气道和肺泡细胞的支气管肺泡灌洗采样。

Robinson B W, James A, Rose A H, Sterrett G F, Musk A W

Department of Medicine, University of Western Australia, Queen Elizabeth II Medical Centre, Nedlands.

Br J Dis Chest. 1988 Jan;82(1):45-55. doi: 10.1016/0007-0971(88)90007-1.

Bronchoalveolar lavage (BAL) cell counts are used to assess 'alveolitis' in patients with interstitial lung diseases (ILD) but inflammatory cells from airways can contribute to the differential cell count. To determine what BAL volume samples airway cells in patients with ILD we measured the proportion of bronchial epithelial cells (BECs) in four successive 25 ml aliquots in a single lung subsegment in 23 patients with ILD (cryptogenic fibrosing alveolitis (CFA) four, rheumatoid lung (RL) three, asbestosis (ASB) 11, sarcoidosis (SARC) five). Cells recovered from the first two 25 ml lavages exhibited higher proportions of BECs (15 +/- 4% and 9 +/- 2% respectively) than those from the remaining two aliquots (3 +/- 1%, 3 +/- 1%, each P less than 0.01), suggesting that the first 50 ml BAL preferentially samples airway cells compared to the second 50 ml BAL. To evaluate airway and alveolar inflammatory cell proportions in ILD we performed two separate 50 ml BALs (samples I and II) in a single subsegment in 38 patients with ILD (CFA seven, RL five, ASB 19, SARC seven) and measured the proportions of recovered cells in each sample separately and combined. Seven control individuals were also studied. Sample I contained 1-67% (mean 26 +/- 3%) of the total recovered cells. Neutrophil (PMN) proportions were higher in sample I compared to sample II in CFA (20 +/- 6 vs 8 +/- 2%), RL (30 +/- 9 vs 8 +/- 2%) and ASB (12 +/- 2 vs 7 +/- 1%), P less than 0.05 for each, but were similar in samples I and II in patients with SARC (3 +/- 1 vs 2 +/- 1%) and controls (2 +/- 1 vs 2 +/- 1%). In combined samples (I + II), absolute PMN proportions were up to 8% higher than in sample II alone whereas absolute lymphocyte proportions were up to 8% less than in sample II alone. These data suggest that separate processing of the fluid recovered from the first 50 ml BAL in ILD patients provides information on the location of inflammatory cells and improves the accuracy of BAL cell counts.

支气管肺泡灌洗（BAL）细胞计数用于评估间质性肺疾病（ILD）患者的“肺泡炎”，但气道中的炎症细胞会影响细胞分类计数。为了确定ILD患者中何种BAL体积能采集到气道细胞，我们在23例ILD患者（隐源性纤维化肺泡炎（CFA）4例、类风湿性肺病（RL）3例、石棉肺（ASB）11例、结节病（SARC）5例）的单个肺亚段中，测量了连续4个25 ml等分样本中支气管上皮细胞（BEC）的比例。从前两个25 ml灌洗中回收的细胞显示出比其余两个等分样本中更高比例的BEC（分别为15±4%和9±2%）（均为3±1%，P均小于0.01），这表明与第二个50 ml BAL相比，第一个50 ml BAL优先采集气道细胞。为了评估ILD中气道和肺泡炎症细胞的比例，我们在38例ILD患者（CFA 7例、RL 5例、ASB 19例、SARC 7例）的单个亚段中进行了两次单独的50 ml BAL（样本I和样本II），并分别和合并测量每个样本中回收细胞的比例。还研究了7名对照个体。样本I包含总回收细胞的1 - 67%（平均26±3%）。在CFA（20±6对8±2%）、RL（30±9对8±2%）和ASB（12±2对7±1%）中，样本I中的中性粒细胞（PMN）比例高于样本II，每组P均小于0.05，但在SARC患者（3±1对2±1%）和对照个体（2±1对2±1%）的样本I和样本II中相似。在合并样本（I + II）中，绝对PMN比例比单独样本II高8%，而绝对淋巴细胞比例比单独样本II低8%。这些数据表明，对ILD患者第一个50 ml BAL回收的液体进行单独处理可提供炎症细胞位置的信息，并提高BAL细胞计数的准确性。