Roger N, Xaubet A, Agustí C, Zabala E, Ballester E, Torres A, Picado C, Rodriguez-Roisin R
Serveis de Pneumologia i Al.lèrgia Respiratòria i, Hospital Clínic, Barcelona, Spain.
Eur Respir J. 1995 Aug;8(8):1275-80. doi: 10.1183/09031936.95.08081275.
Fat embolism syndrome (FES) is a serious clinical disorder occurring in trauma patients. The diagnosis of fat embolism syndrome may be difficult to establish clinically. We therefore wanted to investigate the usefulness of bronchoalveolar lavage (BAL) in the diagnostic evaluation of fat embolism syndrome. We analysed the presence of fat droplets in BAL cells in 32 trauma patients (7 with full diagnostic criteria of fat embolism syndrome, 17 with incomplete diagnostic criteria, and 8 with no diagnostic criteria at the time of bronchoscopy), 9 nontrauma patients with acute respiratory failure and radiographic pulmonary infiltrates, and a control group composed of 10 individuals. An increased percentage of oil red O positive alveolar macrophages (cut-off point > 3%) in BAL was found in 6 out of 7 patients with definite clinical criteria of fat embolism syndrome, and in 6 out of 20 trauma patients without the clinical diagnosis of fat embolism syndrome. In two patients with fat embolism syndrome, sequential BAL showed that the percentage of positive macrophages decreased when the clinical manifestations disappeared. An increased number of BAL macrophages with fat droplets was also observed in two trauma patients without evidence of fat embolism syndrome after long-bone surgical intervention. By contrast, all non-trauma patients had a percentage of positive cells lower than 3%. Our findings suggest that BAL oil red O positive macrophages are frequently observed in trauma patients irrespective of the presence of fat embolism syndrome. Conceivably, a high number of oil red O positive macrophages could reflect clinically silent fat embolization.
脂肪栓塞综合征（FES）是创伤患者中发生的一种严重临床病症。脂肪栓塞综合征的诊断在临床上可能难以确立。因此，我们想研究支气管肺泡灌洗（BAL）在脂肪栓塞综合征诊断评估中的作用。我们分析了32例创伤患者（7例符合脂肪栓塞综合征的完整诊断标准，17例符合不完全诊断标准，8例在支气管镜检查时无诊断标准）、9例患有急性呼吸衰竭且有影像学肺部浸润的非创伤患者以及由10名个体组成的对照组的BAL细胞中脂肪滴的存在情况。在7例具有明确脂肪栓塞综合征临床标准的患者中有6例，以及在20例无脂肪栓塞综合征临床诊断的创伤患者中有6例，发现BAL中油红O阳性肺泡巨噬细胞百分比增加（临界值>3%）。在2例脂肪栓塞综合征患者中，连续的BAL显示当临床表现消失时，阳性巨噬细胞的百分比降低。在2例长骨手术干预后无脂肪栓塞综合征证据的创伤患者中也观察到BAL中含脂肪滴的巨噬细胞数量增加。相比之下，所有非创伤患者的阳性细胞百分比均低于3%。我们的研究结果表明，无论是否存在脂肪栓塞综合征，在创伤患者中经常观察到BAL油红O阳性巨噬细胞。可以想象，大量油红O阳性巨噬细胞可能反映临床上无症状的脂肪栓塞。
