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.

Characteristics of alveolar macrophages in bronchioalveolar lavage fluids from active tuberculosis patients identified by single-cell RNA sequencing

Tuberculosis(TB),is an infectious disease caused by Mycobacterium tuberculosis(M.tuberculosis),and presents with high morbidity and mortality.Alveolar macrophages play an important role in TB pathogenesis although there is heterogeneity and functional plasticity.This study aimed to show the characteristics of alveolar macrophages from bronchioalveolar lavage fluid(BALF)in active TB patients.Single-cell RNA sequencing(scRNA-seq)was performed on BALF cells from three patients with active TB and additional scRNA-seq data from three healthy adults were established as controls.Transcriptional profiles were analyzed and compared by differential gene expression and functional enrichment analysis.We applied pseudo-temporal trajectory analysis to investigate correlations and heterogeneity within alveolar macrophage subclusters.Alveolar macrophages from active TB patients at the single-cell resolution are described.We found that TB patients have higher cellular percentages in five macrophage subclusters.Alveolar macrophage subclusters with increased percentages were involved in inflammatory signaling pathways as well as the basic macrophage functions.The TB-increased alveolar macrophage subclusters might be derived from M1-like polarization state,before switching to an M2-like polarization state with the development of M.tuberculosis infection.Cell-cell communications of alveolar macrophages also increased and enhanced in active TB patients.Overall,our study demonstrated the characteristics of alveolar macrophages from BALF in active TB patients by using scRNA-seq.

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.

Stability of Xuesaitong capsules in gastrointestinal lavage fluid

Objective:To obtain a formulation with high bioavailability through evaluation of the stability of three types of Xuesaitong capsules in the stomachs and intestines of rats.We compared the stability of the Panax notoginsenoside R1 as well as the ginsenosides Rg1,Rb1,Re,and Rd in different formulations.Methods:Artificial stomach fluid(ASF)and artificial intestinal fluid(AIF)were prepared.Stability of three types of Xuesaitong capsules was examined for 4 h in stomachs and 24 h in intestines.Samples were analyzed at different times by high-performance liquid chromatography.Percent content of NGR1,GRg1,GRb1,GRe,and GRd at different times was calculated.Results:Hard capsules incubated in ASF disintegrated within 2e3 min,whereas soft capsules disintegrated within 7e8 min.Components in hard capsules were dissolved rapidly in water,with content of each compound reaching 90%in 5 min,and degradation of each compound reaching 30e50%after incubation for 240 min.Dissolution and degradation of each component in soft capsules with a water-soluble base tended to balance at 30 e90 min.Contents in soft capsules with a lipid-soluble base showed slow dissolution after ASF incubation for 120 min.Five saponins in identical types of capsules incubated in ASF had similar stability curves.Contents of hard capsules and soft capsules with a watersoluble base degraded rapidly within 30 min and reached a plateau when Xuesaitong capsules were incubated in AIF.

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.

Pneumocystis jirovecii diagnosed by next-generation sequencing of bronchoscopic alveolar lavage fluid: A case report and review of literature

BACKGROUND The advent of molecular targeted agents and immune checkpoint inhibitors has greatly improved the treatment of advanced renal cell carcinoma(RCC), thus significantly improving patient survival. The incidence of rare drug-related adverse events has gained increased attention.CASE SUMMARY We report a patient with advanced RCC treated with multiple lines of molecular targeted agents and immune checkpoint inhibitors, who developed a pulmonary infection after treatment with everolimus in combination with lenvatinib. Determining the pathogenic organism was difficult, but it was eventually identified as Pneumocystis jirovecii by next-generation sequencing(NGS) of bronchoscopic alveolar lavage fluid(BALF) and successfully treated with trimethoprim-sulfamethoxazole.CONCLUSION Rare pulmonary infections caused by molecular targeted agents are not uncommon in clinical practice, but their diagnosis is difficult. Evaluating BALF with NGS is a good method for rapid diagnosis of such infections.

