Inoue Y, Barker E, Daniloff E, Kohno N, Hiwada K, Newman L S
Pulmonary Division, National Jewish Medical and Research Center, Denver, CO 80206, USA.
Am J Respir Crit Care Med. 1997 Jul;156(1):109-15. doi: 10.1164/ajrccm.156.1.9612043.
Inhaled beryllium induces specific sensitization and nonspecific effects leading to chronic beryllium disease (CBD). It is not known whether beryllium induces epithelial cell injury and increases alveolar-capillary leak. We hypothesize that lung injury is an early event in this disease and that markers of lung injury reflect severity of CBD. We measured serum and bronchoalveolar lavage fluid (BALF) KL-6 level, a marker of epithelial cell injury, and BALF/serum albumin, a marker of alveolar-capillary permeability, in 26 patients with CBD, 15 beryllium-sensitized subjects without disease (BeS), and 32 control subjects (Ctrl). We examined the association of these markers, BAL cellularity, pulmonary function, gas exchange, serum angiotensin-converting enzyme, chest radiograph, the effects of glucocorticoid therapy, and clinical course. BALF/serum albumin and serum KL-6 increased in CBD and were discriminative markers for CBD. BALF KL-6 and BALF/serum albumin reflected mainly lung cellular and granulomatous inflammation. Serum KL-6, like and BALF KL-6, was associated with permeability change and reflected functional and radiologic abnormalities. Serum KL-6 detected early lung injury in BeS. Epithelial injury and permeability changes occur early in CBD, indicating disease severity. Monitoring of these events with serum KL-6 may be useful for management of CBD.
吸入铍会引发特异性致敏和非特异性效应，进而导致慢性铍病（CBD）。目前尚不清楚铍是否会诱发上皮细胞损伤并增加肺泡-毛细血管渗漏。我们推测肺损伤是该疾病的早期事件，且肺损伤标志物可反映CBD的严重程度。我们测量了26例CBD患者、15例铍致敏但无疾病的受试者（BeS）和32例对照受试者（Ctrl）的血清及支气管肺泡灌洗液（BALF）中的KL-6水平（一种上皮细胞损伤标志物）以及BALF/血清白蛋白（一种肺泡-毛细血管通透性标志物）。我们研究了这些标志物、BAL细胞成分、肺功能、气体交换、血清血管紧张素转换酶、胸部X线片、糖皮质激素治疗效果及临床病程之间的关联。CBD患者的BALF/血清白蛋白和血清KL-6升高，且是CBD的鉴别标志物。BALF KL-6和BALF/血清白蛋白主要反映肺细胞和肉芽肿性炎症。血清KL-6与BALF KL-6一样，与通透性变化相关，并反映功能和放射学异常。血清KL-6可检测出BeS患者的早期肺损伤。上皮损伤和通透性变化在CBD早期就会出现，提示疾病严重程度。用血清KL-6监测这些事件可能有助于CBD的管理。
