间质性肺疾病支气管肺泡灌洗液中性粒细胞趋化因子和肿瘤坏死因子水平及其临床意义

目的探讨间质性肺疾病（ＩＬＤ）时中性粒细胞趋化因子（ＮＣＦ）和肿瘤坏死因子（ＴＮＦα）与ＩＬＤ活动性的关系。方法用膜滤过和放射免疫法检测１１例结节病、７例特发性肺间质纤维化（ＩＰＦ）患者和８名健康者血清及支气管肺泡灌洗液（ＢＡＬＦ）中ＮＣＦ活性及ＴＮＦα水平。结果７例ＩＰＦ患者ＢＡＬＦ中ＮＣＦ、ＴＮＦα分别为２０３±４４ｃｅｌｓ／１０ＨＰ、１１７±２９ｎｇ／Ｌ，明显高于８名对照组（８３±４５ｃｅｌｓ／１０ＨＰ、６５±１４ｎｇ／Ｌ、Ｐ＜０．０１）；１１例结节病患者ＢＡＬＦ中ＮＣＦ、ＴＮＦα分别为１８６±５０ｃｅｌｓ／１０ＨＰ、１２±３ｎｇ／Ｌ，明显高于８名对照组（Ｐ＜０．０１）。ＩＰＦ组ＢＡＬＦ中ＮＣＦ、ＴＮＦα均与中性粒细胞百分比呈正相关（ＮＣＦ：ｒ＝０．８９，Ｐ＜０．０１，ＴＮＦα：ｒ＝０．８６，Ｐ＜０．０５），结节病组ＢＡＬＦ中ＮＣＦ、ＴＮＦα均与淋巴细胞百分比呈正相关（ＮＣＦ：ｒ＝０．７８，Ｐ＜０．０１；ＴＮＦα：ｒ＝０．７３，Ｐ＜０．０１）。结论ＩＰＦ和结节病患者ＢＡＬＦ中ＮＣＦ、ＴＮＦα水平可做为肺泡炎活动性的标志     

肺结节病支气管肺泡灌洗液中肿瘤坏死因子和中性粒细胞趋化因子水平及临床意义

目的评价肺内炎症免疫效应细胞释放的细胞因子对肺结节病发病机理的影响。方法利用微孔滤膜和酶联免疫法,检测１１例肺结节病和７例特发性肺纤维化（ＩＰＦ）患者血清和支气管肺泡灌洗液（ＢＡＬＦ）中肿瘤坏死因子（ＴＮＦα）和中性粒细胞趋化因子（ＮＣＦ）水平,并与８名健康非吸烟者对照。结果肺结节病和ＩＰＦ患者ＢＡＬＦ中的ＴＮＦα为１１．９±３．２、１１．７±３．０ｎｇ·Ｌ１,ＮＣＦ水平以每１０个高倍视野细胞数表示,为１９１±５１、２０３±４４,明显高于正常对照组的６．５±１．４ｎｇ·Ｌ１和８２．５±４５．４（Ｐ＜０．０１）。肺结节病患者ＢＡＬＦ中ＴＮＦα与淋巴细胞、ＩＰＦ患者ＮＣＦ与中性粒细胞呈明显正相关（ｒ＝０．７３和ｒ＝０．８９Ｐ＜０．０１）。结论ＴＮＦα和ＮＣＦ在肺结节病和ＩＰＦ发病机理中起着重要作用,并可作为判定疾病活动性的一项重要参考指标。     

