Paredi P, Kharitonov S A, Loukides S, Pantelidis P, du Bois R M, Barnes P J
Department of Thoracic Medicine, Imperial College School of Medicine at the National Heart and Lung Institute, London, UK.
Chest. 1999 May;115(5):1352-6. doi: 10.1378/chest.115.5.1352.
Interstitial inflammation is a major aggravating factor in fibrosing lung disease associated with scleroderma (FASSc) and cryptogenic fibrosing alveolitis (CFA). Exhaled nitric oxide (NO) production is increased in asthma and bronchiectasis and reflects the degree of inflammation. We investigated whether measuring levels of exhaled NO is valuable in assessing disease activity in patients with CFA and patients with FASSc.
NO levels were measured in 11 patients with CFA (mean age +/- SEM, 58 +/- 12 years old; 5 were male) and 17 patients with FASSc (mean age, 48 +/- 9 years old; 5 were male), and they were compared to BAL cell counts and lung function. Patients with CFA and FASSe had elevated NO levels (11.2 +/-1.0 parts per billion [ppb] and 9.8 +/- 1.0 ppb, respectively; p > 0.05), whereas in a group of 13 nonsmoking normal subjects, the NO levels were not elevated (6.9 +/- 0.5 ppb; p < 0.05). Patients with FASSc (n = 8) who had active BAL (defined as either lymphocytes > 14%, neutrophils > 4%, or eosinophils > 3%) had significantly higher NO levels (13.2 +/- 1.8 ppb), and neutrophil (16.5 +/- 4.0%) and lymphocyte (26.8 +/- 3.4%) BAL cell counts than did patients with FASSc who had inactive BAL (6.7 +/- 1.2 ppb; 1.3 +/- 1.0% and 7.5 +/- 1.3%, respectively; p < 0.05). There was a significant correlation between exhaled NO and lymphocyte cell count in patients with FASSc (r = 0.58; p < 0.05). All patients with CFA had active BAL; however, those treated with corticosteroids (12.9 +/- 1.0% ppb, p < 0.05) had lower NO levels (9.0 +/- 1 ppb) and higher BAL lymphocyte cell couits (16.6 +/- 2.0%) than did those not treated with corticosteroids (7.2 +/- 1.7%; p < 0.05).
We conclude that exhaled NO may be a useful addition to BAL cell counts in disease monitoring.
间质性炎症是硬皮病相关纤维化肺病（FASSc）和隐源性纤维化肺泡炎（CFA）的主要加重因素。哮喘和支气管扩张症患者呼出的一氧化氮（NO）生成增加，反映了炎症程度。我们研究了测量呼出NO水平对评估CFA患者和FASSc患者的疾病活动度是否有价值。
对11例CFA患者（平均年龄±标准误，58±12岁；5例男性）和17例FASSc患者（平均年龄，48±9岁；5例男性）测量了NO水平，并将其与支气管肺泡灌洗（BAL）细胞计数和肺功能进行比较。CFA和FASSe患者的NO水平升高（分别为11.2±1.0十亿分之一[ppb]和9.8±1.0 ppb；p>0.05），而在一组13名不吸烟的正常受试者中，NO水平未升高（6.9±0.5 ppb；p<0.05）。BAL活跃（定义为淋巴细胞>14%、中性粒细胞>4%或嗜酸性粒细胞>3%）的FASSc患者（n=8）的NO水平（13.2±1.8 ppb）、中性粒细胞（16.5±4.0%）和淋巴细胞（26.8±3.4%）BAL细胞计数显著高于BAL不活跃的FASSc患者（分别为6.7±1.2 ppb；1.3±1.0%和7.5±1.3%；p<0.05）。FASSc患者呼出的NO与淋巴细胞计数之间存在显著相关性（r=0.58；p<0.05）。所有CFA患者的BAL均活跃；然而，接受皮质类固醇治疗的患者（12.9±1.0% ppb，p<0.05）的NO水平较低（9.0±1 ppb），BAL淋巴细胞计数较高（16.6±2.0%），而未接受皮质类固醇治疗的患者为（7.2±1.7%；p<0.05）。
我们得出结论，呼出NO可能是疾病监测中BAL细胞计数的有益补充。
