• Tuberculosis and Respiratory Diseases
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• 제68권4호
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• pp.218-225
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• 2010

Background: Bronchoalveolar lavage (BAL) is a useful technique to recover lower airway fluid and cells involved in many respiratory diseases. Miliary tuberculosis is potentially lethal, but the clinical manifestations are nonspecific and typical radiologic findings may not be seen until late in the course of disease. In addition, invasive procedures are often needed to confirm disease diagnosis. This study analyzed the cells and the T-lymphocyte subset in BAL fluid from patients with miliary tuberculosis to determine specific characteristics of BAL fluid that may help in the diagnosis of miliary tuberculosis, using a less invasive procedure. Methods: On a retrospective basis, we enrolled 20 miliary tuberculosis patients; 12 patients were male and the mean patient age was $40.5{\pm}16.2$ years. We analyzed differential cell counts of BAL fluid and the T-lymphocyte subset of BAL fluid. Results: Total cells and lymphocytes were increased in number in the BAL fluid. The percentage of CD4+ Tlymphocytes and the CD4/CD8 ratio in BAL fluid were significantly decreased and the percentage of CD8+ T-lymphocytes was relatively higher. These findings were more prominent in patients infected with the human immunodeficiency virus (HIV). In the HIV-infected patients, the proportion of lymphocytes was significantly higher in BAL fluid than in peripheral blood. There were no significant differences between the BAL fluid and the peripheral blood T-lymphocytes subpopulation. Conclusion: BAL fluid in patients with miliary tuberculosis demonstrated lymphocytosis, a lower percentage of CD4+ T-lymphocytes, a higher percentage of CD8+ T-lymphocytes, and a decreased CD4/CD8 ratio. These findings were more significant in HIV-infected subjects.

• Tuberculosis and Respiratory Diseases
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• 제67권5호
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• pp.402-408
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• 2009

Background: Pre-B-cell colony enhancing factor (PBEF) has been suggested as a novel biomarker in sepsis and acute lung injury. We measured the PBEF in bronchoalveolar lavage (BAL) fluid of acute critically ill patients with lung infiltrates in order to evaluate the clinical utility of measuring PBEF in BAL fluid. Methods: BAL fluid was collected by bronchoscope from 185 adult patients with lung infiltrates. An enzyme-linked immunosorbent assay was then performed on the collected fluids to measure the PBEF. Results: Mean patient age was 59.9 ${\pm}$14.5 years and 63.8% of patients were males. The mean concentration of PBEF in BAL fluid was 17.5 ${\pm}$88.3 ng/mL, and patients with more than 9 ng/mL of PBEF concentration (n=26, 14.1%) had higher Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores on the BAL exam day. However, there were no significant differences in clinical characteristics between survivors and non-survivors. In patients with leukocytosis (n=93) seen on the BAL exam day, the linear regression analysis revealed a significant, positive relationship between PBEF and APACHE II ($r^2$=0.06), SOFA score ($r^2$=0.08), Clinical Pulmonary Infection Score ($r^2$=0.05), and plateau pressure in patients on ventilators ($r^2$=0.07) (p<0.05, respectively). In addition, multivariate regression analysis with PBEF as a dependent variable showed that the plateau pressure ($r^2$=0.177, p<0.05) was correlated positively with PBEF. Conclusion: The PBEF level in the BAL fluid may be a useful, new biomarker for predicting the severity of illness and ventilator-induced lung injury in critically ill patients with lung infiltates and leukocytosis.