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

细菌性肺炎患者的肺部菌群结构分布研究

目的采用16S rRNA测序技术对细菌性肺炎患者和非细菌性肺炎患者的肺泡灌洗液微生物菌群的变化进行分析。方法选择2022年6月到2023年1月在泉州市第一医院呼吸与危重症医学科住院的细菌性肺炎患者20例作为研究对象,以同期非细菌性肺炎患者20例作为对照组。收集入选患者的临床资料、肺泡灌洗液。通过16S rRNA测序检测肺泡关系菌群,并进行生物学信息分析。结果肺炎组的16S rRNA测序得到OTU总数为5857,对照组的OTU为15379,Alpha多样性结果显示在肺炎组的微生物种群丰度等级降低且差异具有统计学意义,Beta多样性分析发现肺炎组和对照组样本间的差异显著。分析肺泡灌洗液的种群组成差异发现,在门、科水平20种群中发现肺炎丰度与对照组相比,益生菌丰度降低而促炎病原菌的丰度升高且差异具有统计学意义。结论细菌性肺炎患者肺泡灌洗液的微生态失衡表现为益生菌丰度降低、致病菌菌群的群落结构发生显著改变,这可能与细菌性肺炎的发生发展有关。

纳米孔测序技术对涂阴肺结核患者诊断价值的多中心临床研究

目的:分析纳米孔测序技术用于涂阴肺结核患者的诊断价值。方法:本研究采集了来自北京、安徽、青海和吉林4个不同省份传染病专科医院2021年9月至2022年4月收治的107例疑似涂片阴性肺结核患者的支气管肺泡灌洗液(BALF)作为研究样本,对其进行BACTEC MGIT 960液体培养(简称“MGIT 960培养”)和GeneXpert MTB/RIF(简称“Xpert”)检测和纳米孔测序。以临床最终诊断结果为参照标准,比较3种方法对肺结核的检测效能。结果:107例疑似肺结核患者中,最终诊断为肺结核70例(65.42%),非结核分枝杆菌病15例(14.02%),非结核病22例(20.56%)。以临床最终诊断结果为参照标准,纳米孔测序技术、MGIT 960培养和Xpert检测的敏感度分别为84.29%(59/70)、37.14%(26/70)和41.43%(29/70),特异度分别为86.49%(32/37)、75.68%(28/37)和97.30%(36/37),约登指数分别为0.71、0.13和0.39。纳米孔测序的曲线下面积(AUC值)为0.854(95%CI:0.773~0.935),Xpert检测的AUC值为0.694(95%CI:0.596~0.792),MGIT 960培养的AUC值为0.564(95%CI:0.451~0.677)。结论:纳米孔测序技术在检测涂阴肺结核方面具有较Xpert和MGIT 960培养更好的诊断效能。

支气管肺泡灌洗液宏基因组二代测序在儿童肺部感染病原体诊断中的价值

目的探讨支气管肺泡灌洗液(BALF)宏基因组二代测序(mNGS)对儿童肺部感染的病原体诊断价值。方法分析2023年3月1日至2024年3月1日在甘肃省妇幼保健院住院治疗的109例肺部感染患儿的临床资料,比较患儿BALF mNGS与常规微生物学检测(CMT)结果。结果109例患儿BALF mNGS检出率(96.3%)高于CMT(66.1%),差异有统计学意义(P<0.01);BALF mNGS共检出280株病原菌,CMT共检出130株病原菌,mNGS能够检测出更多的病原体,尤其对病毒的检出率远高于CMT;在70例mNGS与CMT双阳性样本中,42例mNGS与CMT结果完全或部分匹配,匹配样本中48%为流感嗜血杆菌,19%为肺炎支原体,17%为肺炎链球菌;分析重症肺炎患儿BALF mNGS的病原菌特征发现,重症肺炎患儿的流感嗜血杆菌、副流感病毒及人偏肺病毒检出率均高于非重症肺炎患儿,差异有统计学意义(P<0.05);比较出生信息为足月正常体重儿与早产低体重儿BALF mNGS检测结果发现,早产低体重儿的铜绿假单胞杆菌mNGS检出率高于足月正常体重儿,且早产低体重有合并症患儿的铜绿假单胞杆菌mNGS检出率高于早产低体重无合并症患儿,差异均有统计学意义(P<0.05);足月正常体重儿肺炎支原体mNGS检出率高于早产低体重儿,且足月正常体重无合并症患儿的肺炎支原体mNGS检出率高于足月正常体重有合并症患儿,差异均有统计学意义(P<0.05)。结论BALF mNGS对于肺部感染患儿具有较高的微生物检测阳性率,尤其对于重症感染及复杂病例,BALF mNGS是常规病原学检测的重要补充。

