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DOI: 10.1055/s-2002-19859
© Georg Thieme Verlag Stuttgart · New York
Protein content and biophysical properties of tracheal aspirates form neonates with respiratory failure[1]
Biochemische und biophysikalische Eigenschaften von Trachealaspiraten Früh- und Neugeborener mit akutem respiratorischen VersagenPublikationsverlauf
Publikationsdatum:
19. September 2002 (online)
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Abstract
Background: We aimed at assessing the quality and quantity of protein-leakage across the alveolar-capillary membrane and its influence on surfactant function during the early neonatal period in preterm infants compared to newborns both with respiratory failure.
Patients and methods: We therefore prospectively analyzed total protein, elastase-α1-proteinase inhibitor complex (E-α1-PI) and α2-macroglobulin concentrations in tracheal aspirates from 31 infants ≤ 32 weeks gestational age (group 1 : 29.3 ± 2 weeks, 1214 ± 410 g [means ± SEM]) and from 21 neonates > 32 weeks (group 2 : 37.5 ± 3 weeks, 2890 ± 600 g [means ± SEM]) and measured their surface activity in the pulsating bubble surfactometer.
Results: Day 1 total protein and α2-macroglobulin levels indicated an initial high leakage that declined to day 3 in both groups (from 1652 ± 241 to 708 ± 227 mg/l; p < 0.05; resp. from 28 ± 6 to 12 ± 4 mg/l [means ± SEM]). In group 2 E-α1-PI concentrations were significantly elevated at day 1 compared to group 1 (15 754 ± 5766 versus 3320 ± 1056 μg/l [means ± SEM]). In both groups a high minimum surface tension (15 - 30 mN/m) was recorded from day 1 - 4.
Conclusions: These results suggest in larger newborns a secondary surfactant deficiency due to protein-leakage to play an important role in the pathogenesis of respiratory failure. The increased alveolar-capillary membrane permeability might be caused by inflammatory ARDS-like mechanisms.
Zusammenfassung
Hintergrund: Ziel der Studie ist es, das Ausmaß und die Qualität des Proteineinstroms in den Alveolarraum durch die alveolokapilläre Membran bei sehr unreifen Frühgeborenen und reiferen Früh- und Neugeborenen zu vergleichen.
Patienten und Methoden: Im Rahmen einer prospektiven Studie wurde die Elastase-α1-Proteinaseinhibitorkomplex- (E-α1-PI) und α2-Makroglobulinkonzentration in den Trachealaspiraten von 31 Frühgeborenen eines Gestationsalters ≤ 32 Wochen (Gruppe 1: 29,3 ± 2 Wochen; 1214 ± 410 g [MW ± SEM]) und von 21 reiferen Neugeborenen (Gruppe 2: 37,5 ± 3 Wochen; 2890 ± 600 g [MW ± SEM]) gemessen. Zusätzlich wurden die oberflächenaktiven Eigenschaften der Trachealaspirate am „Pulsating Bubble Surfactometer” gemessen.
Ergebnisse: Die am ersten Lebenstag gemessenen Gesamtprotein- und α2-Makroglobulinwerte zeigen eine initial hohe Leckage, die in beiden Gruppen bis zum 3. Tag signifikant abfällt (von 1652 ± 241 auf 708 ± 227 mg/l; p < 0,05; bzw. von 28 ± 6 auf 12 ± 4 mg/l [MW ± SEM]). In Gruppe 2 fanden sich am ersten Lebenstag signifikant höhere E-α1-PI-Konzentrationen als in Gruppe 1 (15 754 ± 5766 μg/l bzw. 3320 ± 1056 [means ± SEM]). In beiden Gruppen wurden innerhalb der ersten 4 Lebenstage hohe Oberflächenspannungswerte gemessen (γmin nach 150 Zyklen: 1530 mN/m).
Schlussfolgerung: Diese Ergebnisse weisen auf einen durch surfactantinhibierende Plasmaproteine bedingten sekundären Surfactantmangel bei reiferen Früh- und Neugeborenen hin. Eine inflammatorisch induzierte Läsion könnte die erhöhte Durchlässigkeit der alveolokapillären Membran in dieser Gruppe erklären.
Key words
Surfactant - alveolar-capillary membrane - elastase - RDS
Schlüsselwörter
Surfactant - alveolokapilläre Membran - Elastase - ANS
1 This research was supported in part by Boehringer-Ingelheim, Biberach/Riss, Germany.
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1 This research was supported in part by Boehringer-Ingelheim, Biberach/Riss, Germany.
Eva Landmann
Department of Pediatrics and Neonatology
Pediatric Center
Justus-Liebig-University, Gießen
Feulgenstraße 12
35392 Gießen
Germany
Telefon: +49-641-9943410
Fax: +49-641-9943419
eMail: Eva.Landmann@paediat.med.uni-giessen.de