• Journal of Microbiology
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• 제43권1호
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• pp.11-16
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• 2005

Matrix metalloproteinase (MMP)-9 plays an important role in the pathogenesis of bronchial asthma. Neovastat, having significant antitumor and antimetastatic properties, is classified as a naturally occurring multifunctional antiangiogenic agent. We evaluated the therapeutic effect of Neovastat on airway inflammation in a mouse model of asthma. BALB/c mice were immunized subcutaneously with ovalbumin (OVA) on days 0, 7, 14, and 21 and challenged with inhaled OVA on days 26, 29, and 31. Neovastat was administrated by gavage (5 mg/kg body weight) three times with 12 h intervals, beginning 30 min before OVA inhalation. On day 32, mice were challenged with inhaled methacholine, and enhanced pause (Penh) was measured as an index of airway hyperresponsiveness. The severity of airway inflammation was determined by differential cell count of bronchoalveolar lavage (BAL) fluid. The MMP-9 concentration in BAL fluid samples was measured by ELISA, and MMP-9 activity was measured by zymography. The untreated asthma group showed an increased inflammatory cell count in BAL fluid and Penh value compared with the normal control group. Mice treated with Neovastat had significantly reduced Penh values and inflammatory cell counts in BAL fluid compared with untreated asthmatic mice. Furthermore, mice treated with Neovastat showed significantly reduced MMP-9 concentrations and activity in BAL fluid. These results demonstrate that Neovastat might have new therapeutic potential for airway asthmatic inflammation.

• Tuberculosis and Respiratory Diseases
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• 제71권5호
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• pp.322-327
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• 2011

Background: Pneumocystis jirovecii is a fungus that has become an important cause of opportunistic infections. We present a summary of the clinical status and findings from bronchoalveolar lavage (BAL) of patients with Pneumocystis jirovecii pneumonia (PJP). Methods: We selected 30 cases of PJP that were proven through a surgical specimen evaluation. BAL fluid cytology was reviewed, and agreement with the initial diagnosis was evaluated. Results: All 30 cases of PJP occurred in immunocompromised patients. Only 15 of the 30 cases were initially diagnosed as PJP. We found PJP in 13 of the 15 cases that were negative at the initial diagnosis. The most characteristic finding of PJP was frothy exudates, and BAL fluid tended to show rare neutrophils. Two of seven patients with PJP and diffuse alveolar damage (DAD) revealed no frothy exudates in BAL fluid. Conclusion: BAL fluid cytology was reconfirmed as a sensitive and rapid method to diagnose PJP. We must be aware of the possibility of PJP to maintain high diagnostic sensitivity. We cannot exclude PJP in cases of PJP with DAD, even if frothy exudates are not observed in the BAL fluid.

• Tuberculosis and Respiratory Diseases
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• 제45권3호
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• pp.519-528
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• 1998

연구배경: PCR이 지닌 고유의 문제점으로 인해 PCR의 유용성이 평가절하되기도 하였으나 임상적인 맥락에서 PCR을 환자의 진단과 치료에 이용함에 있어 그 유용성을 평가하는 것이 매우 중요하다고 생각된다. 따라서 저자들은 객담 항산균검사로 폐결핵의 진단이 어려울 때 기관지폐포세척액(Bronchoalveolar lavage fluid, BALF) 에 대한 nested PCR을 시행하여 결핵의 진단에서의 유용성을 알아보고자 하였다. 방 법: 단순 흉부사진상 활동성 폐결핵이 의심되나 향산균이 검출되지 않는 환자 혹은 객담의 배출이 불가능한 환자를 대상으로 기관지폐포세척술(Bronchoalveolar lavage, BAL)을 시행하여 세척액으로 결핵균 도말과 배양, PCR 검사를 시행하고 그 결과를 비교하였다. 결 과: BALF 도말 검사 민감도는 20% 배양 검사 민감도는 38%, BALF PCR의 민감도는 40%, 특이도는 95%였다. BALF에서 배양 양성일 때 PCR이 양성인 경우는 47%였고 BALF 배양 음성시 PCR 양성인 경우는 36%였다. BALF PCR 양성일 때 결핵에 대한 예측치는 89%였다. 기관지내시경을 이용한 결핵균 도말 및 PCR 검사로 40례중 18례(45%)에서 조기에 추가 진단이 가능하였으며 이들 중 8례는 도말로 진단이 되었고 10례 (25%) 는 BALF PCR로만 진단이 가능하였다. 객담 검사가 PCR까지 포함하여 모두 음성일 때 BALF 도말로 진단한 경우가 29명중 5명(17%)이었고 도말도 음성으로 나와 PCR로 진단한 경우가 5명(17%)이였다. 배양검사는 2개월이 지나야 결과를 알 수 있으므로 BAL을 시행하여 조기 진단이 된 경우는 29명중 10명이 된다. BAL PCR로만 진단된 경우는 5명으로 12.5%에서 진단이 가능하였다. 결 론: PCR은 과거와는 달리 검사비용이 비교적 저렴한 검사로 결핵의 진단율을 높이고 수일내에 빠른 결과를 얻을 수 있을 것으로 기대된다. BALF PCR 검사를 시행하는 것이 비용과 이득을 따져볼 때 반드시 시행해야 하는 검사라고 결론을 내리기는 어려우나 임상적 상황에 따라 적절히 이용된다면 결핵의 진단율을 높이고 수시간 내에 빠른 결과를 얻을 수 있을 것으로 기대되며, 면역억제 환자의 경우는 치료가 늦어지면 생명이 위험한 경우가 많아 특히 PCR이 유용한 검사가 될 것으로 생각된다.

