Stephenson A H, Lonigro A J, Hyers T M, Webster R O, Fowler A A
Department of Pharmacology, St. Louis University School of Medicine, Missouri 63104.
Am Rev Respir Dis. 1988 Sep;138(3):714-9. doi: 10.1164/ajrccm/138.3.714.
The sulfidopeptide leukotrienes (LT) C4 and D4 have been reported to promote the formation of pulmonary edema when administered into the pulmonary circulation of laboratory animals. As a first step in the evaluation of the hypothesis that these leukotrienes participate in the edema formation of the adult respiratory distress syndrome (ARDS), we investigated whether LTC4 and LTD4 were present in the bronchoalveolar lavage (BAL) fluid of patients with ARDS compared to nonsmoker control subjects and to patients with acute respiratory failure exhibiting no radiographic evidence of widespread pulmonary infiltrates but having a clinical predisposition for developing ARDS, i.e., the "at risk" group. Bronchoscopic lavage was performed with sterile 0.9% NaCl on 32 control subjects, nine patients with ARDS, and nine patients "at risk" for ARDS. Leukotrienes were measured in BAL fluid by radioimmunoassay after methanol extraction and HPLC purification of a 20-ml aliquot of the BAL sample. LTC4 and LTD4 (mean +/- SE) increased from 1.1 +/- 0.2 and 1.2 +/- 0.5 ng/lavage in the BAL fluid of control subjects to 6.3 +/- 2.3 and 20.1 +/- 5.9 ng/lavage in patients "at risk" for ARDS and to 12.5 +/- 3.0 and 30.5 +/- 7.8 ng/lavage in patients with ARDS, respectively. The sulfidopeptide LTs correlated with BAL fluid protein content. These results suggest that increased amounts of LTs in BAL fluid are a general finding in patients with ARDS and those "at risk" for ARDS.
据报道，当将硫化肽白三烯（LT）C4和D4注入实验动物的肺循环时，可促进肺水肿的形成。作为评估这些白三烯参与成人呼吸窘迫综合征（ARDS）肺水肿形成这一假说的第一步，我们调查了ARDS患者支气管肺泡灌洗（BAL）液中是否存在LTC4和LTD4，并与非吸烟对照受试者以及急性呼吸衰竭患者进行比较，后者无广泛肺浸润的影像学证据，但有发生ARDS的临床易感性，即“高危”组。对32名对照受试者、9名ARDS患者和9名ARDS“高危”患者进行了支气管镜灌洗术，灌洗液为无菌0.9%氯化钠溶液。对BAL样本的20 ml等分试样进行甲醇萃取和高效液相色谱（HPLC）纯化后，采用放射免疫分析法测定BAL液中的白三烯。在对照受试者的BAL液中，LTC4和LTD4（均值±标准误）分别为1.1±0.2 ng/灌洗和1.2±0.5 ng/灌洗，在ARDS“高危”患者中分别增至6.3±2.3 ng/灌洗和20.1±5.9 ng/灌洗，在ARDS患者中分别增至12.5±3.0 ng/灌洗和30.5±7.8 ng/灌洗。硫化肽白三烯与BAL液蛋白含量相关。这些结果表明，BAL液中白三烯含量增加是ARDS患者和ARDS“高危”患者的常见表现。
