Ericson Petrea A, Mirgorodskaya Ekaterina, Hammar Oscar S, Viklund Emilia A, Almstrand Ann-Charlotte R, Larsson Per J-W, Riise Gerdt C, Olin Anna-Carin
Department of Respiratory Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
Department of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Transplant Direct. 2016 Aug 26;2(9):e103. doi: 10.1097/TXD.0000000000000615. eCollection 2016 Sep.
There is no clinically available marker for early detection or monitoring of chronic rejection in the form of bronchiolitis obliterans syndrome (BOS), the main long-term complication after lung transplantation. Sampling and analysis of particles in exhaled air is a valid, noninvasive method for monitoring surfactant protein A (SP-A) and albumin in the distal airways.
We asked whether differences in composition of exhaled particles can be detected when comparing stable lung transplant recipients (LTRs) (n = 26) with LTRs who develop BOS (n = 7). A comparison between LTRs and a matching group of healthy controls (n = 33) was also conducted. Using a system developed in-house, particles were collected from exhaled air by the principal of inertial impaction before chemical analysis by immunoassays.
Surfactant protein A in exhaled particles and the SP-A/albumin ratio were lower ( = 0.002 and = 0.0001 respectively) in the BOS group compared to the BOS-free group. LTRs exhaled higher amount of particles ( < 0.0001) and had lower albumin content ( < 0.0001) than healthy controls.
We conclude that low levels of SP-A in exhaled particles are associated with increased risk of BOS in LTRs. The possibility that this noninvasive method can be used to predict BOS onset deserves further study with prospective and longitudinal approaches.
对于肺移植后主要的长期并发症闭塞性细支气管炎综合征（BOS），目前尚无临床上可用于早期检测或监测慢性排斥反应的标志物。对呼出气体中的颗粒进行采样和分析是监测远端气道中表面活性蛋白A（SP-A）和白蛋白的一种有效、非侵入性方法。
我们探讨了在比较稳定的肺移植受者（LTRs，n = 26）和发生BOS的LTRs（n = 7）时，是否能检测到呼出颗粒成分的差异。还对LTRs与一组匹配的健康对照者（n = 33）进行了比较。使用内部开发的系统，通过惯性撞击原理从呼出气体中收集颗粒，然后通过免疫测定法进行化学分析。
与无BOS组相比，BOS组呼出颗粒中的表面活性蛋白A以及SP-A/白蛋白比值更低（分别为P = 0.002和P = 0.0001）。LTRs呼出的颗粒量高于健康对照者（P < 0.0001），而白蛋白含量低于健康对照者（P < 0.0001）。
我们得出结论，呼出颗粒中低水平的SP-A与LTRs发生BOS的风险增加有关。这种非侵入性方法可用于预测BOS发病的可能性值得通过前瞻性和纵向研究方法进行进一步研究。
