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目的以肺泡灌洗液(BALF)中羟脯氨酸(HYP)、基质金属蛋白酶9(MMP-9)及其抑制物(TIMP-1)为观察指标,了解呼吸道异物吸入对气道损害、重建的影响。方法对2002年6月至2003年3月在浙江大学儿童医院住院的46例呼吸道异物患儿,按异物滞留体内时间分为3组(A组:<7d,B组:~30d,C组:>30d),对3组患儿的BALF进行细胞学分析,并对其中的HYP、MMP-9细胞阳性率和TIMP-1质量浓度进行测定。对照组为12例有异物吸入可疑病史,但最后排除的儿童。结果对照组与患儿组间细胞学计数差异无显著性(P>0.05),但肥大细胞仅在患儿BALF中发现。对照组及各组患儿的MMP-9细胞阳性率分别为33.3%、62.5%、80.0%和93.3%,TIMP-1细胞阳性率分别为16.3%、50.0%、80.0%和93.3%,总体差异均有显著性意义(P=0.006和P<0.001);各组间HYP差异有显著性意义(P<0.001)。结论气道异物促进MMP-9、TIMP-1及HYP的表达和分泌,提示气道异物可导致支气管肺组织破坏和重建,其程度与异物滞留时间有关。

Levels of hydroxyproline,matrix metalloproteinase-9 and its inhibitor in bronchoalveolar lavage fluid of children with airway foreign body aspiration

Objective To observe the extracellular matrix remodeling on children with airway foreign body aspiration (FBA) through detecting the expression of matrix metalloproteinase-9 (MMP-9),tissue inhibitor of matrix metalloproteinase-1 (TIMP-1),and hydroxyproline (HYP) in bronchoalveolar lavage fluid (BALF).Methods 12 controls and 46 children with FBA removed via fiberoptic bronchoscopy from 2002~2003 were studied in our unit.Patients were divided into 3 subgroups according to the duration of FBA (subgroup A:<7 days; subgroup B:7~30 days; subgroup C:>30 days).Cell count,levels of MMP-9,TIMP-1 in BALF cells and HYP of BALF was measured.Results The total number of cells and differential cells recovered in BALF did not differ significantly between patients and controls (P=0.431).The positive rate of MMP-9 in controls and subgroups of patients were 33.3%,62.5%,80.0%,and 93.3% with a significant difference (P=0.006).The positive rate of TIMP-1 was 16.3%,50.0%,80.0%,and 93.3% with a significant difference (P<0.001).The differences of HYP in controls and different patients are significant as well (P<0.001).There were positive correlations between the MMP-9,TIMP-1,HYP levels in patients and duration of FB retention (P<0.05).The levels of MMP-9 and TIMP-1 were also associated with percent of mast cell (P=0.009,P=0.005).The differences of MMP-9 and TIMP-1 before and after FB removed were not significant (P=0.131,P=0.522),while the HYP levels decreased significantly than that before FB removed (P=0.001).Conclusion MMP-9,TIMP-1 and HYP are significantly elevated in children with FBA and are related to the extracellular matrix remodeling.These changes are irreversible in short time