Bronchoalveolar lavage fluid assessment facilitates precision medicine for lung cancer

Lung cancer is the most common and fatal malignant disease worldwide and has the highest mortality rate among tumor-related causes of death.Early diagnosis and precision medicine can significantly improve the survival rate and prognosis of lung cancer patients.At present,the clinical diagnosis of lung cancer is challenging due to a lack of effective non-invasive detection methods and biomarkers,and treatment is primarily hindered by drug resistance and high tumor heterogeneity.Liquid biopsy is a method for detecting circulating biomarkers in the blood and other body fluids containing genetic information from primary tumor tissues.Bronchoalveolar lavage fluid(BALF)is a potential liquid biopsy medium that is rich in a variety of bioactive substances and cell components.BALF contains information on the key characteristics of tumors,including the tumor subtype,gene mutation type,and tumor environment,thus BALF may be used as a diagnostic supplement to lung biopsy.In this review,the current research on BALF in the diagnosis,treatment,and prognosis of lung cancer is summarized.The advantages and disadvantages of different components of BALF,including cells,cell-free DNA,extracellular vesicles,and micro RNA are introduced.In particular,the great potential of extracellular vesicles in precision diagnosis and detection of drug-resistant for lung cancer is highlighted.In addition,the performance of liquid biopsies with different body fluid sources in lung cancer detection are compared to facilitate more selective studies involving BALF,thereby promoting the application of BALF for precision medicine in lung cancer patients in the future.

Bronchoalveolar lavage fluid metagenomic next-generation sequencing assay for identifying pathogens in lung cancer patients

Background:For patients with lung cancer,timely identification of new lung lesions as infectious or non-infectious,and accurate identification of pathogens is very important in improving OS of patients.As a new auxiliary examination,metagenomic next-generation sequencing(mNGS)is believed to be more accurate in diagnosing infectious diseases in patients without underlying diseases,compared with conventional microbial tests(CMTs).We designed this study tofind out whether mNGS has better performance in distinguishing infectious and non-infectious diseases in lung cancer patients using bronchoalveolar lavagefluid(BALF).Materials and Methods:This study was a real-world retrospective review based on electronic medical records of lung cancer patients with bronchoalveolar lavage(BAL)and BALF commercial mNGS testing as part of clinical care from 1 April 2019 through 30 April 2022 at The First Affiliated Hospital of Sun Yat-sen University.164 patients were included in this study.Patients were categorized into the pulmonary non-infectious disease(PNID)group(n=64)and the pulmonary infectious disease(PID)group(n=100)groups based onfinal diagnoses.Results:BALF mNGS increased the sensitivity rate by 60%compared to CMTs(81%vs.21%,p<0.05),whereas there was no significant difference in specificity(75%vs.98.4%,p>0.1).Among the patients with PID,bacteria were the most common cause of infection.Fungal infections occurred in 32%of patients,and Pneumocystis Yersini was most common.Patients with Tyrosine kinase inhibitors(TKIs)therapy possess longer overall survival(OS)than other anti-cancer agents,the difference between TKIs and immuno-checkpoint inhibitors(ICIs)was insignificant(median OS TKIs vs.ICIs vs.Anti-angiogenic vs.Chemo vs.Radiotherapy=76 vs.84 vs.61 vs.58 vs.60).Conclusions:our study indicates that BALF mNGS can add value by improving overall sensitivity in lung cancer patients with potential pulmonary infection,and was outstanding in identifying Pneumocystis infection.It could be able to help physicians adjust the follow-up treatment to avoid the abuse of antibiotics.

