序贯支气管肺泡灌洗反映了不同的肺区：肺移植的临床和研究意义。
Sequential broncho-alveolar lavages reflect distinct pulmonary compartments: clinical and research implications in lung transplantation.
机构信息
Toronto Lung Transplant Program, University Health Network, University of Toronto, Toronto, ON, Canada.
Toronto General Hospital, 585 University Ave, PMB 11-128, Toronto, ON, M5G 2N2, Canada.
出版信息
Respir Res. 2018 May 25;19(1):102. doi: 10.1186/s12931-018-0786-z.
BACKGROUND
Bronchoalveolar lavage (BAL) has proven to be very useful to monitor the lung allograft after transplantation. In addition to allowing detection of infections, multiple BAL analytes have been proposed as potential biomarkers of lung allograft rejection or dysfunction. However, BAL collection is not well standardized and differences in BAL collection represent an important source of variation. We hypothesized that there are systematic differences between sequential BALs that are relevant to BAL analysis.
METHODS
As part of 126 consecutive bronchoscopies in lung transplant recipients, two sequential BALs (BAL1 and BAL2) were performed in one location during each bronchoscopy by instilling and suctioning 50 ml of normal saline twice into separate containers. Cell concentration, viability and differentials, Surfactant Protein-D (SP-D), Club Cell Secretory Protein (CCSP), and levels of CXCL10, IL-10, CCL2, CCL5, VEGF-C, RAGE, CXCL9, CXCL1, IL-17A, IL-21, PDGF, and GCSF were compared between BAL1 and BAL2.
RESULTS
Total cell concentration did not differ between BAL1 and BAL2; however, compared to BAL2, BAL1 had more dead cells, epithelial cells, neutrophils, and higher concentrations of airway epithelium-derived CCSP and inflammatory markers. BAL2 had a higher concentration of SP-D compared to BAL1.
CONCLUSION
In this study performed in lung transplant recipients, we show that sequential BALs represent different lung compartments and have distinct compositions. BAL1 represents the airway compartment with more epithelial cells, neutrophils, and epithelium-derived CCSP. Conversely, BAL2 samples preferentially the distal bronchoalveolar space with greater cell viability and higher SP-D. Our findings illustrate how the method of BAL collection can influence analyte concentrations and further emphasize the need for a standardized approach in translational research involving BAL samples.
背景
支气管肺泡灌洗（BAL）已被证明在监测肺移植后的肺移植物非常有用。除了可以检测感染外，还提出了多种 BAL 分析物作为肺移植物排斥或功能障碍的潜在生物标志物。然而，BAL 的采集尚未得到很好的标准化，BAL 采集的差异是造成变化的一个重要来源。我们假设，在支气管镜检查过程中，在一个部位进行的两次连续 BAL（BAL1 和 BAL2）之间存在与 BAL 分析相关的系统差异。
方法
作为 126 例连续肺移植受者支气管镜检查的一部分，在每次支气管镜检查过程中，通过将 50ml 生理盐水两次注入两个单独的容器中，在一个部位进行两次连续 BAL（BAL1 和 BAL2）。比较 BAL1 和 BAL2 之间细胞浓度、活力和差异、表面活性蛋白-D（SP-D）、Club 细胞分泌蛋白（CCSP）以及 CXCL10、IL-10、CCL2、CCL5、VEGF-C、RAGE、CXCL9、CXCL1、IL-17A、IL-21、PDGF 和 GCSF 的水平。
结果
BAL1 和 BAL2 之间的总细胞浓度没有差异；然而，与 BAL2 相比，BAL1 具有更多的死细胞、上皮细胞、中性粒细胞，以及更高浓度的气道上皮衍生的 CCSP 和炎症标志物。与 BAL1 相比，BAL2 具有更高浓度的 SP-D。
结论
在这项在肺移植受者中进行的研究中，我们表明，连续 BAL 代表不同的肺区室，并且具有不同的组成。BAL1 代表气道区室，具有更多的上皮细胞、中性粒细胞和上皮衍生的 CCSP。相反，BAL2 样本优先采集远端支气管肺泡空间，具有更高的细胞活力和更高的 SP-D。我们的发现说明了 BAL 采集方法如何影响分析物浓度，并进一步强调了在涉及 BAL 样本的转化研究中需要采用标准化方法。
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