The Study On The Relationship Between AT2、pulmonary Function And Complications During Peroperative Period

Purpose: Alveolar type II epithelial cells produce pulmonary surfactant and associated protein,play an important role in lung protection. In the actual clinical work, an operation in Department of thoracic surgery patients receives conventional preoperative pulmonary function examination, We often encounter the following situation: some preoperative pulmonary function detection value of poor patients undergoing thoracic operation recovered well, and there are some preoperative pulmonary function detection value is relatively good in patients undergoing thoracic operation after the recovery is poor, appeared even cause of death in patients with pulmonary complications. How to evaluate pulmonary function accurately before operation, preventing the occurrence of postoperative complications is more important. Our research is mainly to solve the following problems: The number of AT2 is indirectly reacted to SP-A detecting, observed the correlation between AT2 and preoperative pulmonary function. Through observation of preoperative pulmonary function of patients with group of normal lung tissue ultrastructure, summed up its characteristics between the two groups, two groups were observed in patients with complication rate, find the correlation between them. We expect to provide a new way for estimating the pulmonary function predicting complication of patients in thoracic perioperative period.Methods: Select patients who had be performed pulmonary lobectomy because of lung cancer in Tianjin Chest Hospital from November, 2013 to June 2014. According to the preoperative pulmonary function classification, mild pulmonary hypofunctiona and moderate pulmonary hypofunction, a total of 73 patients were included in the study.The resected lung lobe is 5 cm away from the lesion, take out two pieces of pulmonary tissues(about 1 cm3) for Immunohistochemistry and transmission electron microscopy(TEM). Fix the specimen of pulmonary tissues for Immunohistochemistry with 10% formalin, and perform paraffin embedding to make into sections of 4 micrometer thickness. Fix the specimen of pulmonary tissues for TEM with specimens fixed liquid immediately, Sent to the TEM under the condition of low temperature(0-4℃). If not be sent the day, placed at 4℃ refrigerator, be sent anotherday. Apply Immunohistochemistry to test ratio of SP-A positive pneumocytes Alveolar type II epithelial cells and the total number of Alveolar type II epithelial cells. Apply TEM to observe the ultrastructural changes of alveolar type II epithelial cells. Using image processing software for cell number and ultrastructure statistical measure. Observe and record the patient postoperative pulmonary complications, patients with pulmonary complications include atelectasis, pulmonary infection, pulmonary embolism, acute respiratory distress syndrome and respiratory failure.Results: 1. Immunohistochemistry showed that according to SP-A staining results, pneumocytes Alveolar type II epithelial cells were divided into SP-A positive cells and SP-A negative cells. 2. TEM observation showed that the ultrastructure of AT2 was destroyed obviously in the group of moderate pulmonary hypofunction, and smoking can increase of type II alveolar epithelial cells injury. 3.The ratio of SP-A positive AT2 cells had a positive correlation to FEV1(r=0.302 P<0.05),and a positive correlation to MVV((r=0.317 P<0.05)). The number of lamellar bodies containing active material structure of AT2 cells had a positive correlation to FEV1(r=0.661 P<0.05)、FEV1%(r=0.838 P<0.05)、MVV(r=0.648 P<0.05) and MVV%( r=0.827 P< 0.05). 4. Beteeen the ratio of SP-A positive AT2 cells and postoperative complications may negatively correlated(r=-0.213 P=0.07).Between the number of lamellar bodies containing active material structure of AT2 cells and postoperative complications may negatively correlated(r=-0.575 P=0.05).Conclusion: 1. The ratio of SP-A positive AT2 cells can reflect the lun function. 2. The number of lamellar bodies containing active material structure of AT2 cells have a good correlation to lung function. 3. The ratio of SP-A positive AT2 cells as well as the number of lamellar bodies containing active material structure of AT2 cells may have a negatively correlation to lung function.