摘要
心源性肺水肿患者痰沫中含有表面活性剂,其中可能包括表面活性剂载脂蛋白A (SP-A)。SP-A对肺表面活性剂有特异性。我们测量了气道分泌物中的SP-A浓度,以确定它是否有助于区分肺水肿和其他疾病。收集11例心源性肺水肿患者、7例临床稳定型充血性心力衰竭患者、5例成人呼吸窘迫综合征(ARDS)患者和20例其他呼吸系统疾病患者(10例插管)的痰液和吸入气道分泌物样本。采用SP-A单克隆抗体双位点同步免疫分析法测定样品的SP-A浓度。痰和抽吸分泌物样本中SP-A的浓度取决于患者的诊断。这些样本按降序排列来自心源性肺水肿患者(1324 +/- 197微克。ml -1;N = 33);ARDS(311 +/- 47微克。ml -1;N = 23); clinically stable congestive heart failure (78 +/- 10 micrograms.mL-1; n = 21); and control conditions (3.0 +/- 0.6 micrograms.mL-1; n = 30). Concentrations from disease samples did not overlap with controls. In samples from patients with cardiogenic pulmonary oedema, the SP-A concentration correlated with mean pulmonary capillary wedge pressure (PCWP) (p < 0.001; n = 39). These findings indicate that the measurement of the surfactant apoprotein A concentration in airway secretions may be useful for the detection of pulmonary oedema.