【Abstract】ObjectiveTo investigate the risk factors for acute lung injury(ALI) after orthotopic liver transplantation(OLT) and to explore the prevention and cure scheme.MethodsThe risk factors responsible for ALI in 4 patients undergoing OLT were analyzed with retrospective investigation.ResultsPortal pulmonary hypertension, longterm mechanical ventilation, severe infection, SIRS, hypercoagulability, overdose transfusion and kidney dysfunction were risk factors for ALI.ConclusionALI frequently occurred after OLT. Reducing and diminishing the risk factors is very important to avoid ALI after OLT.
Objective To investigate the influence of chronic alcohol ingestion on the severity of acute lung injury (ALI) induced by oleic acid and lipopolysaccharide (LPS).Methods Thirty-two SD rats were randomly administrated with alcohol or water for 6 weeks，then instilled with oleic acid and LPS to induce ALI or with normal saline as control.Thus the rats were randomly divided into two injury groups [ethanol group and water group] and two control groups [ethanol group and water group] (n=8 in each group). PaO2,Wet to dry lung weight ratio (W/D)，levels of γ-glutamylcysteinylglycine (GSH) and malonaldehyde (MDA) in the lung tissue were measured.Results Compared to corresponding control groups，the PaO2 and GSH significantly decreased，and the lung W/D and MDA level were significantly increased in the injury groups (all Plt;0.05).In the injury groups，the changes of above parameters were more significant in the alcohol group than thoe in the water group (all Plt;0.05)，except the lung W/D with no significant difference.Conclusion Chronic ethanol ingestion was relevalent to oxidation/ antioxidation imbalance and more severe lung injury in rats with severe septic after trauma,which suggests that chronic alcohol abuse could increase the severity of acute lung injury.
Objective To investigate the effect of aerosolized perfluorocarbon (PFC) (FC77) on gas exchange，histopathological changes of lung in acute lung injury and pulmonary expression of tumor necrosis factor-α (TNF-α) mRNA.Methods After acute lung injury (ALI) was induced by oleic acid (OA)，16 rabbits were assigned randomly into 2 groups,ie.aerosolized perfluorocarbon group (PFC group) and conventional mechanical ventilation group (CMV group).Gas exchange parameters were measured before and after ALI，at 1，2，3，4 h after treatment.Histological sections taken from 6 different parts of lung were stained by hematoxylin and eosion.The express of TNF-α mRNA in the 2 different parts of lung were detected by in situ hybridization (ISH).Results Compared with CMV group，the PaO2 and static lung compliance (CLst) were significantly increased (Plt;0.05)，the histopathological lesions of lung were attenuated，and the TNF-α mRNA expression was decreased significantly in PFC group (all Plt;0.05).There was more expression of TNF-α mRNA in backside than that in foreside of lung in two groups (Plt;0.05).Conclusion Aerosolized perfluorocarbon (PFC) can decrease expression of tumor necrosis factor-α mRNA in the lung，and improve the CLst and oxygenation during acute lung injury.
Objective To investigate the gene expression of beta-defensin-4 (mBD-4) and mBD-6 in acute lung injury (ALI) mouse.Methods Sixty adult mice were randomly divided into a control group and a ALI group.ALI was induced by intraperitoneal injection of lipopolysaccharide (LPS) in the ALI group.The control group was treated with same dose of normal saline.The lung tissues were harvested at different time point after stimulation.The expression of mBD-4 and mBD-6 mRNA was measured by real-time quantitative reverse transcription polymerase chain reaction.DNA sequencing was used to confirm the specificity of mBD-4 and mBD-6 cDNA fragment.Results There were no obvious mBD-4 and mBD-6 mRNA expression in mouse lung in the control group at all time points and ALI 6 h group.In the ALI group a marked increasing expression was found on 12 h，1 d and 3 d after LPS stimulation.The mBD-4 mRNA expression was significant higher in the ALI groups of 1 d and 3 d points than that of ALI 12 h group with no obvious difference between each other.There were no significant differences of mBD-6 mRNA expression between ALI groups of 12 h，1 d and 3 d points Conclusion mBD-4 and mBD-6 mRNA is not constitutive expressed in mouse lung and show a up-regulative expression pattern after ALI.
Objective To determine the risk factors for acute lung injury（ALI） early after orthotopic liver transplantation.Methods The perioperative clinical data of all 275 patients who had undergone orthotopic liver transplantation were analysed retrospectively.Several statistically significant risk factors were screened out with univarite analysis，then independent risk factors were determined with multivariate stepwise logistic regression analysis.Results Of the all 275 patients，the morbidity of ALI was 9.8% with a mortality of 22.2%.Univariate analysis showed that the occurrence of ALI was associated with preoperative infection，severe hepatitis，renal dysfunction，massive blood transfusion in operation，long non-hepatic period and long cold ischemic time.Multivarite stepwise logistic regression analysis revealed that the independent risk factors for ALI were massive blood transfusion in operation（OR=12.12，95%CI 0.958-25.364），longer non-hepatic period（OR=1.23，95%CI 1.034-1.410） and longer cold ischemic time（OR=22.35，95%CI 1.266-43.421）.Conclusion Massive blood transfusion in operation，long non-hepatic period and long cold ischemic time were independent risk factors for ALI early after orthotopic liver transplantation.
