ABSTRACT
Objective:To analyze the effect of lung protective ventilation on lung ventilation function and serum Clara cell protein 16 (CC16) level in patients undergoing gynecological laparoscopic surgery.Methods:The clinical data of 80 gynecological patients who underwent laparoscopic surgery in Yancheng City Jianhu County People′s Hospital from October 2018 to December 2020 were randomly divided into group A and group B by random number table, each group with 40 cases. The patients in group A were treated with intermittent positive-pressure ventilation, and the patients in group B were ventilated with whole course ventilation mode. The pulmonary ventilation function, CC16 level and postoperative pulmonary complications were observed before anesthesia, 10 min of pneumoperitoneum, 30 min of pneumoperitoneum, 5 min of pneumoperitoneum stop and 2 h after operation. The patients were divided into groups according to whether with pulmonary complications, and their pulmonary ventilation function and serum CC16 level were compared. The predictive value of the above indexes for pulmonary complications was analyzed by receiver operating characteristic (ROC) curve.Results:Repeated measurement analysis of variance showed that alveolar arterial oxygen differential pressure (PA-aDO 2) were significant differences in time point factors, time point interaction factors and group factors ( P<0.05); CC16 index were significant differences in time point factor and group factor ( P<0.05). According to the observation from postoperative to discharge, 4 patients (10.0%) in group A had pulmonary complications, 15 cases (37.5%) had pulmonary complications in group B, the levels of PA-aDO 2 and CC16 in patients with complications were significantly higher than those in patients without complications: group A:(332.9 ± 2.0) mmHg (1 mmHg = 0.133 kPa) vs. (290.4 ± 13.2) mmHg, (53.5 ± 1.5) μg/L vs. (39.5 ± 6.5) μg/L; group B: (339.1 ± 8.8) mmHg vs. (305.7 ± 17.9) mmHg, (41.5 ± 4.2) μg/L vs. (39.7 ± 5.8) μg/L, there were statistical differences ( P<0.05). ROC curve analysis showed that the area under the curve(AUC) of PA-aDO 2 and CC16 in predicting pulmonary complications in group A were 0.882 and 0.833, in group B was 0.885 and 0.731. Conclusions:Lung protective ventilation has little effect on lung ventilation function and serum CC16 in patients with gynecological laparoscopic surgery, and the probability of pulmonary complications is lower. The pulmonary ventilation function and CC16 have certain value in predicting postoperative pulmonary complications.
ABSTRACT
Clara cell secretory protein 16(CC16)is one of the most important secreted proteins of Clara cells in respiratory epithelium, which mainly exists in the lining fluid of lung epithelial cells.When the bronchoalveolus-capillary membrane barrier is damaged, a large amount of CC16 will enter the blood.It′s eventually excreted in the urine.In recent years, more and more studies have found that CC16 not only has anti-inflammatory, immune-modulating, anti-oxidation and anti-fibrosis effects, but also is a sensitive indicator of the integrity of the airway epithelium, which can predict the occurrence and development of many children′s pulmonary diseases.This article mainly summarizes the biological characteristics and functions of CC16, and summarizes the research progress of CC16 in the diagnosis and treatment of pediatric pulmonary diseases.
ABSTRACT
Objective:To investigate the clinical significance of changes of serum Clara cell secretory protein(CC16) and pulmonary surfactant protein A(SP-A) in neonates with acute respiratory distress syndrome(ARDS).Methods:The data of 30 neonates with ARDS who needed mechanical ventilation in neonatal intensive care unit of Xi′an Children′s Hospital from January 2016 to November 2018 were collected as observation group, including 12 cases in mild group, 10 cases in moderate group and 8 cases in severe group.The data of healthy newborns during the same period were taken as control group.The serum levels of CC16 and SP-A were detected by ELISA.The serum levels of CC16 and SP-A among different groups were compared.Results:The levels of serum CC16 and SP-A in ARDS group were (59.35±3.67)mg/L and(75.38±6.27)mg/L respectively, (11.26±1.32)mg/L and(18.15±2.69)mg/L in healthy group.The difference was significant( P<0.05). And the differences of serum CC16 and SP-A levels among different degree ARDS groups were significant( P<0.05). The levels of serum CC16 in mild, moderate and severe subgroup were(38.27±16.01)mg/L, (51.25±15.63)mg/L, (84.76±13.12)mg/L and SP-A were(47.02±7.18)mg/L, (73.12±7.98)mg/L, (96.45±12.50)mg/L, which increased with disease severity. Conclusion:Serum CC16 and SP-A are increased and correlated with the severity of neonatal ARDS, which may be used as the index for evaluating the severity of neonatal ARDS in the future.