重型肝炎患者外周血内皮素及一氧化氮水平变化的意义

目的探讨内皮素（ＥＴ）和一氧化氮（ＮＯ）在重型肝炎（ＳＨ）发病中的作用．方法检测３０例ＳＨ,３２例慢性肝炎（ＣＨ）患者外周血ＥＴ和ＮＯ代谢物ＮＯ－２的水平,并用ＮＯ合成酶底物左旋精氨酸（ＬＡｒｇ）进行治疗前后对比．结果ＳＨ患者外周血ＥＴ和ＮＯ－２水平（１３９ｎｇ／Ｌ±１４ｎｇ／Ｌ,１２７μｍｏｌ／Ｌ±４０μｍｏｌ／Ｌ）明显高于ＣＨ组（８５ｎｇ／Ｌ±１５ｎｇ／Ｌ,６３μｍｏｌ／Ｌ±２５μｍｏｌ／Ｌ,Ｐ＜００１）．合并有Ⅲ,Ⅳ期肝性脑病与肝肾综合征患者外周血ＥＴ和ＮＯ－２水平（１４９ｎｇ／Ｌ±１３ｎｇ／Ｌ,１６２μｍｏｌ／Ｌ±３４μｍｏｌ／Ｌ）明显高于非肝性脑病患者（１１５ｎｇ／Ｌ±１２ｎｇ／Ｌ,８８μｍｏｌ／Ｌ±２４μｍｏｌ／Ｌ,Ｐ＜００１）和Ⅱ期肝性脑病患者（１３６ｎｇ／Ｌ±１０ｎｇ／Ｌ,１２２μｍｏｌ／Ｌ±２６μｍｏｌ／Ｌ,Ｐ＜００１）;ＬＡｒｇ静脉滴注后血浆ＥＴ水平和平均动脉压（ＭＡＰ）显著下降,而肌酐清除率（ｃＣｒ）和尿钠含量明显增加．结论ＥＴ和ＮＯ水平升高是引起ＳＨ多脏器功能障碍的重要因素．ＬＡｒｇ长期治疗可能促进ＳＨ患者脑水肿形成和肝肾综合征发生．     

血浆花生四烯酸代谢紊乱在大鼠急性胰腺炎肝脏损害发病机理中的作用

目的探讨急性胰腺炎肝脏受损与血浆花生四烯酸紊乱的关系．方法同时观察不同程度急性胰腺炎大鼠（ｎ＝１４０）肝脏受损情况和血浆花生四烯酸代谢产物血栓素Ｂ２（ＴＸＢ２）和６酮前列腺素Ｆ１α（６ｋｅｔｏＰＧＦ１α）的变化关系，并对急性胰腺炎时大鼠胰腺和肝脏组织病理学观察．结果发现急性出血坏死性胰腺炎大鼠肝脏发生明显病变，其程度与胰腺病理程度一致，急性出血坏死性胰腺炎时血浆ＴＸＢ２从对照组的１２１ｎｇ／Ｌ±２７ｎｇ／Ｌ上升至ＡＰ后２ｈ的３９９ｎｇ／Ｌ±１３１ｎｇ／Ｌ和４ｈ的６０７ｎｇ／Ｌ±１７４ｎｇ／Ｌ（Ｐ＜００１），ＴＸＢ２／６ｋｅｔｏＰＧＦ１α异常（Ｐ＜００１），而ＴＸＢ２／６ｋｅｔｏＰＧＦ１α比值变化与肝脏病理变化呈正相关（ｒｓ＝０８８９７，Ｐ＜００１）．通过异搏定治疗可明显改善胰腺病理损害和稳定血浆花生四烯酸代谢，明显减轻肝脏的损害．结论急性胰腺炎伴发的肝脏损害的发生发展与血浆花生四烯酸代谢紊乱有关     

肝硬变血浆内毒素与一氧化氮水平的改变及关系的研究

目的研究肝硬变患者血浆内毒素与一氧化氮水平改变及关系．方法应用鲎试剂定量法和高效液相色谱分析法分别检测肝硬变患者４４例（男３２例，女１２例；年龄２５岁～７３岁，平均５０４岁±１１０岁）；ＣｈｉｌｄＰｕｇｈＡ级９例，Ｂ级２０例，Ｃ级１５例；其中有腹水者２７例及健康对照２５例（男１８例，女７例，年龄２４岁～６３岁，平均４６８岁±１２４岁）血浆内毒素和一氧化氮水平．结果肝硬变血浆内毒素及一氧化氮水平（２３７１ＥＵ／Ｌ±８２３ＥＵ／Ｌ，３８７１７ｎｇ／ｍｌ±１０６４１ｎｇ／ｍｌ）明显高于对照组（１５６７ＥＵ／Ｌ±２４６ＥＵ／Ｌ，２９２３０ｎｇ／ｍｌ±５４４９ｎｇ／ｍｌ，Ｐ＜００１）．腹水患者内毒素与一氧化氮水平（２３６９ＥＵ／Ｌ±５３６ＥＵ／Ｌ，４１４６７ｎｇ／ｍｌ±１０７０５ｎｇ／ｍｌ）明显高于无腹水者（１９６９ＥＵ／Ｌ±４５２ＥＵ／Ｌ，３２７１７ｎｇ／ｍｌ±７０２０ｎｇ／ｍｌ，Ｐ＜００５，Ｐ＜００１）．一氧化氮与内毒素呈直线正相关（Ｐ＜００１，ｒ＝０７８２）．结论肝硬变患者血浆内毒素及一氧化氮水平皆升高，且两者呈直线正相关．     

