, respiratory rate, blood routine examination result, SpO2, acute physiology and chronic health evaluation (APACHEII), chest X-ray. Take blood samples in the1st,3th,5th,7th days of enrollment. Analyze the plasma SP-D, CC16, SP-A level with enzyme-linked immunosorbent assay (ELISA).Results:1. Compared to sepsis group, level of plasma SP-D is higher in ALI and ARDS group in all time point (P<0.05). Level of plasma SP-D is higher in all time point in ARDS group compared to ALI group (P<0.05). Level of plasma SP-D has no significant difference between each time point in sepsis group. Level of plasma SP-D in each time point is higher than it in the previous time point (P<0.05).2. Compared to sepsis group, level of plasma SP-A in ALI and ARDS group is higher in all time point (P<0.05). Level of plasma SP-A has no significant difference between each time point in ARDS group. Level of plasma SP-A has no significant difference between each time point in sepsis group. Level of plasma SP-A in sepsis group in3rd day has no significant difference compared to that in1st day, level of plasma SP-A is higher in the5th day compared to the3rd day, and is higher in the7th day than the5th day (P<0.05).3. In the1st of enrollment, level of plasma CC16has no difference between sepsis, ALI and ARDS group. In the3rd,5th,7th day, level of plasma CC16is higher in ALI and ARDS group compared to sepsis group, with statistical significance (P<0.05). Level of plasma CC16in ARDS group is higher than ALI group (P<0.05). Level of plasma CC16between each time point in sepsis group had no significant difference. In the3rd,5th day, Level of plasma CC16is higher in ALI group than it in the previous time point (P<0.05). Level of plasma CC16is higher in ARDS group than it in the previous time point (P<0.05).4. Perform ROC curve analyze to three plasma protein of ALI/ARDS patients caused by sepsis. In the diagnosis of septic ALI, plasma SP-A has an area under ROC of0.977, plasma SP-D has an area under ROC of0.727, and plasma CC16has an area under ROC of0.590. In the diagnosis of septic ARDS, plasma SP-A has an area under ROC of0.983, plasma SP-D has an area under ROC of0.820, and plasma CC16has an area under ROC of0.603. Conclusions:1. Level of plasma SP-A has higher value in diagnosing septic ALI/ARDS compared to CC16and SP-D.2. In monitoring progress and severity of septic ALI/ARDS,SP-D has the higher reliability.