Preliminary Study Of Function Of Angiogenin 2 In Treatment Of Pediatric Sepsis Induced Lung Injurry With Extracorporeal Membrane Oxygen

Sepsis is a pathological state of organ dysfunction and abnormal immune reaction caused by infection.Lung injury is one of the most common complications in sepsis and always evolved to acute respiratory distress syndrome(ARDS).Extracorporeal membrane oxygen(ECMO),as an efficient approach for rescuing most severe ARDS,has drawn more and more concentration.However,the molecular mechanism of ECMO during treating severe ARDS has not been well understood.In this study,we collected clinical cases and animal models suffering from sepsis and ARDS.By using histological and molecular methods,we tested the preliminary mechanisms of sepsis and ARDS treating with ECMO.Methods1.We collected the clinical data of pediatric patients,who was diagnosed with sepsis and ARDS from June 2014 to December 2018 in surgical pediatric intensive care unit,Bayi children’s hospital,the seventh medical center of PLA general hospital(former known as Army General Hospital of PL A).2.In vivo part:We used piglets as the experimental animal model.The piglets were divided into three groups:the Mock group,the LPS group and the ECMO group,randomly.The piglets in Mock group receive continuous saline administration.The piglets in LPS group receive a bolus injection of LPS(1mg/kg)and then continuous infusion of LPS with the speed of 0.5mg/kg/hr.The animal in the ECMO group receive the same administration of LPS with those in the LPS group and then support with ECMO.3.In vitro part:The molecular test:After the piglets’ execution,the peripheral blood and lung tissues were collected.The peripheral blood were analyzed with the flow cytometry for the calculation of macrophage and different granular leukocytes.The lung tissue was administrated with HE staining to observe the inflammation state.We also tested the mRNA level of different injury associated molecules,chemotactic factors,inflammatory factors and factors associated with capillary endothelial cells.Results1.We collected 22 pediatric cases with ECMO support and 15 cases were successfully withdrawn from ECMO,in whom 14 cases survived to discharge.Comparing the clinical data from the published data in the mainland China,our center has got a higher survival rate,which keeps an equal level with the data from ELSO.2.The piglets have septic symptoms after infusion of LPS.The vital signs altered significantly.ECMO could provide an efficient oxygen supply although without a significant alteration of compliance of respiratory system.During the early state,ECMO could inhibit the function of heart,especially the function of left ventricle temporarily.Moreover,the function of left ventricle could re-reach to the baseline level after a few hours to days.3.The histological test showed that severe inflammatory cells infiltration,exudation in the alveolar capacity even hemorrhage in the lungs from piglets receiving LPS injection.The M1 subtype of macrophage and parts of neutrocytes were inhibited in the peripheral blood.The injury associated molecules in the lung tissue were significantly up-regulated,as well as the factors associated with capillary endothelial cells.However,the chemotactic factors and inflammatory factors were down-regulated in our test.Conclusions1.ECMOcould be used as an efficient tool for rescuing most severe ARDS.2.Sepsis caused severe injury to lung function and heart function,which could be reversed by treatment with ECMO.3.The innate immune systemin organism with sepsis could be inhibited and the alveolar capillary endothelial cells would be injured during the disease.