Clinical significance of vascular endothelial growth factor levels in bronchoalveolar lavage fluid of patients with acute lung injury / 中华创伤杂志

ABSTRACT

Objective To test the levels of vascular endothelial growth factor (VEGF) in bronchoalveolar lavage fluid (BALF) during acute lung injury (ALI)/acute respiratory distress syndome (ARDS) after the interference with anticoagulation and fibrinolytic in an attempt to find a possible treatment plan for ALI/ARDS.Methods Oleic acid-induced ALI models were used in this study.A total of 96 rats were randomly assigned oleic acid group,salvianolate group,urokinase group,and saline group according to the random number table,with 24 animals per group.In oleic acid group,oleic acid (0.2 ml/kg,caudally) was administered alone.In addition to the oleic acid,the rats in salvianolate and urokinase groups received caudal injection with 10 ml/kg of 0.06％ salvianolate and 5,000 U/kg of urokinase respectively.In saline group,saline solution with an equal volume of oleic acid was caudally administered alone.Effect of the early use of salvianolate and urokinase on levels of VEGF in BALF was measured.Clinically,patients with ALI/ARDS composing survivor and death groups were enrolled and assessed by acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and multiple organ dysfunction syndrome (MODS) score.Besides,healthy population was included as the controls to comparatively analyze the levels of VEGF in BALF in ALI/ARDS group.Results Of the rat models of ALI,early use of salvianolate or urokinase was associated with elevated level of VEGF in BALF (P ＜0.05),which subsequently attenuated the lung injury.In the clinical research,it was found that the level of VEGF in BALF in ALI/ARDS group was much lower than that in control group [(45.9 ± 5.7) pg/ml vs (60.6 ± 4.5) pg/ml] (P ＜ 0.01).The level of VEGF in BALF was negatively correlated with APACHE Ⅱor MODS scores (r =-0.542,-0.659,P ＜ 0.01).Moreover,patients in death group appeared lower VEGF level in BALF than those in survivor group(t =2.68,P ＜ 0.05).Conclusion VEGF level in BALF can be taken as an indicator of patient condition and outcome.Early use of anticoagulation or thrombolytic drugs may play a positive role on patients with ALI/ARDS.