Nakos G, Pneumatikos J, Tsangaris I, Tellis C, Lekka M
University Hospital of Ioannina, Chemistry Department, University of Ioannina, Greece.
Am J Respir Crit Care Med. 1997 Mar;155(3):945-51. doi: 10.1164/ajrccm.155.3.9117030.
The purpose of the present study is twofold: to evaluate alterations in total phospholipid content and individual phospholipid classes of the surfactant, and to detect markers of inflammatory reaction in bronchoalveolar lavage (BAL) from patients with hydrostatic pulmonary edema (HPE). Mechanically ventilated patients with HPE (Group 1) were compared with mechanically ventilated patients without cardiopulmonary disease (Group 2), considered as the control group. Group 3, including patients with high-permeability pulmonary edema, was used for further comparison. BAL was obtained and immediately cooled at 4 degrees C. Total proteins, albumin, and platelet-activating factor--acetylhydrolase (PAF-AcH) were measured. Total lipids were extracted and analyzed after thin-layer chromatographic separation. PAF was determined with bioassay. Total BAL proteins and albumin were found significantly higher in patients with HPE compared with control, but were lower compared with adult respiratory distress syndrome (ARDS). PAF was elevated in patients with HPE and ARDS, whereas in the control group it was actually in nondetectable levels. PAF was significantly higher in ARDS than in HPE patients. BAL neutrophils concentration was higher in HPE compared with control, but lower compared with ARDS. There was an inverse correlation between PAF-AcH and PAF. Quantitative reduction of total BAL phospholipids (PL) and qualititative deficiency was observed in both patients with HPE and ARDS. The findings of this study suggest that there is evidence of inflammation in the airspaces of patients with HPE.
评估表面活性剂中总磷脂含量和各磷脂类别的变化，以及检测静水压性肺水肿（HPE）患者支气管肺泡灌洗（BAL）中的炎症反应标志物。将机械通气的HPE患者（第1组）与无心肺疾病的机械通气患者（第2组，作为对照组）进行比较。第3组包括高通透性肺水肿患者，用于进一步比较。获取BAL样本并立即在4℃下冷却。测量总蛋白、白蛋白和血小板活化因子 - 乙酰水解酶（PAF - AcH）。提取总脂质并在薄层色谱分离后进行分析。用生物测定法测定PAF。发现HPE患者的BAL总蛋白和白蛋白显著高于对照组，但低于成人呼吸窘迫综合征（ARDS）患者。HPE和ARDS患者的PAF升高，而对照组中PAF实际上处于不可检测水平。ARDS患者的PAF显著高于HPE患者。HPE患者的BAL中性粒细胞浓度高于对照组，但低于ARDS患者。PAF - AcH与PAF之间存在负相关。在HPE和ARDS患者中均观察到BAL总磷脂（PL）的定量减少和定性缺乏。本研究结果表明，有证据表明HPE患者的肺泡腔存在炎症。
