支气管肺泡灌洗在肺间质疾病中的应用进展

支气管肺泡灌洗在肺间质疾病中的应用进展南京大学医学院附属鼓楼医院（２１０００８）侯杰支气管肺泡灌洗（ＢＡＬ）是研究肺泡腔内的灌洗液，是一种诊断和研究一些病因不明的肺间质疾病的手段。近年由于新的检查方法不断发展，ＢＡＬ已成为各种急慢性肺部疾病的重要检查...     

p16基因异常甲基化检测在非小细胞肺癌中的应用研究

应用甲基化特异性PCR技术检测 2 1例非小细胞肺癌、18例良性肺部疾病的手术切除标本及对应的支气管肺泡灌洗液。结果表明 4 7.7%的肺癌组织标本呈现p16基因异常甲基化。在检出异常甲基化的肺癌患者的对应支气管灌洗液中 ,70 %也检出甲基化存在。而肺部良性疾病患者在手术切除标本和支气管灌洗液标本中均未检出p16基因甲基化存在。     

治疗性肺灌洗术的临床应用

许多肺部疾病时支气管和肺泡内存在过多的分泌物或异常物质潴留,是因为感染或长期从环境中吸入有害物质或是异常代谢性物质沉积所致,表现为以痰栓阻塞为主的感染性支气管肺炎、黏液黏稠症、吸入性肺炎、多种无机粉尘所致的尘肺(pneumoconiosis)及肺内粉末沉着症、肺泡蛋白沉积症( pulmonary alveolar proteinosis,PAP)等.肺灌洗术是通过纤维支气管镜或双腔支气管导管洗出肺内的特异性物质(分泌物、粉尘等)治疗肺部疾病的一种方法.根据灌洗范围、灌洗量和方法的不同,可分为小容量支气管肺泡灌洗术( bronchoalveolar lavage,BAL)和大容量全肺灌洗术(whole lung lavage,WLL).我们就治疗性肺灌洗术的历史、技术方法、安全性及其临床应用进行综述.     

支气管肺泡灌洗在职业医学中的应用

(一)前言 1898年东德Gustav Killian(1860～1921)用支气管镜摘出气道内异物的论文发表。1960年日本池田茂等创制纤维支气管镜。1974年Reynolds开始用支气管肺泡灌洗术作为肺部感染等肺部疾患的辅助诊断手段之一。由于支气管肺泡灌洗术是获得肺泡表面液体内细胞和物质的一种安全技术,近十年来,支气管肺泡灌洗也很快应用于职业性粉尘和尘肺的发病机理、生化免疫、细胞形态以及粉尘毒性等方面的研究,其是否可以应用于职业性尘肺的综合诊断和治疗上, 已引起国内外学者的注意,并着手研究。本文拟就有关支气管肺灌洗在职业医学方面应用的资料,整理综述如下。     

经纤支镜支气管肺泡灌洗方法治疗严重肺部感染有效性分析

目的:探究经纤支镜支气管肺泡灌洗方法治疗严重肺部感染的有效性分析。方法:将我院收治的82例严重肺部感染患者作为研究对象,以奇偶数字法按患者入院时间将其分为灌洗组和常规组,各41例,常规组应用治疗方案予以吸痰、抗感染、提高免疫力进行治疗,灌洗组则在常规组的基础上采取纤维支气管镜结合支气管肺泡灌洗进行治疗。观察并对比两组患者治疗前后临床指标数据、治疗起效时间和临床治疗有效率。结果:治疗后灌洗组的各项临床指标明显优于常规组;治疗后灌洗组的治疗起效时间要早于常规组;灌洗组患者治疗有效率高于常规组,P值均<0.05,均具有统计学意义。结论:在治疗严重肺部感染时,在常规治疗方案中配合使用纤维支气管镜支气管肺泡灌洗法可有效的提高临床治疗效果,是一种快速又有效的治疗方式。     

无痛纤支镜下小儿肺泡灌洗的术中护理

纤维支气管镜（下称纤支镜）在儿童呼吸道疾病的正确诊断和治疗方面起着非常重要的作用，通过纤支镜行支气管肺泡灌洗，能解决药物治疗和胸部理疗效果不佳的肺部大片感染和肺不张的临床难题。2006年2月至2008年2月，湖北省妇幼保健院儿内科共进行了58例无痛性纤支镜下肺泡灌洗术，术中顺利，效果满意，现报告如下。     

