Nakos G, Kitsiouli E I, Lekka M E
Intensive Care Unit, University Hospital of Ioannina, Chemistry Department, Laboratory of Biochemistry, University of Ioannina, Ioannina, Greece.
Am J Respir Crit Care Med. 1998 Nov;158(5 Pt 1):1504-10. doi: 10.1164/ajrccm.158.5.9802036.
The objective of this study was to determine quantitative and qualitative surfactant alterations, proteins, and platelet activating factor (PAF) in bronchoalveolar lavage (BAL) fluid from patients with pulmonary thromboembolism (PTE) with respect to ventilated patients without PTE. Patients with PTE underwent BAL at the most affected lung area on the first and tenth days of PTE diagnosis. Total proteins and albumin, total lipids, individual phospholipid classes, PAF and PAF-acetylhydrolase (PAF-AcH) activity were determined in BAL fluid. Total proteins and albumin were found to be increased in both successive samples of patients with PTE when compared with the control group (p < 0.001 and p < 0.05, respectively). Total phospholipids, though, were elevated on the first day, but they decreased on the tenth day, in comparison with the control groups (p < 0.05). Alterations in the percentage of individual phospholipid classes were observed in both successive samples of BAL fluid when compared with those in the control subjects. PAF and PAF-AcH were detected in high levels on the first day (p < 0.001), which were reduced on the tenth day (p < 0.05). An inverse correlation between PAF levels and PaO2/FIO2 ratio was observed. Finally, the percentage of macrophages decreased and the percentage of neutrophils increased during the course of PTE. In conclusion, pulmonary embolism is associated with alterations in lung surfactant and inflammation in lung tissue, expressed by an increase in PAF and in neutrophils.
本研究的目的是确定肺血栓栓塞症（PTE）患者支气管肺泡灌洗（BAL）液中表面活性剂、蛋白质和血小板活化因子（PAF）的定量和定性变化，并与无PTE的通气患者进行比较。PTE患者在PTE诊断的第一天和第十天，于受影响最严重的肺区域进行BAL。测定BAL液中的总蛋白、白蛋白、总脂质、各磷脂类、PAF和PAF - 乙酰水解酶（PAF - AcH）活性。与对照组相比，PTE患者连续两次样本中的总蛋白和白蛋白均升高（分别为p < 0.001和p < 0.05）。然而，与对照组相比，总磷脂在第一天升高，但在第十天下降（p < 0.05）。与对照组相比，BAL液连续两次样本中各磷脂类百分比均有变化。第一天检测到高水平的PAF和PAF - AcH（p < 0.001），第十天则降低（p < 0.05）。观察到PAF水平与PaO2/FIO2比值呈负相关。最后，在PTE病程中，巨噬细胞百分比下降，中性粒细胞百分比增加。总之，肺栓塞与肺表面活性剂改变及肺组织炎症相关，表现为PAF和中性粒细胞增加。
