ecmo辅助全肺灌洗联合GM-CSF吸入治疗严重肺泡蛋白沉积症：一项比较队列研究。

IF 3.1 4区医学 Q3 IMMUNOLOGY

Immunobiology Pub Date : 2026-09-01 Epub Date: 2026-08-31 DOI:10.1016/j.imbio.2026.153234

Qiong Li, Jingyu Wu, Hongmei Chen, Qin Huang, Jing Dong, Yue Zhang, Hong Zhou

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引用次数: 0

摘要

目的：本研究评估静脉-静脉体外膜氧合（ECMO）联合全肺灌洗（WLL）和粒细胞-巨噬细胞集落刺激因子（GM-CSF）雾化治疗肺泡蛋白沉积症（PAP）的相关性，重点关注肺功能、氧合、脂质代谢和炎症调节。方法：回顾性队列研究纳入40例PAP患者，根据治疗情况分为WLL + GM-CSF组（n = 20）和ECMO + WLL + GM-CSF组（n = 20）。结果包括肺功能[一氧化碳弥散能力（DLCO%）、用力肺活量（FVC%）]、动脉血气参数[氧分压（PaO2）、二氧化碳（PaCO2）、氧饱和度（SaO2）]、血脂[总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）]、炎症因子如白细胞介素-6 （IL-6）和c反应蛋白]、功能评估（Barthel指数评分、6分钟步行距离）。脂质谱、动脉血气参数、肺功能指标和炎症因子之间的相关性使用Pearson或Spearman相关系数进行评估。结果：与WLL + GM-CSF组相比，ECMO + WLL + GM-CSF组DLCO%和FVC%改善更大，PaO2和SaO2显著升高，PaCO2、促炎标志物（IL-6、CRP）和脂质水平（TC、TG、LDL-C）降低更大。ECMO + WLL + GM-CSF组血清TG与PaO2、DLCO%、FVC%呈负相关，IL-6与FVC%呈负相关。ECMO + WLL + GM-CSF组基于更高的Barthel指数评分和更长的6分钟步行距离也获得了更高的功能恢复。结论：ecmo辅助下的WLL联合GM-CSF与肺功能和氧合的更大改善以及血脂水平和炎症标志物的更大降低相关。

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ECMO-assisted whole lung lavage combined with GM-CSF inhalation for severe pulmonary alveolar proteinosis: a comparative cohort study

Purpose

This study evaluated the association of combining veno-venous extracorporeal membrane oxygenation (ECMO) with whole-lung lavage (WLL) and granulocyte-macrophage colony-stimulating factor (GM-CSF) nebulization in pulmonary alveolar proteinosis (PAP), focusing on pulmonary function, oxygenation, lipid metabolism, and inflammatory modulation.

Methods

This retrospective cohort study included 40 PAP patients, categorized into WLL + GM-CSF (n = 20) and ECMO + WLL + GM-CSF (n = 20) groups according to the treatment they received. Outcomes included pulmonary function [diffusing capacity for carbon monoxide (DLCO%), forced vital capacity (FVC%)], arterial blood gas parameters [partial pressure of oxygen (PaO₂), carbon dioxide (PaCO₂), oxygen saturation (SaO₂)], lipid profiles [total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C)], inflammatory cytokines such as interleukin-6 (IL-6) and C-reactive protein, and functional assessments (Barthel Index score, 6-min walk distance). Correlations between lipids profiles, arterial blood gas parameters, pulmonary functional indicators, and inflammatory cytokines were evaluated using Pearson's or Spearman's correlation coefficients.

Results

The ECMO + WLL + GM-CSF group showed greater improvements in DLCO% and FVC%, significant increases in PaO₂ and SaO₂, and greater reductions in PaCO₂, pro-inflammatory markers (IL-6, CRP), and lipid levels (TC, TG, LDL-C) compared to the WLL + GM-CSF group. In the ECMO + WLL + GM-CSF group, negative correlations were observed between serum TG and PaO₂, DLCO%, and FVC%, and IL-6 inversely correlated with FVC%. The ECMO + WLL + GM-CSF group also achieved higher functional recovery based on the higher Barthel index scores and longer 6-min walk distance.

Conclusion

ECMO-assisted WLL combined with GM-CSF was associated with greater improvements in pulmonary function and oxygenation, as well as greater reductions in serum lipid levels and inflammatory markers.

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来源期刊

Immunobiology 医学-免疫学

CiteScore

5.00

自引率

3.60%

发文量

108

审稿时长

55 days

期刊介绍： Immunobiology is a peer-reviewed journal that publishes highly innovative research approaches for a wide range of immunological subjects, including • Innate Immunity, • Adaptive Immunity, • Complement Biology, • Macrophage and Dendritic Cell Biology, • Parasite Immunology, • Tumour Immunology, • Clinical Immunology, • Immunogenetics, • Immunotherapy and • Immunopathology of infectious, allergic and autoimmune disease.