肺泡灌洗液外观不典型肺泡蛋白沉积症1例报告并文献复习

肺泡蛋白沉积症(pulmonary alveolar proteinosis,PAP)是一种罕见的肺部进行性呼吸功能障碍性疾病,起病隐匿,临床表现缺乏特异性,常被误诊误治。现报道1例嘉定区中心医院收治的肺泡灌洗液外观不典型的PAP患者,经皮下注射重组人粒细胞-巨噬细胞集落刺激因子(granulocyte macrophage-colony stimulating factor,GMCSF)治疗后病情明显好转,并结合相关文献以加分析讨论,以加深对这种疾病及其疗法的认识。

肺部惠普尔养障体感染患者临床及影像特征分析

目的分析和总结肺部惠普尔养障体(TW)感染患者的临床资料,进一步提高对肺部TW感染的认识。方法收集2021年9月1日至2023年1月31日民航总医院呼吸内科收治的7例肺部TW感染患者的临床资料(包括基础信息、检验结果、胸部CT、治疗及转归情况)行回顾性分析。结果7例肺部TW感染患者中男3例、女4例,年龄67(45,73)岁。所有患者既往病史中均存在至少1种可能导致免疫功能异常的基础疾病,最常见的为冠心病(冠状动脉粥样硬化性心脏病)。所有患者外周血白细胞计数均在正常范围,但2例混合感染的患者中性粒细胞百分比明显升高,分别达86.9%和95.9%。胸部CT多表现为磨玻璃密度影、弥漫小结节影或斑片影。7例患者均经支气管肺泡灌洗液病原体靶向二代测序明确诊断,其中2例患者TW为唯一病原体。7例患者均接受抗微生物治疗,其中6例患者治疗后临床症状和影像学均明显改善,1例患者失访。结论肺部TW感染的患者常伴有免疫功能异常的疾病,且常规实验室检查难以确诊,多通过二代测序诊断,胸部CT可呈多种非特异性改变。抗微生物治疗可明显改善病情。

