COMPOSICIÓN DEL SURFACTANTE, DESARROLLO PULMONAR Y PRUEBAS DE MADURACIÓN EN EL FETO.
Palabras clave:
Maduración pulmonar fetal, relación lecitina/esfingomielina, cuerpos lamelares, pruebas diagnósticas, fosfolípidos, Fetal lung maturation, lecithin/sphyngomyelin rate, lamellar bodies, diagnostic tests, phospholipidsResumen
ResumenEl surfactante pulmonar es una sustancia tensoactiva producida por los neumocitos tipo II, cuya concentración en el recién nacido prematuro/ inmaduro está disminuída, llevando a la producción del síndrome de dificultad respiratoria. El surfactante está constituído en un 85% por lípidos, del tipo fosfolípidos en su mayoría. El resto son proteínas surfactantes.
Los fosfogliceridos (lecitinas) y la esfingomielina forman el grupo de fosfolipidos involucrados. La fosfatidil colina y la dipalmitoil fosfatidil colina son las lecitinas más abundantes en el líquido extracelular que recubre los alvéolos pulmonares normales y en el surfactante pulmonar que disminuye su tensión superficial. Así se evita la atelectasia al final de la fase espiratoria de la respiración. En el neumocito II, enzimas remodelan las diferentes lecitinas para convertirlas en dipalmitoil fosfatidil colina.
Una vez que el surfactante es producido en el neumocito, esta substancia migra como “cuerpos la melares” desde el núcleo hasta la superficie apical de la célula desde donde es liberado por exocitosis dentro del alveolo.
Menos de un 0.1% de los recién nacidos presentan Síndrome de Dificultad Respiratoria (llamado antiguamente Enfermedad de Membrana Hialina) cada año, y alrededor de un 10 % de estos mueren. La administracion de corticoesteroides incrementa la madurez pulmonar en casos de riesgo de parto prematuro, o cuando es necesario realizar una cesárea lo más temprano posible. El tratamiento de los bebes prematuros que presentan SDR incluye la administración de surfactantes dentro del árbol traqueobronquial.
El patrón oro de la determinación de madurez pulmonar fetal es la relación lecitina/esfingomielina (L/E), aunque hay algunas otras pruebas como la medición de cuerpos la melares, que resultan confiables, económicas y más fácilmente disponibles en hospitales de menor categoría.
Palabras clave: Maduración pulmonar fetal, relación lecitina/esfingomielina, cuerpos lamelares, pruebas diagnósticas, fosfolípidos.
SURFACTANT COMPOSITION, LUNG DEVELOPMENT AND FETAL LUNG MATURATION TESTS
AbstractPulmonary surfactant is a tensoactive substance produced by type II pneumocytes. Its concentration in premature/inmature babies is decreased, and this causes respiratory distress syndrome. 85% of surfactant are lipids, most of them phospholipids. The remainder are surfactant proteins.
Phosphoglycerides (lecithins) and sphyngomyelin are involved phospholipids. Most abundant lecithins in extracelular fluid covering normal pulmonary alveoli are phosphatydil-choline and dipalmitoil phosphatydil choline, and in pulmonary surfactant (that decreases surface tension) as well. Thus, atelectasis at the end of expiratory phase is avoided. Type II pneumocytes contain a number of enzymes that remodel different lecithins to transform them in dipalmitoil phosphatydil choline. Once surfactant is manufactured by the pneumocyte, it migrates as “lamellar bodies”, from nucleus to apical surface of the cell, where it is released within the alveolus by an exocytosis process.
Less than one percent of newborns develop yearly the respiratory distress syndrome (formerly called “hyaline membrane disease”); about ten percent of them die. Corticoid administration enhances lung maturity in at risk cases of pre-term delivery, or when acesarean sections is indicated as soon as possible, before term. Premature babies having the idiopathic respiratory distress syndrome are treated with surfactant administration into the tracheobronchial tree. Gold standard test to determine fetal lung maturity is lecithin/esphyngomyelin (L/S) rate. There are other tests designed to meet this task, like measurement of lamellar bodies. This test can be trusted, is cheaper is readily available in less sophisticated hospitals and medical centers.
Key words: Fetal lung maturation, lecithin/sphyngomyelin rate, lamellar bodies, diagnostic tests, phospholipids.
Biografía del autor/a
Ariel Iván Ruiz-Parra, Academia Nacional de Medicina
Liliana Muñoz, Instituto Materno-Infantil de Bogotá
Ligia Ome
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