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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.
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Objective:To evaluate the role of aryl hydrocarbon receptor (AhR) in the down-regulation of Clara cell secretory protein (CCSP) expression during endotoxin-induced lung injury in rats.Methods:Twenty-four clean-grade healthy male Sprague-Dawley rats, aged 8 weeks, weighing 200-250 g, were divided into 4 groups ( n=6 each) using a random number table method: normal control group (group C), acute lung injury (ALI) group, ALI+ AhR antagonist group, and ALI+ vehicle group. Lipopolysaccharide(LPS) 1 mg/kg was intratracheally instilled to develop the model of lung injury, while the equal volume of normal saline was given instead in group C. At 2 h before LPS injection, AhR antagonist 6, 2′, 4′-trimethoxyflavone solution 5 mg/kg (diluted to 1 ml in dimethyl sulfoxide solution) was intraperitoneally injected in ALI+ AhR antagonist group, while dimethyl sulfoxide solution 1 ml was given in ALI+ vehicle group. The rats were sacrificed under anesthesia at 48 h after LPS administration. The left lung was lavaged and the broncho-alveolar lavage fluid (BALF) was collected for determination of the concentrations of CCSP by enzyme-linked immunosorbent assay, and the expression of CCSP in the bronchial epithelium in right lung tissues was determined by immunohistochemistry. Results:Compared with group C, the expression of CCSP in the bronchial epithelium was significantly down-regulated, and the concentrations of CCSP in BALF were decreased in the other three groups ( P<0.05 or 0.01). Compared with ALI group and ALI+ vehicle group, the histopathological injury was significantly reduced, the expression of CCSP in the bronchial epithelium was up-regulated, and the concentrations of CCSP in BALF were increased in ALI+ AhR antagonist group ( P<0.01). Conclusions:AhR partially mediates the down-regulation of CCSP expression during endotoxin-induced lung injury in rats.
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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.
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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.
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Objective@#To investigate the role of E-selectin, Clara cell secretory protein 16 (CC-16), and pulmonary surfactant protein A (SP-A) in the diagnosis of neonatal ARDS.@*Methods@#Full-term newborn with ARDS in 9 hospitals of Jiangsu Province from March 1st 2015 to February 29th 2016 were selected as observation group.According to the lung oxygenation of the neonates, they were divided into three groups: mild, moderate and severe.In addition, 60 normal full-term newborns were selected as control group.In the observation group, venous blood samples were taken on the 1st, 3rd and 7th day of diagnosis and the control group within 7 days after birth.The level of E-selectin, CC-16 and SP-A were detected by double antibody sandwich enzyme-linked immunosorbent assay.The changes of the level of E-selectin, CC-16 and SP-A at different time points and in neonatus with different severity of ARDS were compare with control group and correlatively analyzed.@*Results@#The observation group included 60 newborns who met the diagnostic criteria of ARDS with male 38, female 22, day age (7.3 ±3.3) hours, gestational age (39.5 ±1.7) weeks and birth weight (3280 ±577) g. The control group included 60 normal full-term newborns, with male 30, female 30, day age (6.9 ±4.2) hours, gestational age (39.4 ±1.5) weeks and birth weight (3329 ±593) g. There was no significant difference between two groups.The levels of E-selectin[1 d, 3 d, 7 d: (36.36 ±8.32)μg/L, (45.51 ±9.26)μg/L, (57.15 ±6.84)μg/L], CC-16[1 d, 3 d, 7 d: (25.24 ±8.63)mg/L, (48.33±10.83)mg/L, (18.84±10.11)mg/L]and SP-A [1 d, 3 d, 7 d: (58.38±10.31)mg/L, (53.29±11.31)mg/L, (25.99±6.66)mg/L]in the blood of the observation group increased on the first day and reached the peak on the third day, which were significantly higher than those in the control group [E-selectin, CC-16, SP-A: (15.52 ±6.24)μg/L, (11.26 ±5.18)mg/L, (24.30 ±5.27)mg/L] (P<0.05). The levels of E-selectin [mild, moderate, severe are(30.07±6.10)μg/L, (33.39 ±6.64)μg/L, (41.63 ±7.36)μg/L], CC-16 [mild, moderate, severe are(12.61 ±5.80)mg/L, (25.22 ±6.77)mg/L, (30.61 ±4.69)mg/L]and SP-A [mild, moderate, severe are(49.67 ±8.26)mg/L, (7.11 ±7.94)mg/L, (63.19 ±11.45)mg/L]increased gradually in the blood of ARDS neonates with different severity (P<0.05), especially in moderate and severe degree.There was a significant negative correlation between E-selectin (r=-0.629 8), CC-16 (r=-0.679 3), SP-A (r=-0.458 8) and PaO2/FiO2 (P<0.05).@*Conclusion@#The levels of E-selectin, CC-16 and SP-A in the blood of ARDS neonates increased significantly and were closely related to the severity of the disease, which may be a biomarker of neonatal lung injury.
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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??
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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.