基于IL-4/IL-13信号通路探讨肺炎支原体对气道炎症的影响

目的探讨肺炎支原体肺炎(Mycoplasma pneumoniae pneumonia,MPP)中白细胞介素(interleukin,IL)-4/IL-13信号通路对辅助型T细胞2(T helper 2 cell,Th2)分化及气道炎症的影响。方法采用回顾性研究方法,选择2022年1月至2023年1月在首都医科大学附属北京朝阳医院怀柔医院住院的45例MPP患儿(其中轻度MPP组23例,重度MPP组22例)和18例异物吸入患儿(对照组)作为研究对象。收集支气管肺泡灌洗液(bronchoalveolar lavage fluid,BALF),使用人类细胞因子/趋化因子磁珠板试剂盒测定BALF中肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、单核细胞趋化蛋白1(monocyte chemotactic protein 1,MCP1)、IL-6、IL-1β、IL-4、IL-10、IL-13、IL-5、IL-2、γ-干扰素(interferon-γ,IFN-γ)水平。统计学方法采用单因素方差分析、LSD-t检验、χ^(2)检验、Fisher确切概率法和线性判别分析。结果重度MPP组患儿的C反应蛋白(C-reactive protein,CRP)、中性粒细胞百分比均高于轻度MPP组,差异均有统计学意义(P值均<0.05)。轻度MPP组患儿BALF中TNF-α、IL-6、IL-1β、MCP1、IL-4、IL-10和IFN-γ水平均高于对照组,重度MPP组患儿BALF中TNF-α、IL-6、IL-1β、MCP1、IL-4、IL-10和IFN-γ水平均高于轻度MPP组;轻度和重度MPP组患儿中IL-13和IL-5水平均高于对照组,差异均有统计学意义(P值均<0.05)。线性判别分析结果显示,基于细胞因子分组法可以正确识别88.9%的对照组、78.3%的轻度MPP组和86.4%的重度MPP组。轻度、重度MPP组和对照组患儿中的IFN-γ/IL-4比值(3.10±1.75、2.43±1.70与0.97±0.48)、IFN-γ/IL-13比值(2.78±1.95、3.47±2.68与1.00±0.56)显示,轻度和重度MPP组显著高于对照组,差异均有统计学意义(P值均<0.05)。结论轻度MPP和重度MPP的特征是Th1相关细胞因子(IFN-γ)的增加高于Th2相关细胞因子(IL-4和IL-13)的增加,导致BALF炎症增加。

肺炎支原体肺炎患儿肺泡灌洗液中肺炎支原体DNA载量与D-二聚体、乳酸脱氢酶水平及其预测价值

目的探讨肺炎支原体肺炎(MPP)患儿肺泡灌洗液中肺炎支原体DNA(MP-DNA)载量、D-二聚体(D-D)水平及乳酸脱氢酶(LDH)水平对疾病严重程度的预测价值。方法选取2023年3月1日至2023年12月30日安徽省儿童医院感染科收治的180例MPP患儿,男性93例,女性87例,年龄(6.00±2.25)岁,年龄范围为1~13岁。根据MPP的严重程度分为轻症组(n=104)和重症组(n=76)。比较两组间肺泡灌洗液中MP-DNA载量、D-D和LDH水平,分析MP-DNA载量与D-D和LDH的相关性,并通过受试者操作特征(ROC)曲线评估三项指标对重症MPP的预测价值。结果重症MPP组MP-DNA载量和D-D水平显著高于轻症组,差异有统计学意义(P<0.05)。MP-DNA载量与D-D(r=0.496,P<0.001)和LDH(r=0.325,P=0.004)水平均呈正相关,且与D-D的相关性较强。ROC曲线分析结果显示,MP-DNA载量在预测重症MPP中的曲线下面积为0.740,明显高于D-D(曲线下面积为0.614)和LDH(曲线下面积为0.554)。结论MP-DNA载量和D-D水平在重症MPP患儿中显著升高,具有重要的预测价值,其中MP-DNA载量的诊断效能更高。

肺泡灌洗液Xpert、抗酸杆菌涂片、分枝杆菌培养对痰液Xpert阴性肺结核的诊断价值

目的:探讨3种肺泡灌洗液检测方法对痰液XpertMTB/RIF(Xpert)阴性肺结核的诊断价值。方法:选取2021年1月至2023年6月间温州市中心医院收治的痰液Xpert阴性的疑似肺结核患者121例,所有患者均予肺泡灌洗液Xpert、抗酸杆菌涂片、分枝杆菌培养,以临床诊断结果为确诊标准,回顾性比较3种检测方法的诊断价值。结果:121例疑似肺结核患者中有73例诊断为肺结核,肺结核患者比非肺结核患者更年轻(P<0.05)。肺泡灌洗液Xpert的AUC为0.774、灵敏度为54.79%、特异度为100%;抗酸杆菌涂片的AUC为0.510、灵敏度为8.22%、特异度为93.75%;分枝杆菌培养的AUC为0.667、灵敏度为52.05%、特异度为80.85%;3种方法联合检测的AUC为0.721、灵敏度为63.01%、特异度为81.25%。Xpert和联合检测的AUC差异无统计学意义,两者均要高于抗酸杆菌涂片、分枝杆菌培养。3种方法联合的检测灵敏度最高,Xpert次之,抗酸杆菌涂片最低。结论:肺泡灌洗液Xpert、抗酸杆菌涂片、分枝杆菌培养联合检测能够提高痰液Xpert阴性肺结核的诊断性能,减少肺结核的漏诊。