Value of eosinophil count in bronchoalveolar lavage fluid for diagnosis of allergic bronchopulmonary aspergillosis: A case report

BACKGROUND An immediate hypersensitive immune response to Aspergillus fumigatus antigens is one of the main characteristic features of allergic bronchopulmonary aspergillosis(ABPA).As ABPA is an allergic respiratory disease,immunoglobulin E and peripheral-blood eosinophilia have been used as diagnostic indicators.However,eosinophilia in bronchoalveolar lavage fluid(BALF)has not been considered in the diagnostic criteria for ABPA.CASE SUMMARY We present a case of ABPA in which the eosinophil count in peripheral blood was not increased,whereas the eosinophil percentage in BALF reached 60%.After antifungal and hormone therapy,imaging revealed very good resolution of lung infiltration.CONCLUSION The value of the eosinophil count in BALF for the diagnosis of ABPA is worthy of the clinician's attention,especially when the patient’s clinical features lack specificity and the diagnostic parameters are negative.

HPLC Quantification of Dexamethasone Palmitate in Bronchoalveolar Lavage Fluid of Rat after Lung Delivery with Large Porous Particles

A high-performance liquid chromatography (HPLC) method has been developed and validated for the determination of dexamethasone palmitate (DXP) in bronchoalveolar fluid lavage samples (BALF). DXP in rat BALFs containing the internal standard (IS), testosterone decanoate (TD), was extracted using a mixture of chloroform and methanol (9:1, v/v). Extracts were then centrifuged, dried and dissolved in acetonitrile. A chromatographic separation based on an isocratic elution was done using acetonitrile and water (85:15, v/v) as a mobile phase at a flow rate of 1.2 mL/min. The graph of the developed method was linear within the tested calibration range of 0.5 - 40 μg/mL. The overall extraction recovery of DXP from BALF samples was 84.3% ± 1.6%. The accuracy (relative error) and precision (coefficient of variation) values were within the pre-defined limits of ≤15% at all concentrations. This methodology has been applied to determine levels of DXP in BALF samples collected from rats treated with DXP large porous particles. The measured concentrations were successfully evaluated using a non-compartment pharmacokinetic model. Since the developed method requires only a microvolume (100 μL) of BALF sample for analysis, it is therefore particularly suitable for the evaluation of drug biodistribution in lung.

Effects of early bronchoalveolar lavage fluid collected from dogs with smoke inhalation injury on the lungs of rats

Objective: Whether early massive bronchoalveolar lavage can remove the harmful substances from the lungs injured with smoke inhalation remains uncertain. This study was designed to observe the effects of early massive bronchoalveolar lavage fluid (BALF) on the healthy lungs in rats. Methods: Mongrel dogs were inflicted with severe smoke inhalation injury. The injured lungs were lavaged with large amount of normal saline in the first hour after injury and the BALF was collected. The BALF was injected into the healthy lungs of 30 rats (group C) in the dosage of 5 ml/kg. The functions and pathological changes of the lungs were observed 24 h after perfusion with the BALF. The data were compared with those of 23 rats (group B) whose lungs were perfused with the BALF collected from normal dogs and those of 21 rats (group A) whose lungs were perfused with normal saline. Results: The mortality rate 24 h after lung perfusion was higher in group C than in groups A and B. The survivors of group C exhibited fluctuation of respiratory rate (RR), remarkable decrease of PaO 2, significantly higher content of lung water, decrease of total static pulmonary compliance and pulmonary expansion index, and increasse of inflammatory cytokines in the tissues of lungs. Only slight mechanic obstructive effect on the airway was observed in rats of group A and B. The pathological changes of the lungs of the rats in group C were similar to those of the dogs with actual smoke inhalation injury. Conclusion: Our findings indicate that the BALF collected from dogs with acute severe smoke inhalation injury in the early stage after injury injured the normal lungs of rats with the bioactive substances in the BALF. These findings show us that it is a valuable therapeutic procedure to apply massive bronchoalveolar fluid lavage in the early stage after inhalation injury.