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Objective To investigate the effect and mechanism of Clara cell secretory protein (CC16 ) on lung injury of traumatic shock rats.Methods Thirty SD male rats were randomly assigned to three groups:sham-operation group,control group and CC16-treatment group.The rat model of traumatic shock was used in this study.Rats of sham-operation group were operated,but not treated by depletion and recovery.Rats of control group inhaled the physiological saline before fluid resuscitation.Rats of CC16-treatment group inhaled 0.1 μg/mL of recombinant human Clara cell secretory protein (rh-CCSP)before fluid resuscitation.Arterial blood gas analysis and wet/dry weight were detected in each group.The contents of malondialdehyde (MDA),myeloperoxidase (MPO)of lung tissues and lung tissue pathology changes were also studied. Results Compared with control group,pH and PaO2 value in CC16-treatment group increased significantly.Meanwhile,BE value and lung wet/dry weight ratio also decreased significantly (P<0.05).Compared with control group,contents of MDA and MPO in CC16-treatment group decreased significantly (P<0.05).Lung tissue pathology improved in the CC16 group compared with that of control group (P <0.05 ).Conclusion Inhaled Rh-CCSP may have potential protective effect on lung injury tissues of traumatic shock rats model through its antioxidative effect.
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Objective To explore the changes of Clara cell secretory protein(CCSP) in asthmatic children and the effects of inhaling glucocorticoid (ICS) on CCSP.Methods Sixty children with asthma were selected as asthma group(in which 39 cases were male and 21 cases were female,aged 3-12 years old) and 30 healthy children were selected as healthy control group(in which 20 cases were male and 10 cases were female,aged 3-12 years old).Venous blood samples were collected in asthma group and healthy control group in morning before breakfast,and then sera were obtained by centrifuge in speed of 1 500 r?min-1 in 10 min.The dynamic levels of CCSP were measured in sera by enzyme-linked immunosorbent assay.Results 1.In asthmatic children,the CCSP levels in acute episode,3 months after ICS,6 months after ICS, and 12 months after ICS[(5.140?2.331)?g?L-1,(8.730?3.392)?g?L-1,(10.510?2.813)?g?L-1]were all lower than that in healthy control group[(13.230?4.010)?g?L-1](Pa0.05).2.Compared with acute episode,the patients who ICS for 3 months,6 months and 12 months had significantly higher levels of CCSP (Pa0.05).Conclusions CCSP may play a protective role in the airway inflammation of asthma.Glucocorticoid may increase CCSP level in asthmatic children.Glucocorticoid and CCSP may cooperate in anti-inflammation in airway of asthmatic children.
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Objective To explore the role of Clara cell secretory protein(CCSP) in asthmatic children and compare the levels of CCSP in sera and induced sputum.Methods Thirty-four children with asthma who were in remission and 25 healthy controls were enrolled.Sera and hypertonic saline-induced sputum were obtained in asthmatic children,and sera alone were obtained in control subjects.The le-(vels) of CCSP were measured in sera and induced sputum by enzyme linked immunosorbent assay.Results Asthmatic children,compared with controls,had significantly lower concentration of CCSP in sera(P
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Objective To explore the roles of clara cell secretory protein(CCSP)and eosinophil cationic protein(ECP)in the pathoge-nesis of bronchial asthma and to evaluate their diagnostic value in asthmatic children.Methods Induced sputum samples were obtained from 31 asthmatic children during chronic persistent period and clinical remission period.According to global initiative for asthma(GINA),the total of 31 cases accepted systemic treatment by inhaling glucocorticoid.The patients included 18 boys and 13 girls aged from 3.7 to 12.0 years,and their average age was 7.6 years.Sputum CCSP concentrations were measured by enzyme-linked immunosorbent assay(ELISA).And the concentrations of sputum ECP were determined with Pharmacia UniCAP system.Results Asthmatic children had significantly lower CCSP levels in sputum during chronic persistent period compared with clinical remission period(P
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Objective To explore the clinical significance of serum clara cell secretory protein(CC16),total immunoglobulin E(TIgE)and eosinophil cationic protein(ECP)in children with asthma.Methods Serum were collected from 59 cases during asthmatic acute attacks,29 asthmatic children who were in mild conditions,and 30 cases who were in moderate to severe conditions,and 30 healthy children.Serum CC16 concentration were measured by enzyme-linked immunosorbent assay(ELISA),TIgE and ECP concentration were measured by uniCAP100.Results The levels of CC16 in serum of asthmatic children during acute attacks were significantly lower than that in control group(t=2.93 Pa
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Objective:To search for a prophetic marker reflecting the progress of acute respiratory distress syndrome (ARDS).Methods:The serum was obtained from normal controls and patients at difierent stages of ARDS:systemic inflammatory response syndrome (SIRS),acute lung injury(ALI),ARDS and just before dying.Clara cell secretory protein (CC16) in serum was detected using enzyme-linked immunoadsordent assay (ELISA).Results:In the early stage of inflammatory reaction,that is,stage of SIRS,the CC16 levels in serum were higher than normal controls ( P 0.01).Conclusion:The determination of CC16 in serum is a sensitive marker reflecting the integrity of alveolar epithelium and vascular endothelial cell.The alteration of CC16 is presented in the early period of acute inflammatory reaction.The alteration of CC16 is earlier than that of blood gas analysis.CC16 may serve as a helpful marker to foresee and evaluate prognosis of ARDS in early stage.