• The Korean Journal of Physiology and Pharmacology
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• 제13권3호
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• pp.181-187
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• 2009

Intestinal ischemia/reperfusion (I/R) is one of common causes of acute lung injury (ALI). Early and accurate diagnosis of patients who are like to develop serious acute respiratory distress syndrome (ARDS) would give a therapeutic advantage. Ferritin and heme oxygenase-1 (HO-1) are increased by oxidative stress and are potential candidates as a predictive biomarker of ARDS. However, the mechanisms responsible for the increases of ferritin and HO-1, and their relationship to ALI, are unclear. In order to elucidate the interactions between ferritin and HO-1, we studied the changes in ferritin and HO-1 levels in serum and bronchoalveolar lavage (BAL) fluid after intestinal I/R injury in rats. Leukocyte number and protein contents in BAL fluid were elevated following I/R, and the increases were attenuated by mepacrine pretreatment. Both serum ferritin and HO-1 concentrations were progressively elevated throughout the 3 h observation period. Mepacrine pretreatment attenuated the increase of serum and BAL fluid ferritin concentrations, but did not suppress the increase of serum HO-1. Moreover, BAL fluid HO-1 levels did not change after I/R or after mepacrine pretreated I/R compared with sham rats. Unlike ferritin, HO-1 levels are not exactly matched with the ALI. Therefore, there might be a different mechanism between the changes of ferritin and HO-1 in intestinal I/R-induced ALI model.

• Toxicological Research
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• 제26권3호
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• pp.203-208
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• 2010

Bronchoalveolar lavage (BAL) is a useful tool in researches and in clinical medicine of lung diseases because the BAL fluid contains biochemical and cytological indicators of the cellular response to infection, drugs, or toxicants. However, the variability among laboratories regarding the technique and the processing of the BAL material limits clinical research. The aim of this study was to determine the suction frequency and lavage fraction number necessary to reduce the variability in lavage using male Sprague-Dawley rats. We compared the total cell number and protein level of each lavage fraction and concluded that more cells and protein can be obtained by repetitive lavage with a suction frequency of 2 or 3 than by lavage with a single suction. On the basis of total cell recovery, approximately 70% of cells were obtained from fractions 1~3. The first lavage fraction should be used for evaluation of protein concentration because fractions 2~5 of lavage fluid were diluted in manifolds. These observations were confirmed in bleomycin-induced inflamed lungs of rats. We further compared the BAL data from the whole lobes with data from the right lobes and concluded that BAL data of the right lobes represented data of the whole lobes. However, this conclusion can only be applied to general lung diseases. At the end, this study provides an insight into the technical or analytical problems of lavage study in vivo.

