Bronchoalveolar lavage fluid and plasma proteins, chemiluminescence response and protein contents of polymorphonuclear leukocytes from blood and lavage fluid in traumatized patients.

The technique of bronchoalveolar lavage was used to obtain serial samples of lavage every two days from non-contused lung areas of seven traumatized patients and four normals; blood was drawn simultaneously. Urea, total protein, albumin, alpha 1-proteinase inhibitor, alpha 2-macroglobulin, lactate dehydrogenase, beta-N-acetyl-glucosaminidase, myeloperoxidase, and elastase enzyme activity, as well as complexed and total elastase concentrations were determined in bronchoalveolar lavage fluids and plasma samples. Lavage fluid cell pattern was counted. Polymorphonuclear leukocytes were isolated from lavage fluids and blood samples. Granulocyte contents of elastase enzyme activity, complexed and total elastase concentrations, and myeloperoxidase and lactate dehydrogenase activity were determined. Polymorphonuclear leukocyte stimulatory functions were measured by luminol-enhanced chemiluminescence. The following results were obtained for the patient group: Patterns of lavage fluid cells were shifted in favour of polymorphonuclear leukocytes and lymphocytes. The protein determinations of bronchoalveolar lavage fluids and plasma samples gave information about the extent of alterations of permeability of the capillary-interstitial-alveolar space (albumin/urea and alpha 1-proteinase inhibitor/urea ratios) as well as about the amounts of cytoplasmic and lysosomal enzymes released by phagocytes (lactate dehydrogenase/urea, beta-N-acetylglucosaminidase/urea, elastase/urea ratios). Polymorphonuclear leukocytes isolated from bronchoalveolar lavage fluids contained a decreased content of myeloperoxidase and elastase enzyme activities and total elastase concentration; the content of complexed elastase was found to be increased more than 100 fold. From chemiluminescence measurements there was evidence for decreased zymosan-induced stimulatory function, while the photon emission rate of polymorphonuclear leukocytes after passage into the alveolar space was increased.