Comparison on Detection Results of Pathogen Nucleic Acids for Bronchoalveolar Lavage Fluid of Lung Infection Infants Between Uighur Nationality and Han Nationality

Objective:To analyze the detection results of pathogen nucleic acids for bronchoalveolar lavage fluid(BALF)of lung infection infants from Uighur nationality and Han nationality.Methods:A retrospective analysis was performed on the 318 infants with lung infection who were admitted to the hospital from April 2018 to April 2019.According to their nationality,they were divided into Uighur nationality group(190 cases)and Han nationality group(128 cases).The BALF specimens were collected to test pathogen nucleic acid.The distribution and positive rates of[respiratory syncytial virus(RSV),adenovirus(ADV),influenza virus A(IFA),influenza virus B(IFB),parainfluenza virus type 1(PIV I),parainfluenza virus type 2(PIV II),parainfluenza virus type 3(PIV III)],bacteria(Streptococcus pneumoniae,Haemophilus influenzae,staphylococcus aureus,Pseudomonas aeruginosa,klebsiella pneumoniae),Mycoplasma pneumoniae(MP)and Chlamydia pneumoniae(CP)in both groups were observed and compared.Results:The virus detection for RSV,ADV and PIV III were on the top three in BALF from the children in both groups.The total positive rate of virus examination in Uighur nationality group was higher than that in Han nationality group(P<0.05).BALF in both groups was mainly on Streptococcus pneumoniae.The total positive rate of bacteria,MP and detection rate of chlamydia were higher in Uighur nationality group were higher than those in Han nationality group(P<0.05).Conclusion:The pathogen nucleic acid examination for bronchoalveolar lavage fluid in infants with lung viral infection is in the majority,mainly on RSV virus infection.The positive rates of virus,bacteria,MP and CP of children in Uighur nationality are high than those in Han nationality.

Expression of endostatin in serum and bronchoalveolar lavage fluid in patients with lung cancer

Objective To evaluate the expression of endostatin in bronchoalveolar lavage fluid (BALF) and serum in patients with lung cancer,and to analysis the relationship between endostatin expression and clinical prognosis as well as pathophysiological characteristics. Methods The samples of serum and BALF were obtained from 57

Analysis of the T cell receptor Vδ region gene repertoire in bronchoalveolar lavage fluid (BALF) and peripheral blood of asthmatics

Objective To explore the role of γδT cells in the airway of asthmatics and to identify the forces which induce and maintain the inflammatory processMethods Peripheral blood (PB) and bronchoalveolar lavage fluid (BALF) were obtained from7 asthmatic subjects and 7 nonsmoker control subjects The percentage of γδT cells in the PB and BALF was measured by immunofluorescent staining and flow cytometry The frequency of usage and the clonality of Vδ subfamilies (Vδ 1-Vδ 3) were assessed by RTPCR and gene scanning Results A higher proportion of γδT cell was detected in the BALF of asthmatic subjects (7.8%±4.7%) than that from control subjects (3.3%±3.0%, P=0.04) No selective usage for a particular Vδ subfamily was found, but the relative expression level of Vδ 1 was significantly higher in the asthmatic airway (44%±13%) than in the control (19%±5%, P=0.0002) In asthmatic subjects, the monoclonal or oligoclonal expansion of γδT lymphocytes was predominant in the BALF, especially Vδ 1+ T lymphocytes Conclusions Antigenic specific γδT cells might play an important role in the inducement and maintenance of airway inflammation Persistent antigenic stimulation may be the key factor that maintains chronic airway inflammation in asthma

