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@#【Objective】To determine the effects of an open-lung strategy（OLS）comprising moderate positive end- expiratory pressure （PEEP） and intermittent recruitment manoeuvres（RMs） on plasma levels of lung epithelial injury markers［i.e. soluble receptor for advanced glycation end products（sRAGE）and Clara cell protein（CC16）］during low- tidal-volume ventilation for surgery.【Methods】One hundred patients who were undergoing laparoscopic colorectal cancer resection under low-tidal-volume ventilation were enrolled in this study. They were randomly assigned（1∶1）to the OLS group（using PEEP of 6~8 cmH2O and intermittent RM），or the NOLS group（without using PEEP and RM）. Blood samples were taken before anesthesia induction（T1），immediately after surgery（T2）and the postoperative day 3（T3）to measure the plasma concentrations of sRAGE and CC16. 【Results】 Significant differences were not observed in the concentrations of sRAGE and CC16 at T1，T2 and T3 between the two groups（all P > 0.05）. For all the enrolled patients， the concentrations of sRAGE at T2 and T3 were higher than that at T1，the concentration of sRAGE at T3 was higher than that at T2，and the concentration of CC16 at T3 was higher than that at T1 and T2（all P < 0.05）.【Conclusions】In patients under general anesthesia with low-tidal-volume ventilation，the using of an OLS comprising medium PEEP and intermittent RMs can not alter plasma levels of lung epithelial injury markers（sRAGE and CC16）in three days after surgery.
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Objective To investigate the clinical value of combined detection of serum angiopoietin 2 (Ang-2) and Clara cell protein 16 (CC16) in the early diagnosis of acute respiratory distress syndrome (ARDS).Methods Two hundred critical patients, treated at the Department of Critical Care Medicine, Bao'an District People's Hospital, Shenzhen during March 2015 and September 2016,were included in the study. According to the Berlin standard, patients were divided into two groups (n=100 each group): the ARDS group and non-ARDS group.The serum levels of Ang-2 and CC16 were measured by enzyme-linked immunosorbent assay (ELISA) on the first and second day of admission for each patient, in addition to completing APACHEⅡ score, medical history, vital signs collection and other biochemical indicators detection. Finally, paired-samplest test was used to analyze the data. The multiple ROC curve was used to calculate the area under the curve of the reference index of the serum levels of Ang-2 and CC16 on the first and second day.Results On the first and second day, the serum levels of Ang-2 and CC16 were significantly higher in ARDS patients than those in non-ARDS patients, and there was a correlation between the serum levels of Ang-2 and CC16 in ARDS patients. The ROC curve showed that the combined detection of Ang-2 and CC16 on the first day achieved a highest sensitivity of 75.9％ and detection of CC16 on the first day achieved a highest specificity of 70.2％. Conclusion Single-detection of serum levels of Ang-2 and CC16 could be used for early diagnosis of ARDS, and the combined detection of both has a higher sensitivity than single detection.
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Objective@#To investigate the clinical value of combined detection of serum angiopoietin 2 (Ang-2) and Clara cell protein 16 (CC16) in the early diagnosis of acute respiratory distress syndrome (ARDS).@*Methods@#Two hundred critical patients, treated at the Department of Critical Care Medicine, Bao'an District People's Hospital, Shenzhen during March 2015 and September 2016,were included in the study. According to the Berlin standard, patients were divided into two groups (n=100 each group): the ARDS group and non-ARDS group.The serum levels of Ang-2 and CC16 were measured by enzyme-linked immunosorbent assay (ELISA) on the first and second day of admission for each patient, in addition to completing APACHEⅡ score, medical history, vital signs collection and other biochemical indicators detection. Finally, paired-samples t test was used to analyze the data. The multiple ROC curve was used to calculate the area under the curve of the reference index of the serum levels of Ang-2 and CC16 on the first and second day.@*Results@#On the first and second day, the serum levels of Ang-2 and CC16 were significantly higher in ARDS patients than those in non-ARDS patients, and there was a correlation between the serum levels of Ang-2 and CC16 in ARDS patients. The ROC curve showed that the combined detection of Ang-2 and CC16 on the first day achieved a highest sensitivity of 75.9% and detection of CC16 on the first day achieved a highest specificity of 70.2%.@*Conclusion@#Single-detection of serum levels of Ang-2 and CC16 could be used for early diagnosis of ARDS, and the combined detection of both has a higher sensitivity than single detection.
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Objective@#To investigate the effects of long-term exposure to silica dust on serum CC16 and KL-6 levels.@*Methods@#The patients with stage I silicosis who were hospitalized in our hospital from April 2016 to April 2017 were treated as silicosis group. The silica dust exposed workers without silicosis who were taken the physical examination in our hospital were taken as a dust-exposed group. The healthy control group comes from in the same period of community physical examination did not touch the dust. The levels of CC16 and KL-6 in serum of all subjects were determined by enzyme-linked immunosorbent assay (ELISA) , and the levels of CC16 and KL-6 in serum were compared in three groups.@*Results@#Compared with the control group, the serum levels of CC16 in the silicosis group (P<0.01) and the dust-exposed group (P<0.01) were significantly lower. Compared with the control group, the level of serum KL-6 in the silicosis group was significantly decreased (P<0.01) compared with the control group, while the level of KL-6 in the serum of the dust-exposed group was significantly increased (P<0.01) . The ROC area of CC16 for diagnosis of silicosis was 0.92 (P<0.01) , with a sensitivity of 81.37%, specificity of 92.63% and Kappa value of 0.74.@*Conclusion@#Long-term exposure to silica dust may lead to a decrease in serum CC16 levels. Reduced serum CC16 levels may be useful in identifying the diagnosis of silicosis.
