BRONCHOALVEOLAR LAVAGE IN THE DIAGNOSIS OF HARD METAL DISEASE
BRONCHOALVEOLAR LAVAGE IN THE DIAGNOSIS OF HARD METAL DISEASE
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DOI：
10.1016/0048-9697(94)90131-7
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发表时间：
1994-06-30
影响因子：
9.8
通讯作者：
FORNI, A
中科院分区：
文献类型：
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作者：
FORNI, A
支气管肺泡灌洗（BAL）是一种侵入性不强的技术，可以检查各种原因引起的肺深部反应，已被证明在诊断由硬质金属（HM）和/或钴引起的肺部疾病方面也很有用，从而在大多数情况下克服了对开放式肺活检的需要。HM间质性疾病的病例在BAL上表现为高强度肺泡炎，其特征是细胞总数增加，伴有奇异的多核巨细胞和炎症细胞增加。这些结果与脱屑性巨细胞间质性肺炎的组织学模式相符。尽管停止暴露和类固醇治疗，肺泡炎的持续存在，尤其是嗜酸性粒细胞的大量增加，具有不祥的预后意义。少数报告的钴哮喘病例BAL研究显示正常或T淋巴细胞增加，辅助/抑制比倒转。最后一项发现在一些无症状暴露的受试者中也有描述，这表明有亚临床（或临床前？）肺反应。通过中子活化分析测定BAL和其他生物标本中的微量金属（钴、钨、钽），可能对记录最近或过去的接触情况很重要，但对于诊断来说不是鉴别性的，因为没有发现任何金属水平与疾病发生之间的关系。
Bronchoalveolar lavage (BAL) a technique which is not very invasive and which permits investigations of deep lung reactions from various causes, has been demonstrated to be also useful in the diagnosis of lung disorders from hard metals (HM) and/or cobalt, thus overcoming, in most cases, a need for open lung biopsies. Cases with HM interstitial disease show at BAL the sips of a high-intensity alveolitis, characterized by increased total cells with bizarre multinucleated giant cells and increased inflammatory cells. These findings correspond well to the histological pattern of desquamative giant cell interstitial pneumonitis. The persistence of alveolitis and especially high numbers of eosinophils at following BALs, despite cessation of exposure and steroid treatment, has an ominous prognostic significance. The few reported cases of cobalt asthma studied by BAL present either normal findings or increased T lymphocytes with inverted helper/suppressor ratio. This last finding has also been described in some asymptomatic exposed subjects, which indicates a subclinical (or preclinical?) lung reaction. Determination by neutron activation analysis of trace metals (cobalt, tungsten, tantalum) in BAL and other biological specimens may be important in documenting recent or past exposures but is not discriminant for diagnosis, since no relationship has been found between levels of any metal and the occurrence of the disease.