Mamessier Emilie, Milhe François, Badier Monique, Thomas Pascal, Magnan Antoine, Reynaud-Gaubert Martine
Université de la Méditerranée, IPHM IFR 125, EA 3287, Marseille, France.
J Heart Lung Transplant. 2006 May;25(5):523-32. doi: 10.1016/j.healun.2005.12.009. Epub 2006 Apr 11.
BACKGROUND: Chronic lung rejection is characterized by obliterative bronchiolitis (OB) diagnosed based on spirometric criteria reflecting an already advanced process. Biologic markers such as bronchoalveolar lavage (BAL) neutrophilia or increased levels of chemokines (interleukin-8, RANTES [regulated on activation: normal T cell expressed and secreted]) have been proposed as early diagnosis tools. However, BAL is too invasive to be used as a routine strategy. Induced sputum (IS), however, is a non-invasive method of recovering bronchial cells. METHODS: The aim of this study was to compare BAL and IS differential cellular counts as well as IL-8 and RANTES levels between patients with bronchiolitis obliterans syndrome (BOS), recipients with good outcome and well-preserved lung function (non-BOS) and non-transplanted controls. We compared 34 BAL and IS findings obtained consecutively from 34 lung transplant recipients (LTRs), including 22 non-BOS and 12 BOS patients. RESULTS: IS results were compared with 19 samples from non-transplanted controls. IS was well tolerated. There was no correlation between BAL and sputum cell populations. BAL neutrophils and IL-8 levels were increased in BOS, and these parameters were positively correlated. Moreover, BAL neutrophils and IL-8 levels were both negatively correlated with respiratory function. Sputum evaluation allows discrimination of BOS from non-BOS by the presence of higher neutrophil and eosinophil counts. Moreover, IS neutrophils and eosinophils were both correlated with lung function parameters. In contrast to BAL, IL-8 level in sputum was not a useful predictive marker of BOS development. IS RANTES levels were higher in BOS than in healthy recipients and correlated significantly with IS eosinophils. CONCLUSIONS: IS and BAL provide different but complementary data. In this study, IS appeared to be a useful, non-invasive tool for LTR monitoring. Furthermore, IS provides new insights into BOS pathogenesis, especially with regard to implication of eosinophils and its chemokine, RANTES, at the bronchial level.
背景：慢性肺排斥反应的特征是闭塞性细支气管炎（OB），其诊断基于反映病情已进展的肺功能标准。生物标志物如支气管肺泡灌洗（BAL）中性粒细胞增多或趋化因子（白细胞介素-8、RANTES[活化调节：正常T细胞表达和分泌]）水平升高已被提议作为早期诊断工具。然而，BAL侵入性太强，不能作为常规策略使用。而诱导痰（IS）是一种获取支气管细胞的非侵入性方法。 方法：本研究的目的是比较闭塞性细支气管炎综合征（BOS）患者、预后良好且肺功能保存良好的受者（非BOS）和非移植对照者之间BAL和IS的细胞分类计数以及白细胞介素-8和RANTES水平。我们比较了从34例肺移植受者（LTR）连续获得的34份BAL和IS结果，其中包括22例非BOS患者和12例BOS患者。 结果：将IS结果与19份非移植对照者的样本进行比较。IS耐受性良好。BAL和痰液细胞群体之间无相关性。BOS患者BAL中性粒细胞和白细胞介素-8水平升高，且这些参数呈正相关。此外，BAL中性粒细胞和白细胞介素-8水平均与呼吸功能呈负相关。痰液评估可通过较高的中性粒细胞和嗜酸性粒细胞计数将BOS与非BOS区分开来。此外，IS中性粒细胞和嗜酸性粒细胞均与肺功能参数相关。与BAL不同，痰液中的白细胞介素-8水平不是BOS发生的有用预测标志物。BOS患者的IS RANTES水平高于健康受者，且与IS嗜酸性粒细胞显著相关。 结论：IS和BAL提供了不同但互补的数据。在本研究中，IS似乎是LTR监测的一种有用的非侵入性工具。此外，IS为BOS发病机制提供了新的见解，尤其是在支气管水平上嗜酸性粒细胞及其趋化因子RANTES的作用方面。
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