血清IL-17联合血清GM试验和BALF-GM试验对ICU侵袭性肺曲霉菌病的诊断价值

目的通过监测ICU内具有真菌侵袭高风险的肺部感染患者血清IL-17水平、血清半乳甘露聚糖(GM)试验及肺泡灌洗液(BALF)-GM试验变化,探索联合检测对于早期诊断ICU侵袭性肺曲霉病(IPA)的价值。方法选择60例肺部感染且具有真菌感染相关危险因素的患者,将其分为2组,试验组为确诊+临床诊断IPA组(30例);对照组为拟诊IPA组(30例)。分别进行年龄、危重度评分、血常规(淋巴细胞绝对值)、血清IL-17水平、血清GM试验、BALF-GM试验、BALF真菌培养鉴定和细胞学检测以及肺部影像学检查,并采集数据。应用电化学发光法检测各组血清IL-17水平,采用酶联免疫吸附试验进行GM试验检测。应用logistic回归分析及绘制受试者工作特征曲线(ROC),分析血清IL-17水平、血清GM试验以及BALF-GM试验诊断IPA的效能;进一步评估3种指标联合检测对早期诊断IPA的效能。两两指标联合为血清GM试验联合BALF-GM试验、血清IL-17联合血清GM试验、血清IL-17联合BALF-GM试验。结果试验组患者血清IL-17、血清GM试验以及BALF-GM试验水平均明显高于对照组(P<0.05);logistic回归分析及ROC曲线分析结果显示,血清IL-17联合BALF-GM试验对IPA诊断的灵敏度为86.7%,特异度为80.0%,曲线下面积为0.852,高于血清IL-17联合血清GM及血清GM联合BALF-GM检测。结论IPA患者血清IL-17高表达,且与BALF-GM试验联合检测,能提升IPA的早期诊断价值。

基于微滴式数字PCR的肺癌患者BALF-EGFR基因突变分析在靶向治疗中的应用价值评价

目的 探究支气管肺泡灌洗液(BALF)作为表皮生长因子受体(EGFR)基因突变检测标本的临床应用价值。方法 采用微滴式数字聚合酶链反应(ddPCR)检测52例肺癌患者BALF中EGFR基因相关位点(L858R和E746_A750del)突变情况,与相应分子病理结果比较。结果 以分子病理结果为金标准,BALF检测E746_A750del位点灵敏度为58.3%(14/24),特异度为100.0%(14/14),一致性符合率为73.7%(28/38,Kappa=0.508,P<0.01);BALF检测L858R位点灵敏度为64.3%(9/14),特异度为100.0%(14/14),一致性符合率为82.1%(23/28,Kappa=0.643,P<0.01)。与分子病理结果相比,BALF中EGFR基因E746_A750del和L858R突变的检出一致性较高(0.40<Kappa<0.75),BALF中EGFR基因突变检出率与肿瘤分期有关(P<0.05),突变丰度在一定程度上可预测肺癌远端转移。结论 BALF标本在肺癌患者EGFR基因突变检测中有重要的临床应用价值,可作为分子病理检测的补充。

肺结核患者Th1/Th2细胞状态与BALF中微生物群及Notch2 mRNA、IL-27 mRNA表达的相关性

【目的】探讨肺结核患者Th1/Th2细胞状态与支气管肺泡灌洗液(BALF)中微生物群及Notch2、白细胞介素-27(IL-27)表达的相关性。【方法】776例肺结核患者,按病情进展情况分为活动组(n=370)和非活动组(n=406),另选352例非肺结核呼吸系统疾病患者作为对照组,检测患者BALF中微生物群水平,Notch2 mRNA、IL-27 mRNA表达水平和外周血Th1、Th2细胞比例,分析Th1/Th2与BALF中微生物群、Notch2 mRNA、IL-27 mRNA表达的相关性。【结果】活动组、非活动组外周血Th1、Th2细胞比例及Th1/Th2值均低于对照组,活动组Th1细胞比例及Th1/Th2值低于非活动组(P<0.05),但两组Th2细胞比例比较,差异无统计学意义(P>0.05);活动组、非活动组嗜血杆菌、奈瑟菌数量,IL-27 mRNA表达高于对照组,链球菌数量、Notch2 mRNA表达低于对照组(P<0.05),且活动组嗜血杆菌、奈瑟菌数量,IL-27 mRNA高于非活动组,链球菌数量、Notch2 mRNA表达低于非活动组(P<0.05)。Pearson相关性分析显示,肺结核患者Th1/Th2值与链球菌数量及Notch2 mRNA表达呈正相关(P<0.05),与嗜血杆菌、奈瑟菌数量、IL-27 mRNA表达呈负相关(P<0.05)。【结论】肺结核患者的Th1/Th2细胞比例偏低,且随病情发展进一步降低,该免疫失衡与患者BALF中嗜血杆菌、奈瑟菌、链球菌感染及Notch2 mRNA、IL-27 mRNA表达有关。

