Crim C, Keller C A, Dunphy C H, Maluf H M, Ohar J A
Division of Pulmonology and Pulmonary Occupational Medicine, Department of Internal Medicine, Saint Louis University Health Sciences Center, Missouri 63110-0250, USA.
Am J Respir Crit Care Med. 1996 Mar;153(3):1041-6. doi: 10.1164/ajrccm.153.3.8630543.
Lung transplantation is an accepted therapeutic modality in end-stage lung disease. Presently, histologic examination of tissue by transbronchial biopsy remains as the definitive diagnostic procedure for determining rejection. To begin addressing the usefulness of flow cytometric analysis of bronchoalveolar lavage fluid (BALF) in acute lung rejection, we prospectively studied the expression of markers on lymphocytes from BALF samples removed from 10 lung and heart-lung transplant recipients and compared their pattern with that of BALF lymphs obtained from normal volunteers (Norm) and nonrejecting heart transplant recipients (HT) who were receiving similar immunosuppressive regimens. Compared with both Norm and HT subjects, CD4+ lymphocytes in the BALF of lung transplant recipients was significantly reduced. A greater percentage of the CD4+ lymphocytes in nonrejecting lung transplant subjects also expressed the interleukin-2 receptor, but only during the early post-transplant period, suggesting possible reactivity to persistent donor cells. However, the CD8+ lymphocytes were increased only in lung transplant recipients undergoing acute lung rejection. We conclude that the immunologic milieu is indeed altered in the transplanted lung. Further studies in lung transplant recipients are required to evaluate the role of flow cytometry in the early detection of acute lung rejection.
肺移植是终末期肺病公认的治疗方式。目前，经支气管活检对组织进行组织学检查仍是确定排斥反应的决定性诊断程序。为了开始探讨支气管肺泡灌洗（BALF）液流式细胞术分析在急性肺排斥反应中的作用，我们前瞻性研究了从10例肺和心肺移植受者获取的BALF样本中淋巴细胞标志物的表达，并将其模式与从正常志愿者（Norm）和接受类似免疫抑制方案的非排斥性心脏移植受者（HT）获得的BALF淋巴细胞的模式进行比较。与Norm和HT受试者相比，肺移植受者BALF中的CD4 +淋巴细胞显著减少。在非排斥性肺移植受试者中，更大比例的CD4 +淋巴细胞也表达白细胞介素-2受体，但仅在移植后早期，提示可能对持续存在的供体细胞有反应性。然而，仅在发生急性肺排斥反应的肺移植受者中CD8 +淋巴细胞增加。我们得出结论，移植肺中的免疫环境确实发生了改变。需要对肺移植受者进行进一步研究，以评估流式细胞术在急性肺排斥反应早期检测中的作用。
