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目的 从肺泡表面活性物质的变化探讨新生儿猝死综合征的病因。方法 用薄层色谱法对 10例新生儿猝死综合征和 10例对照新生儿 (死于非呼吸系疾病 )的全肺表面活性物质作定性和定量检测。结果 全肺表面活性物质定性分析得到 11个组分 :溶血磷脂酰胆碱、神经鞘磷脂、磷脂酰胆碱、磷脂酰丝氨酸、磷脂酰肌醇、磷脂酰乙醇胺、磷脂酰甘油、二磷脂酰甘油、磷脂酸、胆固醇和中性脂类。定量分析显示 :猝死组全肺表面活性物质含量为 ( 8.9± 1.0 ) mg/g肺湿重 ,显著少于对照组的( 12 .6± 1.4 ) mg/g肺湿重 ( P<0 .0 1)。猝死组的磷脂酰胆碱 ( 4 9.4± 2 .9) %和磷脂酰甘油 ( 2 .6±0 .7) %比例下降 ,而对照组分别为 ( 61.5± 3 .0 ) %和 ( 4 .3± 1.5 ) % ( P<0 .0 1 )。结论 猝死新生儿生前在肺泡表面活性物质代谢方面存在着严重缺陷 :合成数量的减少和合成品种的比例失调。这种缺陷是新生儿猝死综合征的一个重要病因。
Objective To explore the etiology of sudden infant death syndrome from the changes of alveolar surfactant. Methods Ten pulmonary surfactant samples of sudden infant death syndrome and 10 control neonates who died of non-respiratory disease were determined by TLC. Results Qualitative analysis of whole lung surfactant resulted in eleven components: lysophosphatidylcholine, sphingomyelin, phosphatidylcholine, phosphatidylserine, phosphatidylinositol, phosphatidylethanolamine, phosphatidylglycerol, diphosphatidylglycerol Phosphatidic acid, cholesterol and neutral lipids. Quantitative analysis showed that the content of pulmonary surfactant in the sudden death group was (8.9 ± 1.0) mg / g, significantly lower than that in the control group (12.6 ± 1.4 mg / g, P <0. 0 1). The proportion of phosphatidylcholine (4 9.4 ± 2. 9)% and phosphatidylglycerol (2. 6 ± 0. 7)% in the sudden death group was significantly lower than that in the control group (61.5 ± 3.0%) and (4). 3 ± 1.5)% (P <0.01). Conclusions There is a serious defect in the metabolism of alveolar surfactant in neonates with sudden death: the decrease of the synthesis quantity and the imbalance of the synthesized varieties. This defect is an important cause of sudden infant death syndrome.