肺结节病支气管－肺泡灌洗液中血管紧张素转换酶与T淋巴细胞亚群相关性的研究

应用笠原法检测１９例肺结节病患考支气管。肺泡灌洗液中血管紧张素转换酶（ＢＡＬＦ－ＡＣＥ）水平，并将灌洗液中的淋巴细胞％，Ｔ辅助细胞／Ｔ抑制细胞（Ｔ＿Ｈ／Ｔｓ）比值与ＢＡＬＦ－ＡＣＥ含量进行相关分析，结果二者之间有明显正相关（ｒ＝０．４４５３，Ｐ＜０．０５和，ｒ＝０．７０８５，Ｐ＜０．０１）。活动性肺结节病随激素治疗病情好转，ＢＡＬＦ－ＡＣＥ水平逐渐下降。提示ＢＡＬＦ－ＡＣＥ是诊断肺结节病及判定其活动性又一敏感的生物学指标。     

内皮素与一氧化氮在肝硬变血流动力学紊乱中的作用

目的研究内皮素、一氧化氮在肝硬变血流动力学紊乱中的作用及关系．方法应用放免法和高效液相色谱法分别检测肝硬变患者４４例，（男３２例，女１２例；年龄５０４岁±１１０岁），其中腹水患者２７例及健康对照２５例（男１８例，女７例；年龄４６８岁±１２４岁）血浆内皮素（ＥＴ）、一氧化氮（ＮＯ）及部分血管活性物质水平．结果肝硬变组血浆ＥＴ及ＮＯ水平（５７０ｎｇ／Ｌ±２５４ｎｇ／Ｌ，３８７２μｇ／Ｌ±１０６４μｇ／Ｌ）明显高于对照组（３３０ｎｇ／Ｌ±１０９ｎｇ／Ｌ，２９２３μｇ／Ｌ±５４５μｇ／Ｌ，Ｐ＜００１）．腹水患者血浆ＥＴ及ＮＯ水平（６７５ｎｇ／Ｌ±２４７ｎｇ／Ｌ，４１４７μｇ／Ｌ±１０７１μｇ／Ｌ），显著高于无腹水患者（４５９ｎｇ／Ｌ±１８３ｎｇ／Ｌ，３２７２μｇ／Ｌ±７０２μｇ／Ｌ，Ｐ＜００１）．ＮＯ与ＥＴ呈直线正相关（ｒ＝０７７２，Ｐ＜００１）．结论肝硬变患者ＥＴ与ＮＯ水平升高，且腹水患者较无腹水者更升高；两者呈直线正相关     

原发性肝癌血清性激素及组织性激素受体的研究

目的研究人体性激素水平变化与原发性肝细胞癌的关系．方法应用放免法测定肝癌组（２０例），肝硬变组（１６例）及正常对照组（２０例）血清雌二醇（Ｅ２）及睾酮（ＴＴＴ）含量，并用放免组化法（ＰＡＰ法）检测肝癌组织及肝硬变组织的雌二醇受体（ＥＲ）及睾酮受体（ＡＲ）含量．结果肝癌组血清Ｅ２含量（４４５５±９３１ｎｇ／Ｌ）明显高于正常对照组（７６６ｎｇ／Ｌ±１７０ｎｇ／Ｌ）而低于肝硬变组（６４９６ｎｇ／Ｌ±１７６ｎｇ／Ｌ）（Ｐ＜００１）；前者ＴＴＴ含量（２５３３００ｎｇ／Ｌ±５６５６０ｎｇ／Ｌ）明显低于后二者（４５８５８０ｎｇ／Ｌ±３４９６０ｎｇ／Ｌ）（Ｐ＜００１）．肝癌组织ＥＲ（８０％）较肝硬变时（４４％）明显增加（Ｐ＜００２５），且与血清Ｅ２含量有明显负相关关系（ｒ＝－０８４７３，Ｐ＜０００１）．ＡＲ阳性百分率在两者无明显差别（ｒ＝－０３１３５，Ｐ＞００５）．结论血清ＴＴＴ含量改变及肝组织ＡＲ浓度改变与肝癌无明显关系，而血清Ｅ２含量改变及肝组织ＥＲ浓度改变与肝癌的发生、发展有密切关系．提示原发性肝细胞癌是一雌激素依赖性肿瘤．     

