大人の後期呼吸器障害症候群における表面活性物質置換療法
P L Haslam1, D A Hughes, P D MacNaughton
1Cell Biology Unit, National Heart and Lung Institute, London, UK.
Lancet (London, England)
|April 23, 1994
まとめ
人工表面活性剤ALECは,急性呼吸困難症候群 (ARDS) の患者の肺のリンパ脂レベルを改善しました. しかし,持続的な臨床効果は観察されず,ARDSの効果的な治療のためにさらなる研究が必要であることを示唆しています.
科学分野:
- 肺内医学 肺内医学 肺内医学
- クリティカルケア・メディシン
- バイオケミストリー バイオケミストリー
背景:
- 急性呼吸器障害症候群 (ARDS) は,肺損傷と炎症を特徴とする重度の肺疾患です.
- 表面活性物質の欠乏,特にフォスファディチルコリン (PC) の欠乏は,ARDSの特徴であり,肺機能を損なう.
- 現在,ARDSの治療戦略は,病気の遅い段階で有効性が限られている.
研究 の 目的:
- 人工表面活性物質ALECの単一投与の有効性を,ARDSの末期期の成人患者で評価する.
- 肺のリンパ脂組成とタンパク質汚染に対するALEC治療の影響を評価する.
- ALECの投与がARDSの持続的な臨床改善につながるかどうかを判断する.
主な方法:
- 人工表面活性物質ALECの単回投与を,ARDSの末期期にある4人の成人患者に対して,胸腔内挿入した.
- ブロンコアルベオラ洗浄 (BAL) を実施し,治療後24時間後にフォスフォリピド濃度 (フォスファディチルコリン,フォスファディチルグリセロール) とタンパク質汚染を測定しました.
- 臨床状態と患者のアウトカムが持続的な改善のために監視されました.
主要な成果:
- ALEC治療を受けた患者の持続的な臨床改善は観察されなかった.
- BAL測定は,フォスファディチルコリン (最大4.4倍) とフォスファディチルグリセロール (最大34.7倍) の24時間後の有意な増加を示した.
- 増加にもかかわらず,全リン脂に対するフォスファディチルコリン濃度は正常値以下であり,PCに対するタンパク質汚染は依然として高かった.
結論:
- 人工表面活性剤ALECの単一投与は,ARDSの末期に肺のリンパ脂レベルを上昇させることができます.
- フォスフォリピドの増加は,持続的な臨床改善にはつながらなかった.
- ARDSにおけるPCサプリメントの効果を高めるには,最適化された治療用配方と治療法のさらなる研究が必要である.
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