• Tuberculosis and Respiratory Diseases
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• 제43권6호
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• pp.954-964
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• 1996

배경: 미만성 간질성 폐질환(DILD)들은 처음에 폐포염(alveolitis) 으로 시작해 섬유화로 진행하여 심한 폐기능장애를 초래하는 질병군들로서 병의 종류에 따라 침윤되는 염증세포들의 종류에 차이가 있다. 근래에 염증세포들의 침윤을 유도하는 화학주유물질들(chemokine)이 많이 발견되었는데 이들은 화학구조에 따라 C-X-C형과 C-C형으로 분류되며, 구조만 다를 뿐 아니라 작용하는 세포도 차이가 있기 때문에 주로 분비되는 화학주유물질의 종류에 따라 폐포염의 종류가 결정이될 가능성이 많다. 이에 연구자들은 폐포염과 화학주유물질과의 연관성 및 폐포대식세포 (AM)가 이들 화학주유물질의 주 근원이 되는가를 알아보기 위하여 DILD 환자들에서 cytokine을 분비하여 발병기 전에 주작용을 한다고 알려진 AM 에서의 C-X-C 형 IL-8 과 C-C 형인 MIP- 1 ${\alpha}$ 의 분비 및 BAL액내에서의 이들 화학주유물질들의 농도를 폐포염의 양상을 잘 반영한다고 알려진 BAL 액내 세포양상과 비교분석 하였다. 대상및 방법: 대상은 임상소견과 조직검사로 확진된 lPF 환자 10명, 교원성질환과 연관된 폐섬유증 환자 4명, 폐유육종중 10명과 과민성폐장염 환자 2명, 총 26명과 정상 대조군 7명이었고, 이들에서 BAL을 시행하여 그 세포구성의 변화를 관찰하고, AM을 분리배양하여 그 상청액및 BAL액에서 의 IL-8과 MIP- 1 ${\alpha}$ 의 농도를 ELISA 방법으로 측정하여 비교 분석하였다. 결과: AM 에서의 IL-8 분비는 DILD 환자들에서 $8.15{\pm}4.58$ ng/ml로 정상 대조군 ($1.10{\pm}0.93$ ng/ml)보다 유의하게 (p=0.0003) 증가하였고, AM에서 분비된 IL-8 량은 BAL액내 총세포수와 (r=0.484, p=0.0068), 또 BAL액내 dla파구의 백분률 (r=0.592, p=0.0004)및 임파구의 수효 (r=0.516, p=0.0042), AM의 백분플 (r=-0.505, 0.0032) 과 유의한 상관관계를 보여 주었다. AM에서의 MIP- 1 ${\alpha}$ 분비는 DILD환자군에서 ($2.41{\pm}1.45$ ng/ml) 정상인보다 ($0.63{\pm}0.30$ ng/ml, p=0.0031) 유의하게 증가되었으나, MIP- 1 ${\alpha}$ 의 분비량은 BAL액내 총세포수와 r=0.368, p=0.0456로 유의한 상관관계를 나타내었고, AM의 수효와 연관이 있는 경향을 (r=0.356, p=0.0579) 보어 주었을 뿐이었다. BAL 액내의 IL-8 농도는 DILD 환자군에서 ($40.4{\pm}34.5$ pg/ml)로 정상인의 $3.90{\pm}2.47$ pg/ml보다 높았고 (p=0.0094), IL-8 농도와 BAL 액내 총 세포수(r=0.484, p=0.0068), AM의 백분율(r=-0.505, p=0.0032), 임파구의 백분율 (r=0.592, p=0.0004) 및 임파구의 수효 (r=0.516, p=0.0042) 와 좋은 상관관계를 나타내어 IL-8 이 폐내 침윤된 염증세포의 종류를 결정하는데 중요한 역할을 하는 것을 시사하였다. 그러나 BAL액내 MIP- 1 ${\alpha}$ 의 농도는 정상인과 차이가 없었다. 결론: 이상의 결과로 미루어 IL-8과 MIP- 1 ${\alpha}$ 모두가 DILD의 발병기전에 작용하나, IL-8 이 폐포염의 양상을 결정하는데 더 중요한 역한을 하는 것으로 추측되었다.