慢性肾衰患者血清及尿液γ-干扰素的检测及其意义

采用ＥＬＩＳＡ双抗体夹心法检测７１例慢性肾衰（ＣＲＦ）患者及４０例健康成人血及尿的γ－干扰素（ＩＦＮ－γ）水平。结果显示：ＣＲＦ患者血清及尿液ＩＦＮ－γ含量分别为（６２６２±２．６８）ｎｇ／Ｌ和（４３．０１±２．５７）ｎｇ／Ｌ，显著低于正常对照组，［（１０５±７．１０）ｎｇ／Ｌ和（７５±６．１４）ｎｇ／Ｌ］（Ｐ＜０００１），但与尿素氮（ＢＵＮ）及血清肌酐（Ｓｃｒ）无显著相关性（血清及尿ＩＦＮ－γ与ＢＵＮ、Ｓｃｒ相关系数分别是ｒ＝０．２４２５、０３０５６、０１５３３和０１７５０，Ｐ＞００５）。结论：ＩＦＮ－γ作为一种细胞因子参与肾脏病发生、发展过程中的网络调节，血清及尿液中ＩＦＮ－γ水平受到机体Ｔ淋巴细胞及ＮＫ细胞数量及功能影响。     

哮喘患者外周血单个核细胞中白细胞介素-6 mRNA表达与气道炎症的研究

目的探讨外周血单个核细胞（ＰＢＭＣ）中白细胞介素（ＩＬ）６ｍＲＮＡ表达与血嗜酸细胞阳离子蛋白（ＥＣＰ）和１秒用力呼气容积占用力肺活量比值（ＦＥＶ１％）的关系。方法对１２例过敏性哮喘发作期患者、８例缓解期患者及９例健康人，采用ＲＴＰＣＲ法和图像分析半定量法检测ＰＢＭＣ中ＩＬ６ｍＲＮＡ的表达水平及ＥＣＰ和ＦＥＶ１％。结果发作期患者ＩＬ６ｍＲＮＡ的表达明显高于缓解期患者和健康人（Ｐ＜００１），而缓解期患者无明显升高。发作期患者ＩＬ６ｍＲＮＡ的表达水平与血清ＥＣＰ呈中度正相关（ｒ＝０６７９，Ｐ＜００１），而与ＦＥＶ１％呈中度负相关（ｒ＝－０５８９，Ｐ＜００５）。结论过敏性哮喘发作期患者ＰＢＭＣ中ＩＬ６ｍＲＮＡ表达水平显著增强。其气道炎症程度与ＩＬ６基因转录增强有关     

间质性肺疾病患者血清和支气管肺泡灌洗液中内皮素1活？…

评价内皮素对肺纤维化发生，发展作用的影响。方法利用同位素放射免疫直接测定法，检测１０例肺结节病和８例特发性肺纤维化患外周血和支气管肺泡灌洗液中内皮素１（ＥＴ－１）的活性，并与８名健康非吸烟进行对照。结论ＥＴ－１在肺结节病和ＩＰＦ发病机制中起着重要作用，并可作为疾病活动性判定的一项重要参考指标。     

间质性肺疾病支气管肺泡灌洗液中性粒细胞趋化因子和肿瘤坏 …

OBJECTIVE: To investigate the relationship between the level of the neutrophil chemotactic factor(NCF), tumor necrosis factor-alpha(TNF-alpha) in patients with interstitial lung disease(ILD) and the activity of ILD. METHOD: The NCF activities in the BALF and in the serum from 11 patients with sarcoidosis, 7 with idiopathic pulmonary fibrosis (IPF) and 8 normal subjects were determined using the membrane filter and radio-immunoassay. The level of TNF-alpha was also detected. RESULT: In the 7 IPF patients, the level of NCF and TNF-alpha (203 +/- 44 cells/10 HP, 11.7 +/- 2.9 ng/L) in the BALF was higher than that in 8 control patients (83 +/- 45 cells/10 HP, 6.5 +/- 1.4 ng/L, P < 0.01). The level of NCF and TNF-alpha in the BALF from 11 patients with sarcoidosis (186 +/- 50 cells/10 HP, 12 +/- 3 ng/L) was highet than those in 8 control patients (P < 0.01). The level of NCF and TNF-alpha in the BALF from patients with IPF was positive correlated with the percentage of neutrophil (NCF: r = 0.89, P < 0.01; TNF-alpha: r = 0.86, P < 0.05). The level of NCF and TNF-alpha in the BALF of patients with sarcoidosis was positive correlated with the percentage of lymphocyte (NCF: r = 0.78, P < 0.01; TNF-alpha: r = 0.73, P < 0.01. CONCLUSION: The level of NCF and TNF-alpha in the BALF from patients with IPF and sarcoidosis can act as the marker of the activity of alveolitis of IPF and sarcoidosis.     

