Bousquet J, Van Vyve T, Chanez P, Enander I, Michel F B, Godard P
Service des Maladies Respiratoires, CHU, CJF-INSERM 92-10, Montpellier, France.
Allergy. 1993;48(17 Suppl):70-5; discussion 76. doi: 10.1111/j.1398-9995.1993.tb04703.x.
Bronchoalveolar lavage (BAL) greatly improved our understanding of asthma allowing to demonstrate the key role of inflammation in the pathogenesis of the disease. BAL is a safe procedure, even in severe patients when properly performed. BAL samples large and small airways and alveoli. Cells and mediators may be measured in BALF but they only represent an indirect estimation of the bronchial inflammation. Before performing BAL, the clinical status of the patients should be ascertained and drugs taken may have to be withdrawn. BALF markers should follow some requirements: (1) markers should be released by cells that are pertinent to airways inflammation (and reparation) in asthma, and, if possible they should be specific of a single cell type, (2) the enumeration of cells or titration of the marker or of its metabolites should be specific and sensitive, (3) if possible the titration should not be modified by the sampling procedure, (4) pilot studies should have demonstrated that the cell is increased or the secretory product is released during challenge in asthmatic subjects, (5) studies in a large number of patients should have demonstrated that the levels of the marker are increased in chronic asthmatics, that these levels are correlated with the severity of the disease and are decreased during effective anti-inflammatory treatment, and (6) if possible the cell or marker should be specific to asthma (but at present there is no such cell or marker). Eosinophils and granule secretory products follow most of these requirements. BAL represents an important research tool to assess the effects of therapeutic interventions.
支气管肺泡灌洗术（BAL）极大地增进了我们对哮喘的理解，使我们能够证明炎症在该疾病发病机制中的关键作用。BAL是一种安全的操作，即使在重症患者中，若操作得当也是如此。BAL可对大小气道及肺泡进行采样。可在支气管肺泡灌洗液（BALF）中检测细胞和介质，但它们仅间接反映支气管炎症情况。在进行BAL之前，应确定患者的临床状况，可能需要停用正在服用的药物。BALF标志物应符合一些要求：（1）标志物应由与哮喘气道炎症（及修复）相关的细胞释放，若可能，它们应是单一细胞类型所特有的；（2）细胞计数或标志物及其代谢产物的滴定应具有特异性和敏感性；（3）若可能，滴定不应因采样过程而改变；（4）前期研究应已证明在哮喘患者激发试验期间该细胞增加或分泌产物释放；（5）大量患者的研究应已证明慢性哮喘患者中该标志物水平升高，这些水平与疾病严重程度相关且在有效的抗炎治疗期间降低；（6）若可能，该细胞或标志物应是哮喘所特有的（但目前尚无此类细胞或标志物）。嗜酸性粒细胞和颗粒分泌产物符合这些要求中的大多数。BAL是评估治疗干预效果的重要研究工具。
