Rennard S I, Ghafouri M, Thompson A B, Linder J, Vaughan W, Jones K, Ertl R F, Christensen K, Prince A, Stahl M G
Department of Internal Medicine, University of Nebraska Medical Center, Omaha 68105.
Am Rev Respir Dis. 1990 Jan;141(1):208-17. doi: 10.1164/ajrccm/141.1.208.
Bronchoalveolar lavage has been widely used to sample the lower respiratory tract. Most of the material recovered with this technique represents alveolar contents. A number of modifications have been suggested in order to obtain samples relatively enriched for bronchial material. In order to be able to use a standard technique for bronchoalveolar lavage to sample both airways and "routine" alveolar material, a simple modification of the technique as described by Reynolds and Newball was used: five sequential 20-ml aliquots were infused into the lower respiratory tract, and each aliquot was immediately aspirated. The return from the first aliquot was processed separately from the return from the subsequent four aliquots. These last four aliquots were pooled. Analysis of the first aliquot revealed it to be enriched for ciliated epithelial cells when compared with the subsequent aliquots. There were also differences in inflammatory cell composition with the bronchial sample containing relatively more neutrophils and relatively less lymphocytes. Aspiration during transoral bronchoscopy was documented by quantifying salivary amylase in the bronchial and alveolar lavage fluids. It was estimated, however, that the aspiration was not of quantitative significance in the vast majority of subjects studied. Finally, with the technique of fractional processing of bronchoalveolar lavage samples, it was possible to compare the protein concentrations in bronchial and alveolar lavages. Most prominent among the differences was a marked relative enrichment in the bronchial samples for immunoglobulin A. The technique of fractional processing of bronchoalveolar lavage samples provides a simple means to obtain samples enriched for bronchial and alveolar components. This should facilitate analysis of lower respiratory tract specimens in airway disease.
支气管肺泡灌洗已被广泛用于获取下呼吸道样本。通过该技术回收的大部分物质代表肺泡内容物。为了获得相对富集支气管物质的样本，人们提出了一些改进方法。为了能够使用标准的支气管肺泡灌洗技术来采集气道和“常规”肺泡物质的样本，我们采用了对雷诺兹和纽博尔所描述技术的一种简单改进：将五个连续的20毫升等分试样注入下呼吸道，每个等分试样立即被吸出。第一个等分试样的回抽物与随后四个等分试样的回抽物分开处理。最后这四个等分试样合并在一起。对第一个等分试样的分析表明，与随后的等分试样相比，它富含纤毛上皮细胞。炎症细胞组成也存在差异，支气管样本中中性粒细胞相对较多，淋巴细胞相对较少。通过对支气管和肺泡灌洗液中的唾液淀粉酶进行定量，记录了经口支气管镜检查期间的误吸情况。然而，据估计，在绝大多数研究对象中，误吸在数量上并无显著意义。最后，通过支气管肺泡灌洗样本的分次处理技术，可以比较支气管和肺泡灌洗液中的蛋白质浓度。其中最显著的差异是支气管样本中免疫球蛋白A明显相对富集。支气管肺泡灌洗样本的分次处理技术提供了一种简单的方法来获取富含支气管和肺泡成分的样本。这将有助于对气道疾病中下呼吸道标本的分析。