特发性肺纤维化和结节病患者基质金属蛋白酶的变化及其临床意义

目的 探讨特发性肺纤维化(IPF)和结节病患者基质金属蛋白酶(MMP)-1和MMP-7的变化及其临床意义. 方法 经临床确诊的IPF患者44例为IPF组,其中男23例、女21例,年龄46～70岁,平均(58±9)岁;Ⅱ期结节病患者20例为结节病组,其中男9例、女11例,年龄35～65岁,平均(50±12)岁.均进行肺功能和支气管肺泡灌洗检查.采用酶联免疫吸附试验测定血清和BALF中MMP-1和MMP-7水平.非正态分布的计量资料以中位数表示,采用两个独立样本比较的Wilcoxon秩和检验进行统计学分析,采用Spearson相关性检验进行相关分析. 结果 IPF组患者血清和BALF中MMP-1中位数(范围)分别为3.78(0.14～13.44)和1.09(0.04～5.14)μg/L,均明显低于结节病组的7.79(4.67μ10.68)和2.08(0.05μ4.16) μg/L,两组血清中MMP-1水平的差异有统计学意义(z=-3.53,P<0.01);IPF组患者血清和BALF中MMP-7中位数(范围)分别为7.83(3.57～14.37)和3.75(1.10～9.87)μg/L,均明显高于结节病组的4.04(0.06～9.94)和1.16(0.02～4.47)μg/L,两组血清和BALF中MMP-7水平的差异均有统计学意义(z值分别为-3.84和-5.33,均P<0.01).IPF组患者血清中MMP-7水平与DLCO占预计值%和BALF中性粒细胞构成比呈显著负相关(r值分别为-0.56和-0.47,均P<0.01),IPF组患者BALF中MMP-7水平与DLCO占预计值%呈显著负相关(r=-0.31,P<0.05). 结论 在肺纤维化炎症细胞浸润阶段MMP-1水平高于纤维化阶段,在纤维化基质重塑阶段MMP-7水平高于炎症阶段.MMP-7有可能作为肺纤维化严重程度的参考指标.     

肺结节病支气管肺泡灌洗液中肿瘤坏死因子和中性粒细胞趋化 …

OBJECTIVE: To evaluate the role of cytokines released by the inflammatory cells and immunocytes from patients in pathogenesis of developing sarcoidosis. METHODS: With well- microchemotaxis and allergy immunology, the level of tumor necrosis factor-alpha (TNF-alpha) and neutrophil chemotactic factor (NCF) was measured in the serum and BALF of 11 sarcoidosis and 7 IPF and 8 normal subjects (non-smokers). RESULTS: The levels of TNFalpha (11.9 +/- 3.2, 11.7 +/- 3.0 ng x L(-1)) and NCF (191 +/- 51, 203 +/- 44 cell x 10HP(-1)) of BALF in the patients with sarcoidosis and IPF were significantly higher than these in control group (P < 0.01) and were higher than those in serum. The level of TNF-alpha in the BALF of patients with sarcoidosis was positively correlated with the percentage of lymphocytes (r = 0.73, P < 0.01). The activity of NCF in the BALF of patients with IPF was positively correlated with the percentage of neutrophils (r = 0.89, P < 0.01). CONCLUSIONS: It indicated that TNF-alpha and NCF might play an important role in the pathogenetic process of the sarcoidosis and IPF, and can act as the marker of activity of these diseases.     