肺部感染儿童支气管肺泡灌洗液病原及细胞学分析

目的分析肺部感染儿童支气管肺泡灌洗液(BALF)中的病原及细胞学成分,为临床提供诊断及治疗依据方法选取2021年8月至2022年10月于泉州市儿童医院住院治疗的42例患儿作为研究对象,其中23例BALF培养确诊为细菌感染性肺炎的患儿为细菌性肺炎组,19例支气管异物行异物取出术后BALF培养无细菌生长的患儿为支气管异物组。采用液基细胞学沉降法对上述两组患儿BALF进行病理学分析。结果23例细菌性肺炎以肺炎链球菌感染为主,肺部CT易合并肺不张;19例支气管异物以左主支气管异物多见,其中以坚果类异物为主。细菌性肺炎组的中性粒细胞百分比、C反应蛋白(CRP)水平高于支气管异物组,差异有统计学意义(P<0.05);细菌性肺炎组的淋巴细胞百分比低于支气管异物组,差异有统计学意义(P<0.05);细菌性肺炎组BALF中性粒细胞百分比高于支气管异物组,差异有统计学意义(P<0.05);两组BALF中淋巴细胞百分比、巨噬细胞百分比、纤毛柱状上皮细胞百分比比较,差异无统计学意义(P>0.05)。结论儿童细菌性肺炎以肺炎链球菌感染多见,其BALF细胞学组成以中性粒细胞为主,这为临床诊断及治疗提供了依据,避免临床抗生素滥用。

儿童难治性肺炎支原体肺炎肺泡灌洗液病菌量与Th1/Th2细胞免疫应答的相关性研究

目的探究儿童难治性肺炎支原体肺炎肺泡灌洗液病菌量与Th1/Th2细胞免疫应答的相关性。方法随机选择郑州大学附属儿童医院诊治的96例难治性肺炎支原体肺炎患儿为研究对象,根据肺泡灌洗液中肺炎支原体DNA含量进行分组,即>106/m L为高菌量组(n=35),103~106/m L为中菌量组(n=30),<103/m L为低菌量组(n=31)。检测三组患儿肺泡灌洗液的炎性因子水平,对比三组的炎性因子水平、肺部影像学与实验室检查结果、临床表现和基础情况,分析肺泡灌洗液中肺炎支原体DNA含量与炎性因子的相关性。结果在体温高于39℃、热程高于10天患儿占比以及总发热时间、使用抗生素后热程、住院时间、乳酸脱氢酶、血小板计数、中性粒细胞计数、淋巴细胞计数上,三组比较差异有统计学意义(P<0.05),白细胞计数比较差异无统计学意义(P>0.05);双侧或大量胸腔积液、肺不张或者大片肺实变发生率、白细胞介素-4(interleukin-4,IL-4)水平比较,差异有统计学意义(P<0.05),三组之间的双侧肺病变、左侧肺病变、右侧肺病变发生率以及肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、干扰素(interferon-γ,INF-γ)、IL-8水平比较差异无统计学意义(P>0.05);肺泡灌洗液中IL-4与肺炎支原体DNA水平呈正相关(P<0.05),肺泡灌洗液中TNF-α、INF-γ、IL-8与肺炎支原体DNA水平无相关性(P>0.05)。结论儿童难治性肺炎支原体肺炎肺泡灌洗液病菌量与Th1/Th2细胞免疫应答具有相关性,肺炎支原体DNA菌量越高,肺内外损害和肺部炎症越严重,Th1/Th2免疫应答失衡。