急性肺损伤/急性呼吸窘迫综合征（ALI/ARDS）是指心源性以外的各种肺内外致病因素导致的原发或继发的急性、进行性呼吸衰竭，其病理改变主要表现为肺上皮及内皮细胞的损伤、炎性浸润和透明膜形成，并伴有肺间质纤维化。临床表现为以呼吸窘迫、顽固性低氧血症和非心源性肺水肿为特征的一种急性进行性呼吸困难。采用常规的治疗难以纠正其低氧血症，死亡率高达60%，严重威胁人们的生命健康[1]。自1967年Ashbaugh及其同事首次描述ALI/ARDS以来，医学研究者进行了大量关于ALI/ARDS发病机制及病理生理学的基础及临床研究，但是迄今ALI/ARDS的发病机理仍未完全阐明。近年来越来越多的研究提示凋亡因子（Fas/Fas配体，即Fas/FasL）介导的细胞凋亡在ALI/ARDS的发生发展过程中有着十分重要的作用[2，3]。本文就Fas/FasL的生物学特性及其在ALI/ARDS发病机制中的作用作一综述。
输血相关性急性肺损伤（TRALI）是发生于输血期间或输血后的罕见并发症，以急性缺氧和非心源性肺水肿为特点，因死亡率高（5%~10%）而越来越受到临床关注[1]，据2004年美国食品药品管理局（FDA）的数据，TRALI为输血相关性死亡的首要因素[2]。根据文献资料，输注血制品、含血浆制品、新鲜冰冻血浆（FFP）和血小板的TRALI发生率分别约为1/5 000[3]，1/2 000[4]，1/7 900[5]和1/432[6]。据报道，所有血制品（除白蛋白外）均可引起TRALI[7]，甚至有作者怀疑大剂量给予白细胞介素-2（IL-2）也可能导致TRALI[8]。目前，我国有关TRALI的报道较少，仅有个别死亡案例报道[9，10]，而相关的研究报道很少，这可能与我们尚未认识到TRALI的危险性，以及对其的诊断率较低有关。
Objective To investigate the effects of inhaled prostaglandin E1 （PGE1）on Th1/Th2 polarity in rat model of lipopolysaccharide（LPS） induced acute lung injury（ALI）.Methods Healthy adult male Wistar rats [weight （200±20）g] were randomly divided into normal control（NS） group，LPS group and PGE1 group.The model of ALI were established by injecting LPS of 5 mg/kg into caudal vein.The rats in PGE1 group inhaled aerosolized PGE1（2 μg/mL）for 30 minutes after LPS injection,then repeat the procedure 12 hours later. 1 h，6 h，12 h and 24 h after last PGE1 inhalation,enzyme linked immunosorbant assay （ELISA） was empolyed to measure the level of interferon-γ（IFN-γ）and interleukin-4（IL-4）in the serum and bronchoalveolar lavage fluid（BALF）and the ratio of IFN-γ/IL-4（Th1/Th2）was calculated.Pathological examination was made under light microscope.Results Pathological examination of lung tissue demonstrated success ALI model.Compared to NS group,the ratio of IFN-γ/IL-4（Th1/Th2）both in serum and BALF in LPS group elevated significantly（Plt;0.01）. PGE1 administration significantly decreased the ratio IFN-γ/IL-4 in serum after 6h（Plt;0.01）and in BALF at all time points（Plt;0.01）.Conclusion The imbalance of was found in the LPS induced ALI，inhaled PGE1 aerosol inhalation could restore Th1/Th2 cytokine balance in the rats model induced by LPS.
急性肺损伤（ALI）和急性呼吸窘迫综合征（ARDS）是指由心源性以外的各种肺内外致病因素所导致的急性进行性缺氧性呼吸衰竭，它们具有性质相同的病理生理改变，严重的ALI或ALI的最终严重阶段被定义为ARDS，临床表现以呼吸窘迫、顽固性低氧血症和非心源性肺水肿为特征，采用常规的治疗难以纠正其低氧血症，死亡率高达60%。目前，有关ALI/ARDS的研究取得较多进展，其中，能有效评估ALI病情和预测死亡率的临床参数和生化指标一直是研究热点。
急性肺损伤（ALI）和急性呼吸窘迫综合征（ARDS）是临床常见的危重病症，是指非心源性的各种肺内外因素导致的急性进行性呼吸衰竭，临床上以呼吸窘迫，顽固性低氧血症和非心源性肺水肿为特征。急性呼吸窘迫综合征是急性肺损伤的严重阶段。肺微血管通透性增高而导致的肺泡渗出液中富含蛋白质的肺水肿及透明膜形成，并伴有肺间质纤维化由肺内炎症细胞为主导的肺内炎症失控导致的肺泡毛细血管膜损伤形成肺水肿是其共同的病理特征。因此是否能有效清除肺泡内过多液体，维持肺泡腔内相对干燥的环境，对于有效的气体交换具有十分重要的意义，并且在一定程度上决定了病情的转归[1]。