• Journal of Preventive Medicine and Public Health
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• 제47권1호
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• pp.57-63
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• 2014

Objectives: We established a Wistar rat model of asthma caused by toluene diisocyanate (TDI) exposure, and investigated the relationship between TDI exposure concentrations and respiratory hypersensitivity, airway inflammation, and cytokine secretions in animals, to better understand the mechanism of TDI induced occupational asthma. Methods: Wistar rats were exposed to two different concentrations of TDI vapor four hours a day for five consecutive days. Bronchoalveolar lavage (BAL) was performed, and differential leucocytes from the BAL fluid were analyzed. Lung histopathological examination was carried out to investigate the inflammatory status in the airways. Production of cytokines interleukin (IL)-4 and IL-5 productions in the BAL fluid in vivo was determined with enzyme-linked immunosorbent assay kits. Results: The TDI-exposed rats exhibited greater airway hypersensitivity symptoms than the control rats. The BAL differential cell count and lung histopathological examination demonstrated that inflammation reactions were present in both the central and peripheral airways, characterized with marked infiltration of eosinophils in the TDI-exposed rats. The cytokine assay showed that IL-4 and IL-5 were predominantly produced in the BAL fluid in vivo. Conclusions: These findings imply that TDI exposure concentrations may greatly affect the occurrence and extent of inflammatory events and that Th2 type cytokines may play an important role in the immunopathogenesis of TDI-induced occupational respiratory hypersensitivity.

• 대한한방소아과학회지
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• 제20권1호
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• pp.181-194
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• 2006

Objective : Author evaluate the effects of Citri Reticulatae Viride Pericarpium for the bronchial asthma using assesment of the vascular endothelial growth factor after Citri Reticulatae Viride Peicarpium was intravenously administered Ovalbumine(OVA)-sensitized and -challenged mice. Material and Methods : Twenty-four female mice, 8-10 weeks old and free of murine specific pathogens, were sensitized by intraperitoneal injection of OVA. Of the sensitized mice, ten mice didn't administrate Citri Reticulatae Viride Pericarpium and the other ten mice administrated Citri Reticulatae Viride Pericarpium. Mice were sensitized on the first and fourteen days introspectional injection of 20 ${\mu}g$ OVA. After$21^{st}\;22^{th}\;and\;23^{rd}$, the initial sensitization, the mice were challenged for 30 minutes with an aerosol of 1% OVA in saline. Citri Reticulatae Viride Pericarpium administered 200mg/kg in the tail of the mouse, one a day, for 7 days and beginning 14 days after first sensitization. Bronchoalveolar lavage was performed 72 hours after the last challenge, and total cell numbers in the BAL fluid were count. Also, lever of VEGF in the BAL fluid was measured by Enzyme immunoassays and Western blot analysis. Results: Total cell numbers in BAL fluid were significantly greater than from 72 hrs after OVA inhalation compared with cell numbers in the control group. However, there was no difference of the total cell numbers between OVA-challenge groups without Citri Reticulatae Viride Pericarpium, and OVA-challenge with Citri Reticulatae Viride Pericarpium. Enzyme immunoassay revealed that VEGF levels in the BAL fluids were significantly increased 72 hrs after OVA inhalation compared with levels in the control group. After administration of the Citri Reticulatae Viride Pericarpiu, the levels of the VEGF in BAL fluids 72 hrs after OVA inhalation reduced dramatically. Western blot analysis revealed that VEGF protein levels were increased in the all mice which were challenge with OVA, without administered Citri Reticulatae Viride Pericarpium, compared the normal mouse. However, in the groups of the administered Citri Reticulatae Viride Pericarpium, the VEGF protein level markedly decreased. Conclusion: Citri Reticulatae Viride Pericarpium might affect the treatment of the bronchial ashma as a inhibition of the VEGF.