Godding V, Bodart E, Delos M, Sibille Y, Galanti L, De Coster P, Jarjour N, Busse W W
Department of Paediatrics, UCL Mont-Godinne, Yvoir, Belgium.
Clin Exp Allergy. 1998 Apr;28(4):504-9. doi: 10.1046/j.1365-2222.1998.00231.x.
Acute eosinophilic pneumonia (AEP) is characterized by respiratory distress, eosinophilic infiltration in the lung, acute onset, resolution of symptoms with corticosteroids and the absence of relapse. Studies to identify the pathophysiology of AEP in adults have demonstrated eosinophil activation in the BAL fluid, and the presence of high levels of interleukin 5 (IL-5) in the BAL.
To investigate the pathophysiology of AEP with pleural effusion in a paediatric patient.
ECP levels in the BALand pleural fluid was determined by radioimmunoassay. IL-5 and GM-CSF concentrations in the BAL and pleural fluid were measured by Elisa. Immunohistochemistry studies performed on open lung biopsy included a specific ICAM-1 immunostaining and a ECP specific immunostaining (EG2+).
High levels of ECP were found in the BAL (5 microg/L) and pleural fluid (750 microg/L) demonstrating eosinophil activation at these sites. Immunohistochemistry illustrated activated (EG2+) eosinophils in the interalveolar septa and alveolar space and detected increased expression of ICAM-1 on alveolar epithelial cells. High levels of IL-5 were measured in the BAL (1334 pg/mL) and pleural fluid (7014 pg/mL), while elevated concentrations of GM-CSF (150 pg/mL) were found in the BAL.
We conclude that in this paediatric patient with AEP activated eosinophils were present in the BAL fluid, in the interalveolar septa and in the pleural space while increased ICAM-1 expression was detected on alveolar epithelial cells, contributing, at least partly, for their adhesive interactions. IL-5 and GM-CSF are likely important to the massive eosinophil recruitment and activation in the lung, while IL-5 is probably related to eosinophil accumulation and activation in the pleural space. Thus, lung generation of eosinophil-active cytokines is central to the pathophysiology of AEP in paediatric patients.
急性嗜酸性粒细胞性肺炎（AEP）的特征为呼吸窘迫、肺部嗜酸性粒细胞浸润、起病急、使用皮质类固醇后症状缓解且无复发。针对成人AEP病理生理学的研究已证实支气管肺泡灌洗（BAL）液中嗜酸性粒细胞活化，且BAL中存在高水平的白细胞介素5（IL-5）。
研究一名患有胸腔积液的儿科AEP患者的病理生理学。
采用放射免疫分析法测定BAL液和胸腔积液中的嗜酸性粒细胞阳离子蛋白（ECP）水平。通过酶联免疫吸附测定法测量BAL液和胸腔积液中IL-5和粒细胞巨噬细胞集落刺激因子（GM-CSF）的浓度。对开放性肺活检标本进行免疫组织化学研究，包括特异性细胞间黏附分子-1（ICAM-1）免疫染色和ECP特异性免疫染色（EG2+）。
在BAL液（5微克/升）和胸腔积液（750微克/升）中发现高水平的ECP，表明这些部位存在嗜酸性粒细胞活化。免疫组织化学显示肺泡间隔和肺泡腔内有活化的（EG2+）嗜酸性粒细胞，并检测到肺泡上皮细胞上ICAM-1表达增加。在BAL液（1334皮克/毫升）和胸腔积液（7014皮克/毫升）中检测到高水平的IL-5，而在BAL液中发现GM-CSF浓度升高（150皮克/毫升）。
我们得出结论，在这名患有AEP的儿科患者中，活化的嗜酸性粒细胞存在于BAL液、肺泡间隔和胸腔内，同时在肺泡上皮细胞上检测到ICAM-1表达增加，这至少部分促成了它们的黏附相互作用。IL-5和GM-CSF可能对肺内大量嗜酸性粒细胞的募集和活化很重要，而IL-5可能与胸腔内嗜酸性粒细胞的积聚和活化有关。因此，肺内嗜酸性粒细胞活性细胞因子的产生是儿科患者AEP病理生理学的核心。