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OBJECTIVE: To study the method and significance of serum level of Clara cell protein(CC16) and surfactant protein D(SP-D) in the early diagnosis of patients with occupational silicosis. METHODS: By a convenience sampling method, 73 male patients with occupational silicosis were included in the silicosis group, 27 male workers who exposed to dust without occupational silicosis were selected as the dust exposure group, and 27 healthy men with no history of occupational dust exposure were selected as control group. The levels of serum CC16 and SP-D were detected by enzyme-linked immune sorbent assay. RESULTS: Serum levels of CC16 in patients of silicosis and dust exposure groups were significantly lower than those of the control group [(40.15±13.31) vs(53.85±11.45) mg/L,(25.2±48.18) vs(53.85±11.45) mg/L, P<0.05]. The serum level of CC16 in silicosis group was higher than that of dust exposure group [(25.24±8.18) vs(40.15±13.31) mg/L, P<0.05]. Serum level of SP-D in silicosis group was significantly higher than those in the controls and dust exposure group [(59.22±10.67) vs(49.07±9.72) mg/L,(59.22±10.67) vs(46.82±10.40) mg/L, P<0.05]. Bayes discrimination analysis was used to establish a combined diagnostic discriminant model with age, CC16 and SP-D levels. The correct rates for the control group, the dust exposure group and the silicosis group were 100.0%, 59.3% and 83.6%, respectively, and the classification accuracy was 81.9%. The discrimination effect is good. Based on the length of service, age, CC16 and SP-D levels, the Bayes discriminant analysis was used to establish a combined diagnostic discriminant model. The correct rates of the dust exposure and silicosis groups were 100.0% and 91.8%, respectively, and the classification accuracy was 94.0%. CONCLUSION: Bayes discriminant analysis combined with serum level of CC16 and SP-D is useful for the early diagnosis of occupational silicosis and improve the diagnostic accuracy.
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Objective To study the change and clinical value of SP‐D ,CCL18 and CC16 in serum and in exhaled breath con‐densate in acute exacerbation of chronic obstructive pulmonary disease .Methods Sixty two cases of COPD patients admitted in our hospital from 2010 January to 2013 December were selected as the research object .All the 62 patients were divided into group A(32 patients with COPD in acute exacerbation) and group B(30 patients with COPD in remission stage) in accordance with the severity of COPD .Thirty six cases of health people were selected as the control group .Statistical subjects SP‐D ,CCL18 ,CC16 content in se‐rum and in exhaled breath condensate ,and the relations between the various indexes and age ,smoking ,pulmonary function and BMI were analyzed .Results The exhaled breath condensate SP‐D ,CCL18 content in group A was significantly higher than that of B group and the control group (P<0 .05) ,and the SP‐D ,CCL18 in group B was higher than that in control group (P<0 .05) .The se‐rum SP‐D ,CCL18 ,CC16 content in group A was significantly higher than that of B group and the control group (P<0 .05) ,and the SP‐D ,CCL18 ,CC16 in group B was higher than that in control group (P< 0 .05) .Serum SP‐D ,CCL18 levels were significantly higher than those in the exhaled breath condensate (P< 0 .01) .Exhaled breath condensate SP‐D was positively associated with smoking age (r=0 .298 ,P<0 .05) ,and FEV1% pred ,FEV1/FVC (% ) showed a negative correlation (r= -0 .318 ,-0 .402 ,P<0 .05);the serum levels of SP‐D was positively associated with tobacco (r=0 .297 ,P<0 .05) ,and FEV1% pred ,FEV1/FVC (% ) were negative correlated (r= -0 .278 ,-0 .298 ,P<0 .05);serum CC16 and FEV1% pred ,FEV1/FVC (% ) were negatively corre‐lated (r= -0 .358 ,-0 .382 ,P<0 .05);Exhale breath condensate SP‐D ,condensate CCL18 ,SP‐D ,CCL18 serum ,serum CC16 were are positively correlated in each two (P<0 .05);and there was no significant correlation between other indexes and age ,smoking , pulmonary function and BMI etc .Conclusion Exhaled breath condensate ,serum SP‐D ,serum CCL18 ,exhaled breath condensate , exhaled breath condensate ,serum CC16 are closely related to acute exacerbation of COPD ,and monitoring the indicators can be judgment of the degree and prognosis of COPD .