缺氧复合氰化钠中毒对大鼠BALF和肺组织磷脂含量的影响

目的研究缺氧合并氰化钠(NaCN)中毒对大鼠肺支气管灌洗液(BALF)和肺组织中磷脂含量的影响。方法雄性SD大鼠72只,随机分为平原实验组和高原实验组。高原实验组动物置于低压舱(4000m,61kPa,舱内温度20±3℃)内,平原实验组置于普通试验室(海拔308m,大气压97.7kPa,室温20±3℃)内3d后进行实验。每组设0、0.5、1、2、4、6h等6个观测点,0h时点大鼠不注射NaCN,其余大鼠腹腔注射NaCN(3.6mg/kg),于注射后0、0.5、1、2、4h和6h时点放血处死动物,取全肺,分别检测肺/体比值,肺干/湿重比,制取BALF及肺组织匀浆,定磷法测总磷脂(TPL)含量。结果高原实验组部分大鼠鼻腔有少量泡沫状血性分泌物流出,注射后1h内3只动物中毒死亡。平原实验组大鼠NaCN中毒后,肺/体比值、肺干/湿重比、BALF中TPL含量显著增加(P<0.05),而肺组织中TPL含量明显降低(P<0.05)。高原实验组大鼠NaCN中毒后,肺/体比值、肺干/湿重比、BALF中TPL含量增加更显著(P<0.05),肺组织中TPL含量降低更明显(P<0.05)。结论缺氧和氰化物中毒可能对肺组织存在联合损伤效应。

针刺对哮喘大鼠BALF中嗜酸性粒细胞及肺组织p38MAPK的影响

目的观察针刺对支气管哮喘大鼠支气管肺泡灌洗液中嗜酸性粒细胞,肺组织p38蛋白激酶(p38MAPK)蛋白表达的影响,探讨针刺对哮喘大鼠气道炎症的改善机制。方法将SPF级雄性SD大鼠随机分为空白组(C组)、哮喘模型组(M组)、哮喘模型针刺组(A组),每组10只。制作卵蛋白致敏哮喘大鼠模型,取大椎、肺俞(双)、风门(双)穴位给予针刺,隔日一次,共针7次。针刺干预实验结束时,计数哮喘大鼠支气管肺泡灌洗液(BALF)中嗜酸性粒细胞;用Western Blot技术检测大鼠肺组织p38MAPK的蛋白含量。结果 M组大鼠BALF中嗜酸性粒细胞数较C组显著增多(P<0.05);A组大鼠BALF中白细胞和嗜酸性粒细胞数明显低于M组(P<0.05)。M组大鼠肺组织p38MAPK蛋白表达较C组增多(P<0.05);A组大鼠肺组织p38MAPK蛋白表达低于M组(P<0.05)。结论针刺对哮喘的治疗作用与降低大鼠BALF中嗜酸性粒细胞数目,降低肺组织p38MAPK蛋白表达有关。

检测BALF中CRP和T细胞亚群对肺结核与肺癌鉴别诊断的意义

目的评价联合检测支气管肺泡灌洗液(BALF)中C反应蛋白(CRP)浓度及T淋巴细胞亚群在肺癌及肺结核鉴别诊断中的意义。方法对43例确诊的肺癌患者、37例肺结核患者以及20例健康体检者,采用免疫比浊法检测BALF中CRP浓度,流式细胞仪检测T淋巴细胞亚群水平。结果肺结核组BALF中CRP浓度高于健康对照组和肺癌组(P<0.05),与肺结核组和健康对照组相比,肺癌组BALF中的T细胞亚群中CD4+细胞比例和CD4+/CD8+比值显著下降(P<0.05),而CD8+比例无明显差异(P>0.05)。各种肺癌类型之间,CD4+、CD8+细胞比较无明显差异(P>0.05)。诊断肺结核时,BALF中CRP浓度为29.2 mg/L时特异性最高,为91.4%;诊断肺癌时,BALF中T细胞分类CD4+细胞比例为34.2%时特异性最高,为87.9%。结论联合检测BALF中CRP及T淋巴细胞亚群,对肺癌与肺结核的鉴别诊断具有一定的价值。