特发性肺纤维化患者支气管肺泡灌洗液中白细胞介素13的水平及意义

目的　探讨特发性肺纤维化 (IPF)患者支气管肺泡灌洗液 (BALF)和外周血中白细胞介素 13 (IL 13 )水平的变化及其意义。方法　选择 17例IPF患者 (IPF组 )和 8名无器质性肺疾病者 (对照组 )。采用IL 13特异的酶联免疫吸附法测定 (ELISA)法检测 2组BALF和外周血中IL 13的水平 ,分析患者IL 13水平与其肺功能、血气之间的关系。结果　IPF组BALF和外周血中IL 13水平分别为(3 0 1± 86)ng/L、(178± 3 6)ng/L ;对照组分别为 (10 3± 2 4)ng/L、(55± 15)ng/L ,两者比较差异均有显著性 (P <0 0 1)。IPF组BALF中IL 13水平与BALF中性粒细胞数呈正相关 (r =0 786,P <0 0 1) ,与用力肺活量、一秒钟用力呼气容积、肺一氧化碳弥散量及动脉血氧分压均呈一定的等级负相关 (r分别为 -0 898、-0 878、-0 874、-0 890 ,P均 <0 0 1)。结论　IL 13可能在IPF的发病过程中起一定作用 ,并有可能作为判断病变进展情况的一项指标     

Proteolytic activities in bronchoalveolar lavage fluid of interstitial lung diseases: correlation to stage and prognosis

In 18 patients with sarcoidosis, 10 patients with idiopathic pulmonary fibrosis (IPF), 6 patients with exogen allergic alveolitis (EAA), and 9 control persons we investigated proteolytic activities in bronchoalveolar lavage fluid (BALF). In lymphocyte-macrophage alveolitis (i.e. sarcoidosis and EAA) proteolytic activities in BALF were low, but the activities correlated with lung function deterioration within 1 year. In IPF (i.e. in neutrophil alveolitis) we found a striking correlation between proteolytic activities and stage of disease: high activities correlated with early stages, lower values with late stages of IPF. Measurement of proteolytic activity in BALF seems to be of interest to differential diagnosis and to prognosis of interstitial lung disease.     

特发性肺纤维化患者肺泡灌洗液及血清中前列腺素E2和白细胞介素12、13水平变化的意义

目的　探讨特发性肺纤维化 (IPF)患者肺泡灌洗液及血清中前列腺素E2 (PGE2 )和白细胞介素 12、13(IL 12、IL 13)水平变化的意义。方法　用放射免疫法及酶联免疫吸附法 ,检测 30例IPF患者 (IPF组 )血清及支气管肺泡灌洗液 (BALF)中PGE2 和IL 12、IL 13的水平 ;健康非吸烟的自愿献血者 30名 ,为血清对照组 ,检测其血清PGE2 和IL 12、IL 13的水平 ;以胸痛为主诉进行BALF检查证实为健康者 9名 ,作为BALF对照组 ,检测其BALF中PGE2 和IL 12、IL 13的水平。结果　IPF组患者BALF中PGE2 为 (5 91± 88)ng/L、IL 12为 (1 34± 0 2 5 )ng/L、IL 13为 (38± 5 )ng/L ,对照组BALF中PGE2 、IL 12、IL 13分别为 (2 38± 7)、(2 2 9± 0 2 6 )、(2 0± 4 )ng/L ,两组相比差异有显著意义 (P值均 <0 0 1) ;血清IL 13水平的变化与BLAF一致 ,但IPF组患者血清PGE2 为 (2 35± 13)ng/L、IL 12为 (2 35± 0 14 )ng/L ,与血清对照组相比差异无显著性 (P >0 0 5 )。结论　IPF患者BALF中PGE2 水平升高 ,可能与IL 13的增高和IL 12水平的下降有关 ,并在IPF的发生、发展中起重要的作用。肺纤维化患者PGE2水平增高主要发生在肺的局部 ,而并非全身性的。     

Bronchoalveolar lavage fluid angiotensin-converting enzyme in interstitial lung diseases