肺曲霉菌感染病例分析

目的探讨支气管肺泡灌洗液半乳甘露聚糖(Galactomannan,GM)试验对临床肺部曲霉菌感染患者的诊断价值。方法对2017年西安交通大学第一附属医院收治的肺部曲霉菌感染的一例重症患者的临床资料、影像学及病原学资料、诊断和治疗过程及药物浓度监测结果进行分析总结。结果患者病情危重,以慢性阻塞性肺疾病急性加重期,肺部感染,Ⅱ型呼吸衰竭为主要诊断。给予抗细菌及真菌等治疗效果不佳,治疗过程中多次血GM试验阴性,G试验阴性,痰培养及血培养均阴性。但患者体温、白细胞升高,治疗中给予纤维支气管镜检查,并留取支气管肺泡灌洗液培养及GM试验,结果提示GM试验3.87,支气管肺泡灌洗液培养提示烟曲霉生长。患者诊断明确,根据药敏结果结合患者脏器功能选择伏立康唑抗真菌治疗,并监测药物浓度指导抗真菌药物调整,患者好转出院。结论对于血清GM试验阴性的重症肺部感染患者,常规抗感染治疗效果不佳时,应尽早行支气管肺泡灌洗液GM试验及培养。支气管肺泡灌洗液GM试验比血清GM试验更有利于肺部曲霉菌感染的早期诊断。     

纤维支气管镜在机械通气合并肺部感染中的应用

目的总结纤维支气管镜检查和支气管肺泡灌洗对机械通气合并肺部感染患者的临床疗效.方法对58例因各种原因呼吸衰竭行机械通气合并肺部感染患者应用纤维支气管镜检查气道、负压吸除气道分泌物、取痰细菌培养、支气管肺泡灌洗等治疗.结果纤维支气管镜检查并活检发现腺癌1例;发现气管狭窄2例;明确了出血部位2例;痰培养阳性50例.58例经纤维支气管镜治疗,治疗后PaO2、PaCO2、SaO2明显好转,与治疗前比较差异有统计学意义(P＜0.05),机械通气时间明显缩短.结论纤维支气管镜检查和支气管肺泡灌洗在机械通气合并肺部感染中的应用是安全、有效的治疗方法.     

红外分光光度法测定支气管肺泡灌洗液中游离二氧化硅含量

支气管肺泡灌洗术(BAL)已广泛应用于肺部疾病的诊断和治疗。而临床用于尘肺治疗已近十年,并取得较为满意效果。要探讨有关BAL治疗尘肺的机制,就必须准确测定支气管肺泡灌洗液(BALF)中游离二氧化硅的含量有关BALF中SiO_2的测定,国内仍采用焦磷酸法,国外已有用X线衍射及红外分光光度法的报道。本文研究红外法测定BALF中SiO_2的含量,并与焦磷酸法比较,说明红外法具有快速、准确、简便等优点。     

支气管肺泡灌洗术在尘肺临床中的应用

支气管肺泡灌洗术(Broncho AlveolarLavage BAL)是近20年来发展起来的一项安全、可对肺泡异物、炎症和免疫反应产物进行反复取样、促排的技术。通过对其采集的支气管肺泡灌洗液(BALF)的细胞成份和非细胞成份的研究,可以进一步探讨某些肺部疾患的病因、发病机制、诊断、疗效评价及预后情况。本文着重介绍近年来BAL在尘肺方面的应用。     

The influence of cigarette smoke on the selected bronchoalveolar cells in experiment

The occurence of lung diseases (obstructive, malignant) resulting from smoking has an increasing tendency. The lung is the primary organ at risk from the effects of inhaled cigarette smoke and smoking has been implicated as a contributing factor to the causation of various respiratory diseases. The aim of presented work was to find out the subchronic effect of the 6-month exposure to cigarette smoke on the selected inflammatory and cytotoxic parameters of bronchoalveolar lavage in W rats and thus to contribute to understanding of the mechanism of action of tobacco smoke and/or path mechanism of lung injury developed after cigarette smoking. In special chamber, the animals smoked 8 standard research 1R1 type of cigarettes per day, except Saturdays and Sundays, during 6 months. The daily concentration of total particulate matter (TPM)/m3 air for two hours per exposure requiring to burn eight cigarettes was 85 mg. Animals were sacrificed after the 6-month exposure and bronchoalveolar lavage (BAL) was performed and selected inflammatory and cytotoxic BAL parameters were examined and compared with the control group. Following BAL parameters were investigated: the total cell and alveolar macrophages (AM) count in BAL, the differential cell count (% of AM, % of polymorphonuclears--PMN, % of lymphocytes--Ly), proportion of immature AM, proportion of bi-nucleated cells--BNC, viability, the phagocytic activity of AM, cytokines TNF-alpha (tumor necrosis factor alpha) and IL-1beta (interleukin-1beta). CONCLUSION: A) The 6-month smoking of eight cigarettes daily significantly changed prevailing number of examined BAL parameters; B) The presence of inflammatory and cytotoxic responses in lung tissue can probably signalize beginning or developing of disease process.     

