Balbi B, Pignatti P, Corradi M, Baiardi P, Bianchi L, Brunetti G, Radaeli A, Moscato G, Mutti A, Spanevello A, Malerba M
Division of Pneumology, Fondazione Salvatore Maugeri, IRCCS, Via Revislate 13, 28010, Veruno, Italy.
Eur Respir J. 2007 Oct;30(4):769-81. doi: 10.1183/09031936.00112306.
Bronchoalveolar lavage (BAL), induced sputum and exhaled breath markers (exhaled nitric oxide and exhaled breath condensate) can each provide biological insights into the pathogenesis of respiratory disorders. Some of their biomarkers are also employed in the clinical management of patients with various respiratory diseases. In the clinical context, however, defining normal values and cut-off points is crucial. The aim of the present review is to investigate to what extent the issue of defining normal values in healthy adults has been pursued for the biomarkers with clinical value. The current authors reviewed data from literature that specifically addressed the issue of normal values from healthy adults for the four methodologies. Most studies have been performed for BAL (n = 9), sputum (n = 3) and nitric oxide (n = 3). There are no published studies for breath condensate, none of whose markers yet has clinical value. In healthy adult nonsmokers the cut-off points (mean+2sd) for biomarkers with clinical value were as follows. BAL: 16.7% lymphocytes, 2.3% neutrophils and 1.9% eosinophils; sputum: 7.7 x 10(6).mL(-1) total cell count and 2.2% eosinophils; nitric oxide: 20.2 ppb. The methodologies differ concerning the quantity and characteristics of available reference data. Studies focusing on obtaining reference values from healthy individuals are still required, more evidently for the new, noninvasive methodologies.
支气管肺泡灌洗（BAL）、诱导痰和呼出气标志物（呼出一氧化氮和呼出气冷凝液）均可为呼吸系统疾病的发病机制提供生物学见解。它们的一些生物标志物也用于各种呼吸系统疾病患者的临床管理。然而，在临床环境中，确定正常值和临界点至关重要。本综述的目的是研究在多大程度上针对具有临床价值的生物标志物探讨了健康成年人正常值的定义问题。本文作者回顾了文献中专门针对这四种方法的健康成年人正常值问题的数据。大多数研究针对BAL（n = 9）、痰液（n = 3）和一氧化氮（n = 3）进行。目前尚无关于呼出气冷凝液的已发表研究，其标志物均无临床价值。在健康成年不吸烟者中，具有临床价值的生物标志物的临界点（均值+2标准差）如下。BAL：淋巴细胞16.7%，中性粒细胞2.3%，嗜酸性粒细胞1.9%；痰液：总细胞计数7.7×10⁶.mL⁻¹，嗜酸性粒细胞2.2%；一氧化氮：20.2 ppb。这些方法在可用参考数据的数量和特征方面存在差异。仍需要开展侧重于从健康个体获取参考值的研究，对于新的非侵入性方法而言更为明显。