结节病患者肺功能检测和BALF淋巴细胞表型关系的研究

目的 :通过测定结节病患者的肺通气功能、弥散功能、血气分析以及支气管肺泡灌洗液 (BALF)的细胞学 ,并就其之间的相关性进行分析 ,以探究肺功能测定指标与BALF检测之间的相关性。方法 :结节病患者及正常对照组各 18例 ,行肺通气功能和弥散功能及动脉血气分析检测 ,所有受试者均行支气管肺泡灌洗液 (BALF)细胞学检查。结果 :(1)与正常对照组相比 ,结节病组静息状态肺通气功能基本正常 (P >0 .0 5 ) ,单口呼吸法肺弥散功能(DLCO % )减低 (P <0 .0 5 ) ,并有小气道功能障碍 ,尤以FEF50 %减低明显 (P <0 .0 5 )。 (2 )结节病患者BALF中淋巴细胞 %明显增高 (P <0 .0 1) ,CD+4 /CD+8亦明显高于对照组 (P <0 .0 5 )。 (3)结节病患者DLCO %减低与BALF中淋巴细胞 %增加及CD+4 /CD+8比增加均呈负相关 (分别为 r=- 0 .6 7,P <0 .0 1和 r=- 0 .5 5 ,P <0 .0 5 ) ,且小气道功能中FEF50 %减低与BALF中淋巴细胞 %增加呈明显负相关 (r =- 0 .5 4,P <0 .0 5 )。结论 :肺弥散功能以及小气道功能的检查与BALF细胞学检测指标存在较明显的相关性 ,可作为早期结节病病情活动性判定的一项重要参考指标。

氰戊菊酯对肺损伤的研究——BALF中细胞及其膜性结构的动态观察

采用透射电镜,动态观察了氰戊菊酯染毒大鼠肺灌洗液(BALF)中细胞及其膜性结构的改变。结果表明:0.19mg/kg氰戊菊酯未诱发肺细胞毒反应;0.93mg/kg仅引起轻度肺泡炎;≥4.66mg/kg时,可导致肺实质损伤,主要表现为细胞构成明显改变,细胞生物膜结构严重损伤,细胞大量溶解、死亡以及多个融合细胞灶的形成。这些反应可发生于染毒后30分钟,4～24小时达高峰,4天后恢复正常。本次研究结果,为深入探讨氰戊菊酯对肺脏的毒性,提供了细胞形态学依据。

FQ-PCR检测BALF中结核杆菌-DNA对肺结核诊断的应用研究

目的:对FQ-PCR检测BALF中结核杆菌-DNA对肺结核诊断的应用进行研究。方法:随机选取2013年12月-2014年11月期间本院收治的肺结核患者110例作为本次研究的对象,所有患者实施纤支镜检查、活检、刷检,BALF中结核杆菌-DNA行FQ-PCR检测,对检查结果进行分析研究。结果:在本次研究中,确诊为肺结核的患者有40.00%(44/110);FQ-PC检测的敏感性明显高于常规涂片镜检,差异有统计学意义(P<0.05)。结论:在肺结核的诊断中,FQ-PCR检测的敏感度高,操作简单方便,检测速度较快,是BALF中结核杆菌-DNA检查的重要方法,在肺结核的诊断中有重要的应用价值。