ABSTRACT
Objective To observe the changes of serum clara cell protein?16 ( CC?16 ) and monocyte chemotaxis protein?1 (MCP?1) level in patients with acute respiratory distress syndrome (ARDS) and to explore their relationship with the disease severity and prognosis of ARDS??Methods One hundred and fourteen patients with ARDS who were admitted to Changzhi People′s hospital from January 2017 to March 2018 were selected as the subjects??They were divided into mild group ( n＝37),moderate group (n＝41) and severe group ( n＝36) according to the severity of ARDS??Sixty healthy persons in out?patient examination were selected as control group??The survival situation of patients in 4 weeks were recorded,the patients were divided into survival group ( n＝65) and death group ( n＝49) according to their survival situation??The age,gender,body mass index (BMI),smoking history,acute physiology and acute physiology and chronic health evaluation II ( APACHE II) score,sequential organ failure assessment ( SOFA) score, serum CC?16 and MCP?1 level were analyzed in each group??The relationship between serum CC?16,MCP?1 level and disease and prognosis of patients with ARDS were analyzed??Results With the increase of disease severity,APACHE II score, SOFA score and serum CC?16, MCP?1 level in patients with ARDS were significantly increased??The differences were statistically significant ( F＝1 216??886,1 339??247,290??879, 417??262; all P＝0??000)??The APACHE II score,SOFA score and serum CC?16,MCP?1 levels in the death group were (22??13± 2??47) scores,( 15??09 ± 1??97) scores,( 23??85 ± 4??27) μg／L, ( 36??64 ± 5??21) ng／L respectively,which were significantly higher than those in the survival group (18??25±2??35) scores,(13??23 ±2??03) scores,(17??34±4??13) μg／L,(27??93±4??88) ng／L,the differences were statistically significant (t＝8??538,4??905,8??211,9??146;all P＝0??000)??Pearson correlation analysis showed that there was a positive correlation between serum CC?16 level and MCP?1 level in patients with ARDS ( r＝0??589, P ＝0??000)??Meanwhile,the CC?16,MCP?1 were positive correlation with APACHE II score,SOFA score and mortality (CC?16:r＝0??504,0??549,0??472;P＝0??000,0??000,0??012;MCP?1:r＝0??493,0??528,0??435;P＝0??006, 0??000,0??025)??APACHE II score ( OR＝3??083,95%CI:0??025－1??364,P＜0??05),CC?16 ( OR＝5??403, 95%CI:0??011－6??561, P＜0??05) and MCP?1 ( OR＝2??892, 95%CI: 0??034－1??619, P＜0??05) were all closely related to ARDS death??CC?16 independent detection, MCP?1 independent detection and the two combined detection predicted the under?curve area, sensitivity and specificity of ARDS patients with in 4 weeks were 0??830, 82??35% and 72??16%; 0??719, 79??25% and 72??19%; 0??866, 85??06% and 80??72%respectively??Conclusion CC?16,MCP?1 are abnormally high expression in serum of patients with ARDS, and its levels are closely related to the severity and prognosis of patients with ARDS??CC?16 combined with MCP?1 detection has high diagnostic value for patients with ARDS,which can be used as an effective index to judge the disease and prognosis of patients with ARDS??
ABSTRACT
Objective To explore the changes of serum Clara cell secretory protein 16 (CC16), pulmonary surfactant protein D (SP-D) in children with pneumonia and its clinical significance. Methods A total of 81 pediatric patients with community-acquired pneumonia were selected, including severe pneumonia with mechanical ventilation group (n=21), severe pneumonia with non-mechanical ventilation group (n=30), mild pneumonia group (n=30), and the control group (n=20) was selected in the physical examination of healthy children over the same period. We detected the concentration of serum CC16, TNF-α, IL-6 and SP-D for the 4 groups by ELISA, and evaluated the clinical values of serum CC16, TNF-α, IL-6 and SP-D for severe pneumonia by using ROC curve.We recorded pulmonary dynamic compliance(Cdyn),airway resistance(Raw),peak inspiratory pressure (PIP), work of breathing (WOB) and other respiratory mechanical parameters, and analyzed the correlations between CC16 and TNF-α, IL-6, SP-D and respiratory mechanical parameters. Results The concentrations of serum CC16 in pneumonia group were all significantly lower than that in the control group, and those in severe pneumonia groups were lower than that in mild pneumonia group, and mechanical ventilation group was lower than that in non-mechanical ventilation; the concentration of serum TNF-α, IL-6 and SP-D in pneumonia groups were all obviously higher than that in the control group, and severe pneumonia group were higher than that in mild pneumonia group, and those in mechanical ventilation group were also higher than that in non-mechanical ventilation group (P<0.05). Compared to that before removing the ventilator, concentration of serum CC16 in severe pneumonia with mechanical ventilation group decreased significantly at 1 hour and lowered down at 72 hours; but the concentration of serum TNF-α, IL-6 and SP-D in severe pneumonia with mechanical ventilation increased significantly at 1 hour and went higher at 72 hours, the differences were all statistically significant (all of P<0.05); compared to that before weaning from the ventilator, the value of Cdyn decreased obviously in severe pneumonia with mechanical ventilation at 72 hours and lowered down at 1 hour; but the values of Raw, PIP, WOB in severe pneumonia with mechanical ventilation increased obviously at 72 hours and more higher at 1 hour, the differences were all statistically significant (all of P<0.05). The concentration of serum CC16 showed all negative correlations with TNF-α, IL-6 and SP-D, but it showed positive correlation with Cdyn(all of P<0.01).In the ROC curve,the area under the ROC curve of CC16,TNF-α,IL-6 and SP-D in serum was 0.905, 0.704, 0.832, 0.825, respectively (for all of which P<0.01). Conclusion The concentrations of serum CC16 and SP-D were associated with the severity of community acquired-pneumonia in children. The level of serum CC16 was positive associated with Cdyn in children with mechanical ventilation. CC16 has better prediction and evaluation effect on the change of severe pneumonia.