In this study we evaluated the disease specificity of bronchoalveolar lavage fluid angiotensin-converting enzyme (BALF-ACE), its correlation with cellular constituents of bronchoalveolar lavage fluid (BALF), and for sarcoidosis, with other proposed markers of disease activity. Furthermore, the question of the clinical value of BALF-ACE determinations in in interstitial lung diseases or any of its subgroups was addressed. The study population consisted of 222 patients, 69 with biopsy proven sarcoidosis, 3 with hypersensitivity pneumonitis, 4 with acute histoplasmosis, 27 with idiopathic pulmonary fibrosis (IPF), 4 with rheumatoid arthritis-related interstitial fibrosis, 9 with pulmonary drug toxicity, 16 with pulmonary malignancies, 26 with other parenchymal lung disease entities, and 30 in whom the final diagnosis remained indeterminate. Elevated BALF-ACE concentrations were seen in all diagnostic categories. In sarcoidosis BALF-ACE levels correlated well with lavage lymphocyte counts (r = 0.49; p less than 0.0001), in contrast to IPF where they correlated well with lavage neutrophil counts (r = 0.51; p less than 0.007). The correlation of BALF-ACE and serum-ACE was significant. In sarcoidosis the mean BALF-ACE level was lower for patients with Stage-I chest roentgenographic patterns (0.664 U/L), compared to those with Stage II (1.112 U/L) and Stage III (1.083 U/L). It was concluded that elevated BALF-ACE levels are not specific for sarcoidosis. The correlations of BALF-ACE levels with different cellular constituents of BALF suggest a different cellular origin of BALF-ACE. In sarcoidosis BALF-ACE levels correlate well with other proposed markers of disease activity and seem to reflect pulmonary activity better than serum ACE.(ABSTRACT TRUNCATED AT 250 WORDS)     

Levels of cytokeratin 19 fragments in bronchoalveolar lavage fluid correlate to the intensity of neutrophil and eosinophil-alveolitis in patients with idiopathic pulmonary fibrosis

Cytokeratin 19 (CK19) is a specific cytoskeletal structure for simple epithelia, including bronchial and alveolar epithelial cells (BAEC). Since CK19 is abundant in alveolar epithelial cells, and could be released from injured alveolar epithelium in idiopathic pulmonary fibrosis (IPF), we investigated the levels of CK19 fragments in the bronchoalveolar lavage fluids (BALF) of 16 patients with idiopathic pulmonary fibrosis (IPF) and 12 patients with sarcoidosis using enzyme-linked immunoassay. There were also 19 control subjects (10 asymptomatic smokers and nine non-smokers). BALF from the non-smokers as well as the asymptomatic smokers contained few CK19 fragments (0.2+/-0.2, 1.3+/-0.5 pg ml(-1) respectively). There were significantly high levels of CK19 in the BALF from patients with IPF (7.3+/-1.4 pg/ml; P<0.01 vs. control non-smoker). Even if the levels of CK19 were expressed as relative to the albumin concentration, significantly increased levels of CK19 fragments were noted in BALF from patients with IPF. However, these levels were not found in BALF from patients with sarcoidosis. Importantly, levels of CK19 fragment in BALF were significantly correlated to the number of neutrophils (r = 0.791, P<0.001) and eosinophils (r = 0.771, P<0.001) but not to that of macrophages or lymphocytes in BALF from IPF patients. Our results suggest the usefulness of CK19 measurement in BALF for assessing the presence of bronchiolo-alveolar epithelial injuries in idiopathic pulmonary fibrosis.     

特发性肺纤维化患者支气管肺泡灌洗液和血清基质金属蛋白酶及其抑制剂检测

目的探讨特发性肺纤维化(IPF)患者支气管肺泡灌洗液(BALF)及血清中基质金属蛋白酶9(MMP9)、基质金属蛋白酶组织抑制剂1(TIMP1)水平的变化。方法2001至2004年用酶联免疫吸附(ELISA)法检测30例IPF患者BALF及血清中MMP9和TIMP1的水平,同时行肺高分辨率CT(HRCT)及肺功能检查。健康非吸烟的自愿献血者30名,为血清对照组。以胸痛为自觉症状在我院自愿进行纤维支气管镜及BALF检查,经体检及X线检查证实为健康者13名,作为BALF对照组。结果IPF患者BALF及血清中MMP9水平为(245±26)和(203±32)ng/L,对照组为(205±22)和(186±16)ng/L,两组相比差异无统计学意义;IPF组BALF及血清中TIMP1水平[(522±81)、(166±29)ng/L]高于对照组[(201±31)、(87±16)ng/L],差异有统计学意义;IPF组BALF及血清中MMP9/TIMP1比值(0.53±0.18,1.5±0.3)低于对照组(1.06±0.38,2.6±0.5)。HRCT、肺功能评分及BALF中上述指标与MMP9无明显相关性,与TIMP1呈正相关,与MMP9/TIMP1比值呈负相关。结论IPF患者肺纤维化的发生与TIMP1水平升高及MMP9/TIMP1比值降低对细胞外基质降解的抑制有关,后者可能意义更大;患者肺影像学及肺功能变化可能也与此有关。