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Objective To determine the effects of intrauterine growth retardation(IUGR) caused by malnutrition during pregnancy on the lung structure and expression of Clara cell protein (CCSP) and interferon (IFN)-γ in the fetal lungs,and to explore their relation ship with pulmonary disease.Methods Fetal rats from maternal protein-malnutrition dams were studied on day 20(term 21.5 day).The lung pathology was examined by means of Hematoxylin and eosin(HE) stain.Plasma was collected to determine the CCSP and IFN-γ concentration.Lungs were harvested to measure the expression of CCSP and IFN-γ mRNA by using fluorescent quantization reverse transcription (RT)-PCR and the levels of CCSP and IFN-γ protein were assessed by using enzyme-linked immunosorbent assay.Results Malnutrition fetus body weight significantly less compared to control group,so did the lung weight.However,lung weight,expressed as a percentage of body weight between the 2 groups was not different.The IUGR group had significantly decreased alveolar number manifested by lower radial alveolar count,and significantly increased mean linear intercept of alveoli.Both the CCSP mRNA expression and protein level in lung of IUGR rats were decreased compared with control rats (all P ＜ 0.05).A decline in plasma CCSP protein concentration was also noted compared with control group (P ＜0.05).Furthermore,IUGR group fetus showed lower IFN-γ levels both in circulation and in the lung tissue (all P ＜ 0.05).Conclusions Intrauterine malnutrition significantly alters lung structure and cytokine IFN-γ level,and the latter may further inhibit the transcription of CCSP gene.These alterations may contribute to both early and late postnatal respiratory morbidity.
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Objective To explore the clinical value of clara cell protein 16 (Cc 16) in the early diagnosis of ARDS in critically ill patients.Methods A total of 55 critically ill patients admitted between March 2013 and December 2013 in the Intensive Care Unit were enrolled for study.The inclusion criteria were as follows:sepsis,pneumonia,multiple injuries,patients after emergency or elective operation and non-cardiogenic diseases,whereas the exclusion criteria were cardiogenic pulmonary edema,age ≤ 18 years or≥80 years and disease course prolonged over one week.The level of serum Cc16 was detected with enzyme linked immunosorbent assay (ELISA).In addition,data of other biochemical examinations,the Acute Physiology and Chronic Health Evaluation (APACHE]Ⅱ) score and the relevant medical data were documented.The patients were divided into ARDS groups and non-ARDS groups based on clinical data met Berlin definition.Results The sensitivity and specificity of serum Cc16 for diagnosis of ARDS were 92％ and 80％,respectively with the area under the curve being 0.92,which were better than those of APACHE Ⅱ score,D-dimer,C-reactive protein,N-terminal pro-brain natriuretic peptide and serum albumin detected by the means of receiver operating characteristic curve,and cut off value was 20.62 ng/L.The bivariate analysis showed there was negative correlation between Cc16 and oxagenation index in ARDS patients and the Pearson correlation coefficient of serum Cc16 with oxygenation index was r =-0.342 (P =0.04).The results of one-way analysis of variance showed difference in level of Cc16 between subgroups (F =15.76,P =0.005 17).The level of Ccl6 in severe ARDS group was (64.18 ± 12.95) ng/L which was higher than that in mild ARDS group (35.87 ± 11.28) ng/L (P =0.001 14),and in moderate ARDS group (38.66 ± 20.14) ng/L (P =0.004 9),and in non-ARDS group (16.72 ± 8.74) ng/L (P =0.000 32).There was no statistically significant difference in Cc16 level between mild ARDS group and moderate ARDS group (P =0.682).The level of serum Ccl6 did not correlate with type or days of respiratory ventilation support,28-day survival rate or 120-hour survival rate and days of ICU stay and hospital stay.Conclusions The diagnostic value of serum Cc16 is very high in determining the presence and severity of ARDS in addition to the Berlin criteria in critically ill patients accurately assessing degree of lung injury.
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Objective To detect the dynamic changes of the level of serum Clara cell protein(CC16)and surfactant protein-D(SP-D)in rats with pulmonary fibrosis induced by bleomycin and to evaluate their value in early diagnosis of pulmonary fibrosis. Methods Sixty Wistar rats were randomly divided into two groups, the control group and bleocin-induced pulmonary fibrotic group,with 30 rats in each group. The rats were killed at 1,3,7,14 and 28 days of treatment Pathology changes of lung tissue were observed by HE,Masson stain,alkaline hydrolysis to assess the hydroxyproline concentration of lung tissue, enzyme-linked immunosorbent assay (ELISA) was used to measure the levels of serum CC16 and SP-D. Results The hydroxyproline concentration of lung tissue in the pulmonary fibrotic group ((913. 1 ±69. 3) μg/g) were higher than those of the control group ((790. 5 ± 36. 8) μg/g) from the seventh day(P <0. 05). The levels of serum CC16 of the pulmonary fibrotic group((27. 34 ± 0. 32) μg/L) were lower than those of the control group((27. 85 ±0. 32)μg/L) since the third day(P<0. 05) ,and tended to decrease with the development of the disease. However,the levels of SP-D of the former group were always higher(P <0. 05), and tended to increase with the development of the disease. Conclusions The levels of serum CC16 and SP-D changed considerably in early-stage of pulmonary fibrosis, thus might be used as biomarker for early diagnosis and have some value for pathogenesis of pulmonary fibrosis.