Sternberg R I, Whitsett J A, Hull W M, Baughman R P
Department of Internal Medicine, Children's Hospital, University of Cincinnati, OH, USA.
J Lab Clin Med. 1995 Apr;125(4):462-9.
To understand better the interaction between surfactant protein A (SP-A), human immunodeficiency virus (HIV) and Pneumocystis carinii pneumonia (PCP), we measured SP-A from bronchoalveolar lavage (BAL) fluid in immunosuppressed patients (HIV-positive [HIV+] and HIV noninfected [HIV-]) who were examined for possible pneumonia. Forty-five HIV+ patients, 16 with PCP and no other pathogen (HIV+/Pc) and 29 with no evidence of pulmonary pathogen (HIV+ controls), were compared with 6 HIV- patients with PCP (HIV-/Pc) and 11 control patients with no underlying disease (controls). Despite a similar inflammatory response in the HIV-infected patients whether they had PCP or not, we found increased BAL SP-A concentrations in HIV+/Pc patients as compared with HIV+ control patients (HIV+/Pc: median, 10.3 micrograms/ml; range, 2.8 to 24.3 micrograms/ml; HIV+ control: median, 1.9; range, 0.06 to 3.83 micrograms/ml; p < 0.05). The amount of SP-A in the HIV+ control group was significantly lower than healthy, uninfected volunteers, suggesting that HIV itself may lower SP-A levels. Six HIV+/Pc patients underwent BAL after 21 days of therapy and showed complete resolution of the P. carinii organism. There was a significant drop in the amount of SP-A at follow-up lavage (initial mean, 14.1 micrograms/ml; follow-up mean, 7.4 micrograms/ml; p < 0.02). We also found a significant correlation between the amount of P. carinii and the amount of SP-A in the BAL fluid (Spearman rank, 0.74; p < 0.01). We conclude that SP-A content is increased in HIV+ patients with PCP. The relationship between SP-A concentration and the abundance of P. carinii present in the BAL fluid may be related to SP-A binding to P. carinii or to alterations in surfactant protein homeostasis.
为了更好地理解表面活性蛋白A（SP-A）、人类免疫缺陷病毒（HIV）与卡氏肺孢子虫肺炎（PCP）之间的相互作用，我们检测了接受肺炎可能性检查的免疫抑制患者（HIV阳性[HIV+]和未感染HIV[HIV-]）支气管肺泡灌洗（BAL）液中的SP-A。将45例HIV+患者（16例患有PCP且无其他病原体[HIV+/Pc]，29例无肺部病原体证据[HIV+对照]）与6例患有PCP的HIV-患者（HIV-/Pc）和11例无基础疾病的对照患者（对照）进行比较。尽管无论是否患有PCP，HIV感染患者的炎症反应相似，但我们发现与HIV+对照患者相比，HIV+/Pc患者的BAL SP-A浓度升高（HIV+/Pc：中位数为10.3微克/毫升；范围为2.8至24.3微克/毫升；HIV+对照：中位数为1.9；范围为0.06至3.83微克/毫升；p<0.05）。HIV+对照组中的SP-A量显著低于健康、未感染的志愿者，这表明HIV本身可能会降低SP-A水平。6例HIV+/Pc患者在治疗21天后接受了BAL，结果显示卡氏肺孢子虫完全清除。随访灌洗时SP-A量显著下降（初始平均值为14.1微克/毫升；随访平均值为7.4微克/毫升；p<0.02）。我们还发现BAL液中卡氏肺孢子虫的量与SP-A的量之间存在显著相关性（斯皮尔曼等级相关系数为0.74；p<0.01）。我们得出结论，患有PCP的HIV+患者的SP-A含量增加。SP-A浓度与BAL液中卡氏肺孢子虫数量之间的关系可能与SP-A与卡氏肺孢子虫的结合或表面活性蛋白稳态的改变有关。
