影响呼吸窘迫综合征晚早产儿表面活性剂治疗反应的生化特征及临床因素

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics Pub Date : 2025-05-13 DOI:10.1016/j.jpeds.2025.114644

Lucia Lanciotti, Anna Sartori, Manuela Simonato, Alessio Correani, Paola Cogo, Ilaria Burattini, Chiara Giorgetti, Roberta Centorrino, Barbara Loi, Daniele De Luca, Virgilio Carnielli

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The concentration of disaturated-phosphatidylcholine (DSPC), surfactant protein-B (SP-B), total proteins, IL-1β, IL-6, and TNF-α in epithelial lining fluids were measured by high-performance liquid chromatography-mass spectrometry, ELISA, Lowry, or Luminex techniques, respectively, and corrected using plasma-to-bronchoalveolar lavage fluid urea ratio. Clinical data, including inspired oxygen fraction (FiO2) and preductal hemoglobin saturation (SpO2), were recorded in real-time.Results: We studied 55 late-PTRDS, 44 moderately-PTRDS and 18 term-NLD infants. DSPC was lower in late-PTRDS (43 [24-124] mg/dL) than in term-NLD (249 [147-688] mg/dL, p<0.001) but similar to that of moderately-PTRDS (30 [9-80] mg/dL, p=0.083). SP-B, total proteins, IL-1β, IL-6, and TNF-α were similar between late-PTRDS and moderately-PTRDS. SP-B, total proteins, and IL-6 were significantly higher in late-PTRDS than term-NLD. 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引用次数: 0

摘要

目的：评价呼吸窘迫综合征（RDS）晚期早产儿对表面活性物质的主要生物物理活性成分和炎症介质，并探讨表面活性物质良好应答的相关因素。研究设计：这是一项前瞻性、多中心、队列研究，纳入晚期（胎龄34+0/7-36+6/7周[晚期ptrds]）和中度（胎龄32+0/7-33+6/7周，[中度ptrds]）早产儿RDS。无肺部疾病（Term - nld）的足月婴儿作为对照。分别采用高效液相色谱-质谱法、ELISA、Lowry或Luminex技术测定上皮内层液中不饱和磷脂酰胆碱（DSPC）、表面活性剂蛋白-b （SP-B）、总蛋白、IL-1β、IL-6和TNF-α的浓度，并用血浆与支气管肺泡灌洗液尿素比校正。实时记录临床数据，包括吸入氧分数（FiO2）和血红蛋白饱和度（SpO2）。结果：55例晚期ptrds， 44例中度ptrds， 18例足月nld。晚期ptrds患者的dsc （43 [24-124] mg/dL）低于中期nld患者（249 [147-688]mg/dL）和pRDS患者（30 [9-80]mg/dL, p=0.083）。SP-B、总蛋白、IL-1β、IL-6和TNF-α在晚期ptrds和中度ptrds之间相似。SP-B、总蛋白和IL-6在ptrds晚期明显高于nld中期。表面活性剂治疗前每延迟1小时，FiO2阈值每增加5个点，SpO2/FiO2每减少5个点，获得良好反应的可能性分别降低12% （p=0.002）、28% （p=0.019）和15% （p=0.028）。结论：晚期ptrds的dsc和SP-B水平与中度ptrds相似。早期给药、较低的FiO2阈值和表面活性剂治疗前更好的氧合与表面活性剂治疗的更好反应相关。

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Biochemical Features and Clinical Factors Influencing Response to Surfactant Treatment among Infants Born Late Preterm with Respiratory Distress Syndrome.

Objective: To evaluate main biophysically active surfactant components and inflammatory mediators, and to identify the factors associated with good response to surfactant, in late preterm infants with respiratory distress syndrome (RDS).

Study design: This was a prospective, multicenter, cohort study enrolling late (gestational age 34^+0/7-36^+6/7 weeks [late-PT_RDS]) and moderately (gestational age 32^+0/7-33^+6/7 weeks, ]moderately-PT_RDS]) preterm infants with RDS. Term infants with no lung disease (term-NLD) were enrolled as controls. The concentration of disaturated-phosphatidylcholine (DSPC), surfactant protein-B (SP-B), total proteins, IL-1β, IL-6, and TNF-α in epithelial lining fluids were measured by high-performance liquid chromatography-mass spectrometry, ELISA, Lowry, or Luminex techniques, respectively, and corrected using plasma-to-bronchoalveolar lavage fluid urea ratio. Clinical data, including inspired oxygen fraction (FiO₂) and preductal hemoglobin saturation (SpO₂), were recorded in real-time.

Results: We studied 55 late-PT_RDS, 44 moderately-PT_RDS and 18 term-NLD infants. DSPC was lower in late-PT_RDS (43 [24-124] mg/dL) than in term-NLD (249 [147-688] mg/dL, p<0.001) but similar to that of moderately-PT_RDS (30 [9-80] mg/dL, p=0.083). SP-B, total proteins, IL-1β, IL-6, and TNF-α were similar between late-PT_RDS and moderately-PT_RDS. SP-B, total proteins, and IL-6 were significantly higher in late-PT_RDS than term-NLD. Each hour of delay for surfactant administration, each 5-point increase in FiO₂ threshold, and each 5-point decrease in SpO₂/FiO₂ before surfactant treatment decreased the likelihood of good response by 12% (p=0.002), 28% (p=0.019) and 15% (p=0.028), respectively.

Conclusions: Late-PT_RDS had DSPC and SP-B levels similar to moderately-PT_RDS. Early administration, lower FiO₂ threshold, and better oxygenation prior to surfactant treatment were associated with a better response to surfactant therapy.

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来源期刊

Journal of Pediatrics 医学-小儿科

CiteScore

6.00

自引率

2.00%

发文量

696

审稿时长

31 days

期刊介绍： The Journal of Pediatrics is an international peer-reviewed journal that advances pediatric research and serves as a practical guide for pediatricians who manage health and diagnose and treat disorders in infants, children, and adolescents. The Journal publishes original work based on standards of excellence and expert review. The Journal seeks to publish high quality original articles that are immediately applicable to practice (basic science, translational research, evidence-based medicine), brief clinical and laboratory case reports, medical progress, expert commentary, grand rounds, insightful editorials, “classic” physical examinations, and novel insights into clinical and academic pediatric medicine related to every aspect of child health. Published monthly since 1932, The Journal of Pediatrics continues to promote the latest developments in pediatric medicine, child health, policy, and advocacy. Topics covered in The Journal of Pediatrics include, but are not limited to: General Pediatrics Pediatric Subspecialties Adolescent Medicine Allergy and Immunology Cardiology Critical Care Medicine Developmental-Behavioral Medicine Endocrinology Gastroenterology Hematology-Oncology Infectious Diseases Neonatal-Perinatal Medicine Nephrology Neurology Emergency Medicine Pulmonology Rheumatology Genetics Ethics Health Service Research Pediatric Hospitalist Medicine.