伴有MP感染的大叶性肺炎患儿BALF中细胞因子水平变化及其意义

目的探讨伴有肺炎支原体(MP)感染的大叶性肺炎患儿支气管肺泡灌洗液(BALF)中细胞因子的水平变化及其意义。方法选取我院确诊的大叶性肺炎患儿140例,根据MP-DNA检测结果分为A组96例(MP-DNA检测阳性)、B组44例(MP-DNA检测阴性),收集时间2016年1月-2017年6月,对比两组BALF中相关细胞因子,并根据临床肺部感染评分(CPIS)进行亚组分析。结果 A组患儿的BALF中的IL-17、IL-33、IL-6、IL-8、IL-10、TNF-α、HMGB1的水平均显著的高于B组患儿,差异均具有统计学意义(P <0. 05); A组的轻症、重症患儿的BALF中的IL-17、IL-33、IL-6、IL-8、IL-10、TNF-α、HMGB1的水平均分别高于B组的轻症、重症患儿(P <0. 05); A组和B组的重症患儿BALF中的IL-17、IL-33、IL-6、IL-8、IL-10、TNF-α、HMGB1的水平均显著的高于本组的轻症患儿(P <0. 05)。结论伴有MP感染的大叶性肺炎患儿BALF中细胞因子水平较不伴有MP感染的大叶性肺炎患儿显著升高,并且随着病情加重而升高。

五味地龙汤对哮喘豚鼠BALF中EOS和肺支气管组织形态学的影响

目的:观察五味地龙汤对实验性支气管哮喘豚鼠支气管肺泡灌洗液(BALF)中嗜酸性粒细胞(EOS)的计数和肺、支气管组织形态学的影响。方法:用OVA腹腔注射及气道吸入激发建立哮喘豚鼠模型,对支气管肺泡灌洗液离心后计数BALF中EOS。光镜观察其肺支气管病理组织学变化。结果:①一般情况:哮喘模型组豚鼠均出现不同程度的呼吸次数增加、张口等呼吸困难症状,各药物组豚鼠OVA激发后,地塞米松组和五味地龙汤大剂量组没有出现明显不适症状。②BALF中EOS计数显示:各组与哮喘模型组EOS(15.57±1.51)个/mm3比较,差异均有非常显著的统计学意义(P<0.01)。五味地龙汤大剂量组和地塞米松组与正常对照组EOS(0.83±0.75)个/mm3比较,差异均无统计学意义(P>0.05)。哮喘性模型组BALF中EOS数明显增加。③光镜观察:模型组见支气管黏膜下层充血水肿,嗜酸性粒细胞灶状浸润,腔内可见部分粘液及渗出物。地塞米松组:气管及支气管管壁结构正常,无炎性渗出。五味地龙汤大剂量组:气管管壁结构逐渐恢复,炎症减轻,水肿明显消失。管腔炎性渗出物明显减少。结论:五味地龙汤可能通过减少气道EOS浸润,减轻炎性渗出,抑制杯状细胞和平滑肌增生,抑制气道重塑,从而发挥平喘的作用。

BALF对周围型肺癌的诊断价值

目的探讨支气管肺泡灌洗液(BALF)对内镜检查阴性的周围型肺癌患者的诊断价值。方法选取我科2011年1月至2014年7月住院行支气管镜检查镜下阴性的患者共114例,进行支气管肺泡灌洗和支气管镜下肺活检(TBLB)。根据病理结果 ,将所有患者分为肺癌(周围型肺癌)组和肺良性病变组。对比两组患者BALF中肿瘤指标水平和细胞基质金属蛋白酶-7(matrix metalloproteinase-7,MMP-7)、Survivin mRNA相对表达量。以开胸手术或经皮肺穿刺病理活检结果为金标准,对比IBAL和TBLB检测对于肺癌的灵敏度、特异度。结果肺癌组BALF中CEA、CYFRA21-1、ET-1和NSE水平显著高于肺良性病变组,P<0.01。肺癌组的MMP-7、Survivin mRNA相对表达量显著高于肺良性病变组,P<0.01。IBAL检测肺癌的灵敏度为72.41%,特异度为62,50%;TBLB检测肺癌的灵敏度为79.31%,特异度为67.86%。两种检测肺癌方法灵敏度和特异度无显著差异,P>0.05。结论行支气管肺泡灌洗可以提高内镜检查阴性周围型肺癌患者的诊断率,进而早期手术治疗。