Role of bronchoalveolar lavage in analysis of diffuse pulmonary diseases

Bronchoalveolar lavage (BAL) is often referred to as "Liquid biopsy of the lung". We reviewed the usefulness of BAL in the analysis of diffuse pulmonary diseases, focussing on the influences of smoking on cellular and soluble components in BAL, what causes the discrepancy between findings in BAL fluids and those in biopsy specimens and how cardiovascular system is influenced during this procedure. BAL offers a practical approach to not only academic, but clinical analysis such as therapeutic guide and prognosis.     

Bronchoalveolar lavage analysis, gallium-67 lung scanning and soluble interleukin-2 receptor levels in asbestos exposure

This study examined different markers of lung immunologic and inflammatory responses to previous asbestos exposure. We performed bronchoalveolar lavage (BAL) and gallium-67 (67Ga) lung scans and measured serum and BAL soluble interleukin-2 receptor (IL-2R) and angiotensin-converting enzyme (SACE) levels in 32 subjects with a history of significant asbestos exposure, 14 without (EXP) and 18 with (ASB) radiographic evidence of asbestosis. BAL analysis revealed increases in neutrophils in both ASB and EXP when compared to controls (P less than 0.01), which persisted after adjustment for smoking category. Although significant abnormalities of macrophage and total lymphocyte profiles were not found in the study population, lymphocyte subpopulation analysis revealed elevation of BAL T4/T8 ratios in the entire study group (ASB + EXP) when compared to controls (P less than 0.05), independent of smoking category. 67Ga lung scan activity was increased in 56% of ASB and in 36% of EXP: no correlations between positive scans and different radiological and functional parameters could be found. There was no significant elevation of mean SACE, serum, or BAL IL-2R levels in any of the study categories. These data suggest that asbestos exposure may be associated with parenchymal inflammation, even in the absence of clinical criteria for asbestosis. Abnormalities of gallium uptake and of BAL analysis reflect the clinically inapparent inflammation. The increased BAL T4/T8 ratios observed suggest that abnormal local pulmonary immunoregulation may play a role in the pathogenesis of asbestos-related lung diseases.     

Non-fibrous dust load and smoking in dental technicians: a study using bronchoalveolar lavage.

A study was conducted with transmission electron microscopy to find whether bronchoalveolar lavage could be used to identify subjects with occupational exposure to mineral particles. Non-fibrous mineral particles in bronchoalveolar lavage (BAL) fluid from 46 dental technicians and 41 white collar controls with lung diseases but free from occupational exposure to dusts were analysed. The total particle concentration in BAL fluid was significantly higher in dental technicians than in controls (12.18 x 10(5) particles/ml of BAL fluid, v 2.03 x 10(5) particles/ml, p < 0.001). Dental technicians had significantly more crystalline silica, aluminium, and alloys containing nickel and chromium. There was a non-significant twofold increase of total particle concentration in the lungs of dental technicians who were smokers compared with non-smokers. The results strongly support the use of BAL fluid analysis to assess dust accumulation in workers in heavily exposed occupations such as dental technicians. This is a valid method to evaluate occupational exposure to non-fibrous mineral particles, and may be useful to determine the occupational aetiology of some respiratory diseases.     

Retention of Asbestos Bodies in the Lungs of Welders

Examination of asbestos bodies (AB) retained in the lungs is a useful way of assessing past occupational exposure to this material. AB retention has been extensively studied in workers directly exposed to asbestos, but less so in those end users, such as welders, who use asbestos-containing products. We therefore retrospectively studied AB retention in 211 welders, for whom biological testing procedures had been requested by a chest physician, between 1988 and 1991. Optical microscopy of AB was performed on samples of sputum (40 subjects), bronchoalveolar lavage fluid (BAL) (147 subjects), and lung tissue obtained after thoracotomy (38 subjects). Information on previous jobs and exposure was obtained using a questionnaire (the mean duration of welding activities was 16.6 years). Eighty-two subjects (38.9%) had elevated lung retention of AB in all the samples studied. Significant AB retention occurred in only 30% of sputum samples, but in 40.1% of BAL samples and 39.5% of lung tissue samples. The duration of welding activities correlated with the density of AB in BAL or lung tissue (r = 0.31, p < 0.01 and r = 0.49, p < 0.05, respectively). On the basis of the questionnaire, only two of the welders with significant AB retention had other occupational exposure to asbestos. Our findings suggest that welding activities may increase lung retention of AB, and consequently might produce higher risks of fibrotic and/or malignant pulmonary diseases. These potential risks need to be brought to the attention of doctors; a longitudinal follow-up may also be warranted in such populations, even after individuals have ceased their welding jobs.     

BAL fluid cytology in the assessment of infectious lung disease

The need for rapid laboratory results has marked the application of bronchoalveolar lavage (BAL) fluid cytology as a valuable tool in the assessment of infectious lung conditions. The techniques of BAL fluid processing presented here can be performed in a microbiological laboratory. The diagnostic value of BAL fluid cytology for the prediction of ventilator-associated pneumonia is discussed.     

