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Airway pepsin levels in otherwise healthy surgical patients receiving general anesthesia with endotracheal intubation.

Chest (2012-11-03)
J Kyle Bohman, Daryl J Kor, Rahul Kashyap, Ognjen Gajic, Emir Festic, Zhaoping He, Augustine S Lee
ABSTRACT

Airway pepsin has been increasingly used as a potentially sensitive and quantifiable biomarker for gastric-to-pulmonary aspiration, despite lack of validation in normal control subjects. This study attempts to define normal levels of airway pepsin in adults and distinguish between pepsin A (exclusive to stomach) and pepsin C (which can be expressed by pneumocytes). We performed a prospective study of 51 otherwise healthy adult patients undergoing elective extremity orthopedic surgery at a single tertiary-care academic medical center. Lower airway samples were obtained immediately following endotracheal intubation and just prior to extubation. Total pepsin and pepsin A concentrations were directly measured by an enzymatic activity assay, and pepsin C was subsequently derived. Pepsinogen/pepsin C was confirmed by Western blot analyses. Baseline characteristics were secondarily compared. In all, 11 (22%; 95% CI = 9.9%-33%) had detectable airway pepsin concentrations. All 11 positive specimens had pepsin C, without any detectable pepsin A. Pepsinogen/pepsin C was confirmed by Western blot analyses. In a multivariate logistic regression, men were more likely to have airway pepsin (OR, 12.71, P = .029). Enzymatically active pepsin C, but not the gastric-specific pepsin A, is frequently detected in the lower airways of patients who otherwise have no risk for aspiration. This suggests that nonspecific pepsin assays should be used and interpreted with caution as a biomarker of gastropulmonary aspiration, as pepsinogen C potentially expressed from pneumocytes may be detected in airway samples.

MATERIALS
Product Number
Brand
Product Description

Sigma-Aldrich
胃蛋白酶 来源于猪胃粘膜, powder, ≥250 units/mg solid
Sigma-Aldrich
胃蛋白酶 来源于猪胃粘膜, lyophilized powder, ≥3,200 units/mg protein
Sigma-Aldrich
胃蛋白酶 来源于猪胃粘膜, powder, ≥400 units/mg protein
胃蛋白酶, powder, European Pharmacopoeia (EP) Reference Standard
Sigma-Aldrich
胃蛋白酶 来源于猪胃粘膜, powder, slightly beige, ≥500 U/mg
Sigma-Aldrich
胃蛋白酶 来源于猪胃粘膜, powder, slightly beige, 1200-2400 U/mg