儿童急性呼吸窘迫综合征肺泡灌洗液中巨噬细胞的动态变化

The dynamic change of alveolar macrophage in BALF on children with ARDS

目的 观察儿童急性呼吸窘迫综合征 (ARDS)肺泡灌洗液 (BALF)中肺泡巨噬细胞 (AM)的变化规律 ,评价巨噬细胞在ARDS早期诊断的作用。方法 16例患儿在确诊为ARDS后 6h检测血清巨噬细胞移动抑制因子 (MIF)浓度 ,并于 6h、 12h、 18h分别收集肺泡灌洗液检查白细胞总数及分类 ,8例正常儿童及 16例肺炎急性期患儿检测血清MIF并收集一次肺泡灌洗液并作细胞计数和分类。结果 ARDS患儿MIF显著高于正常儿童及肺炎患儿。BALF肺泡巨噬细胞数在ARDS患儿显著高于肺炎儿童组及正常对照组。随着病程推移 ,ARDS患儿BALF肺泡巨噬细胞肝占比例呈逐渐下降趋势。而白细胞总数及中性粒细胞数 (GRAN)所占比例逐渐增高。结论 肺泡巨噬细胞可能是ARDS的早期效应细胞 ,在启动和激活多形核细胞的趋化和炎症的发展中起重要作用。

Objective To investigate the dynamic change of the alveolar macrophage(AM) in broncho-alveolar lavage fluid (BALF)on patients with ARDS, and to evaluate the diagnostic value of AM in early phase of ARDS.Methods Analysis was performed in BALF on patients,who were classified into ARDS(n=16), pneumonia(n=16) and normal control groups(n=8). The level of macrophage migration inhibitor factor(MIF)in serum was also evaluated.Results The level of MIF in serum and macrophage count in BALF from patients with ARDS was higher than those in the other two groups(P<0.01). During ARDS, the proportion of AM declined gradually, and total leucocyte and granulocyte count increased.Conclusion Macrophage may take an important role in the chemotaxis of PMN and the development of inflammation, and may be the effector cell in the earlier period of ARDS.