Reliability of bronchoalveolar lavage in the routine clinical assessment of patients with sarcoidosis. A retrospective analysis

BACKGROUND: The aim of the study was to evaluate the reliability of bronchoalveolar lavage in the routine clinical assessment of patients with sarcoidosis. METHODS: Study design: retrospective analysis. Setting: 2 Divisions of Respiratory Medicine, both in the context of a public general hospital (Ospedale Morelli, Sondalo, Italy and Ospedale Civile, Piacenza, Italy). Patients: 89 patients with definitely diagnosed diffuse infiltrative lung disease, who underwent bronchoalveolar lavage as part of their initial diagnostic work-up in the period 1991-2001. Fifty-one of them had biopsy-proven sarcoidosis. Diagnostic procedures were: transbronchial lung biopsy (n=26), bronchial biopsy (n=11), skin biopsy (n=6), surgical lung biopsy (n=4), superficial lymph node biopsy (n=3), mediastinal lymph node biopsy (n=1). In 38 patients various interstitial lung diseases were diagnosed, according to established criteria. Measures: we compared the percentage of BAL lymphocytes and CD4/CD8 ratio in the 2 groups. Sensitivity, specificity, positive and negative predictive value of BAL parameters were calculated with a cut-off value of 28% for BAL lymphocytes and 3.5 for CD4/CD8 ratio. RESULTS: The percentage of lymphocytes was similar in the 2 groups (p=0.19); CD4/CD8 ratio was 5.7+/-4.9 in sarcoidosis and 2.0+/-3.3 in the other patients (p=0.0001). BAL CD4/CD8 ratio in sarcoidosis had sensitivity 58%, specificity 86%, positive predictive value 85%, negative predictive value 61%. CONCLUSIONS: BAL has a low sensitivity in patients with sarcoidosis; CD4/CD8 ratio >or=3.5 strongly suggests sarcoidosis but is not specific enough if considered alone.     

尘肺患者支气管肺泡灌洗液分析

对72例尘肺及19名健康志愿者的支气管肺泡灌洗液(BALF)进行了细胞学及生化成份的分析。结果提示矽肺早期阶段(Ⅰ期)细胞浓度明显高于正常对照组及其他各期矽肺;细胞分类表现为矽肺淋巴细胞(Lym)比率增加,石棉肺除Lym增加外,嗜中性细胞(Neut)亦明显增加;矽肺、石棉肺的肺泡巨噬细胞(PAM)比率相对减少。生化成份测定结果为矽肺BALF的总蛋白、白蛋白、乳酸脱氢酶(LDH)、β-葡萄糖醛酸酶(β-G)及IgG含量不同程度增高,石棉肺除了Ⅰ期LDH活力升高外,其余指标变化不明显。作者认为BALF的细胞学改变是免疫效应细胞对外来刺激的一种应答,并与随之出现的炎性介质及生化变化有密切关系,可能是肺纤维化形成的基础。     

大鼠染石英粉尘后不同时间肺灌洗液细胞中羟脯氨酸等指标变化

本文对大鼠染５０ｍｇ石英尘后不同时间的肺灌洗液细胞中羟脯氨酸等指标变化进行了研究。结果表明：染尘后各时相肺灌洗液中细胞分类，细胞中羟脯氨酸及总脂，上清腋中总脂，总蛋白，乳酸脱氢酶及铜蓝蛋白均出现不同程度的变化，多以１４或３０天变化最明显。进一步对染尘３０天内各指标进行分析表明，以肺灌洗液细胞中的羟脯氨酸与全肺胶原增加这间的相关性最好，说明该指标为反映早期肺纤维化特异性强，相关性好的重要指标。     

Early lung events following low-dose asbestos exposure

A conscious sheep model recently developed to study sequentially the bronchoalveolar milieu was applied to the investigation of the early lung events following very low dose asbestos exposure. UICC Canadian chrysotile fibers were administered in three monthly intratracheal injections of a suspension of 0 (controls), 1, 2, 4, 8, and 16 mg of asbestos in 50 ml saline. Three sheep per dose were repeatedly exposed to the same monthly doses and all were studied by serial pulmonary function (PF) tests, transbronchial lung biopsies (LB), and bronchoalveolar lavages (BAL). These low-dose exposures did not change the PF tests; routine lung histopathology was not altered except for the observation of occasional fibers in the alveoli, but there was a significantly higher yield in the total BAL cellular due to a marked increase in the macrophage and a small rise in the lymphocyte populations. These changes in the BAL cells occurred without significant changes in the biochemical analyses of the BAL supernatant. These data establish that very low dose asbestos exposure induces migration of macrophages and lymphocytes into the bronchoalveolar milieu. These cells have a major role in the lung defense and have been implicated in the development of asbestos-related diseases.