Lechapt Emmanuelle, Habibi Anoosha, Bachir Dora, Galacteros Frederic, Schaeffer Annette, Desvaux Dominique, Brochard Laurent, Housset Bruno, Godeau Bertrand, Maitre Bernard
Department of Pathology, Sickle Cell Disease Center, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Inserm U492, Université Paris XII, Créteil, France.
Am J Respir Crit Care Med. 2003 Dec 1;168(11):1373-7. doi: 10.1164/rccm.200302-174OC. Epub 2003 Sep 11.
Previous reports have shown that in more than 40% of adults with acute chest syndrome (ACS), fat droplets suggestive of pulmonary fat embolism were present in alveolar macrophages. To determine whether induced sputum (IS) is a reliable test for detecting this embolism, we compared bronchoalveolar lavage and IS results in 20 patients with ACS. We found a correlation between the number of Oil Red O-stained macrophages in sputum and lavage fluid (Spearman's coefficient: rho = 0.657, p < 0.018). Sputum cytology was then studied in another 60 patients who had sickle cell disease with ACS. An elevated percentage of Oil Red O-stained macrophages was found in the sputum of 37/47 patients, but they did not include any of the patients with sickle cell disease but no clinical symptoms. Patients suffering from ACS with Oil Red O-stained macrophages had more extrathoracic concomitant pain than those without (76 vs. 50%, p < 10-8), had more neurologic symptoms (7 vs. 0%, p < 10-8), a lower differential platelet count (-49 +/- 121 vs. +85 +/- 229, p < 0.04), and higher abnormal transaminase values (28 vs. 17%, p < 0.01). We conclude that IS analysis is a safe, noninvasive, and useful test for fat embolism detection in ACS.
既往报道显示，在超过40%的急性胸综合征（ACS）成人患者中，肺泡巨噬细胞内存在提示肺脂肪栓塞的脂肪滴。为确定诱导痰（IS）检测这种栓塞是否可靠，我们比较了20例ACS患者的支气管肺泡灌洗和IS结果。我们发现痰液和灌洗液中油红O染色巨噬细胞数量之间存在相关性（Spearman系数：rho = 0.657，p < 0.018）。然后对另外60例患有镰状细胞病合并ACS的患者进行痰液细胞学研究。在47例患者中的37例痰液中发现油红O染色巨噬细胞百分比升高，但其中不包括任何无临床症状的镰状细胞病患者。存在油红O染色巨噬细胞的ACS患者比不存在的患者有更多的胸外伴随疼痛（76%对50%，p < 10-8）、更多的神经症状（7%对0%，p < 10-8）、更低的血小板差值计数（-49±121对+85±229，p < 0.04）以及更高的转氨酶异常值（28%对17%，p < 0.01）。我们得出结论，IS分析是检测ACS中脂肪栓塞的一种安全、无创且有用的检测方法。
