Changes And Significance Of Inflammatory Factors And Pulmonary Surfactant Proteins In Bronchoalveolar Lavage Fluid Of Neonates With ALI/ARDS

? Objective ? The levels of tumor necrosis factor-alpha TNF-alpha,interleukin-6,interleukin-8,surfactant-associated protein-A(SP-A) and surfactant-associated protein-B(SP-B) in bronchoalveolar lavage fluid(BALF) were measured.The relationship between pulmonary inflammation and acute lung injury/acute respiratory distress syndrome(ALI/ARDS) in neonates was analyzed and compared.The role of inflammatory factors and pulmonary surfactant protein in BALF in the development of neonatal ALI/ARDS was discussed.?Methods?The neonates who need mechanical ventilation in the neonatal ward of the Affiliated Hospital of Jiangsu University and Women & Children,s Yangzhou Health care Hospital from January 2012 to January 2017 were selected as the subjects of study.According to the diagnostic criteria drawn up by Demirakca,the patients were divided into ALI group and ARDS group according to the arterial oxygen partial pressure(PaO2)/ oxygen concentration(FiO2)? 300 mm Hg as ALI and? 200 mm Hg as ARDS.Meanwhile,the neonates without pulmonary diseases were selected as control group.All children were given bronchoalveolar lavage after admission.Expression of TNF-a,IL-6,IL-8,SP-A and SP-B in BALF of children with different degrees and stages were detected by ELISA.?Results?1.General data comparison: 76 cases in the observation group,including 40 cases in group ALI,36 cases in group ARDS,and 26 cases in control group.There was no significant difference in gestational age,birth weight and sex between the three groups of newborns(P>0.05).2.Levels of TNF-a,IL-6,IL-8,SP-A and SP-B in BALF of neonates with different degrees of lung injury and control group: In the 3 groups,The levels of TNF-,IL-6 and IL-8 were the highest in group ARDS,while those in SP-A and SP-B were the lowest.Compared with the control group,the differences were statistically significant(P<0.05).The levels of TNF-a,IL-6 and IL-8 in group ALI were significantly higher than those in the control group,while the levels of SP-A and SP-B were significantly lower than those in the control group,the differences were statistically significant(P<0.05).Compared with ALI group,the levels of TNF-a,IL-6and IL-8 in ARDS group were significantly higher,while the levels of SP-A and SP-B were significantly lower,the differences were statistically significant(P<0.05).3.Levels of TNF-a,IL-6,IL-8,SP-A and SP-B in BALF of children with ALI/ARDS in different periods: The levels of TNF-a,IL-6 and IL-8 in children with ALI/ARDS on ventilator 24 hours were significantly higher than those before ventilator,and the levels of TNF-a,IL-6 and IL-8 in children with ALI/ARDS before weaning were significantly lower than those before ventilator.The levels of SP-A and SP-B in ALI/ARDS patients were significantly lower than those before ventilator,and before withdrawal,the levels of SP-A and SP-B increased significantly compared with before ventilator,the differences were statistically significant(P<0.05).?Conclusions?1.The level of TNF-a,IL-6 and IL-8 increased significantly in neonatal ALI/ARDS BALF,suggesting that TNF-a,IL-6 and IL-8 may be involved in the development of lung injury,and the degree of change has a certain correlation with the severity of lung injury.2.The level of SP-A and SP-B in BALF of ALI/ ARDS neonates decreased significantly,and the degree of change was negatively correlated with the degree of lung injury,suggesting that SP-A and SP-B had certain protective effects on lung injury.3.Inflammation is closely related to lung injury,and the heavier the inflammation,the more severe the lung injury.4.Detection of TNF-a,IL-6,IL-8,SP-A and SP-B contributes to early diagnosis of lung injury.