Doppelisotopen-Albuminfluxmessung: Diagnose und Therapiemonitoring des Acute Lung Injury^[*]

Zusammenfassung

Ziel: Acute Lung Injury (ALI) ist ein Krankheitsbild mit hoher Letalität, das durch eine erhöhte pulmonale Kapillarpermeabilität mit einem nichtkardialen Lungenödem gekennzeichnet ist. In der vorliegenden Studie sollte überprüft werden, ob die Doppelisotopen-Albuminfluxmessung sich neben der Diagnostik einer erhöhten pulmonalen Kapillarpermeabilität auch zum Monitoring therapeutischer Interventionen (Stickstoffmonoxid (NO)-lnhalation) eignet. Methoden: Bei 12 Patienten mit ALI wurde der transvaskuläre Albuminflux vor, während und nach NO-Inhalation mittels Doppelisotopenmethode bestimmt. Als Tracer dienten ^99mTc markiertes Albumin und ⁵¹Cr markierte autologe Erythrozyten. Die Aktivität beider Radiopharmazeutika wurde simultan über der Lunge mit einem Sondenmeßgerät und im arteriellen Blut ermittelt. Zur Quantifizierung des transvaskulären Albuminfluxes wurden der Normalized Index (Nl) und Normalized Slope Index (NSI) errechnet. Darüber hinaus wurden die pulmonalen Gefäßdrücke und weitere physiologische Parameter bestimmt. Ergebnisse: Alle 12 Patienten wiesen, als Ausdruck einer schweren Permeabilitätsstörung vor der NO-Inhalation deutlich erhöhte NSI auf. Während der NO-Inhalation fiel der NSI von durchschnittlich 0,0074 ± 0,0046 min^-1 auf -0,0051 ± 0,0041 min^-1. Nach Beendigung der NO Gabe stieg der NSI erneut auf durchschnittlich 0,0046 ± 0,0111 min^-1 an. Der NSI Abfall zeigte eine gute Korrelation zum NO-induzierten Abfall des pulmonal-venösen Gefäßwiderstandes. Schlußfolgerung: Unter NO Inhalation kommt es zu einer Reduzierung des transvaskulären Albuminfluxes. Die Doppelisotopen-Albuminflux-messung eignet sich sowohl zur Diagnostik als auch zum Therapiemonitoring bei ALI-Patienten.

Summary

Purpose: Acute Lung Injury (ALI) is a clinical condition which is associated with a high lethality. It is characterized by an increased pulmonary capillary permeability and non-cardiogenic pulmonary edema. This study was designed to answer the question whether double isotope albuminflux measurement is a useful tool both for diagnosis of increased pulmonary capillary permeability and for monitoring therapeutic interventions (nitric oxide (NO) inhalation). Method: In 12 patients with clinical signs of ALI, transvascular albuminflux was measured by a double radioisotope technique before, during and after NO inhalation. ^99mTc labeled albumin and ⁵¹Cr labeled autologous erythrocytes were used as tracer. The radioactivity of both radiopharmaceuticals was measured externally over the right lung by a radiation probe and simultaneously in arterial blood. For quantification of transvascular albuminflux Normalized Index (Nl) and Normalized Slope Index (NSI) were calculated. Furthermore, pulmonal vascular pressures and other physiological parameters were recorded. Results: All 12 patients showed markedly increased NSI before inhalation of NO. NSI decreased from 0.0074 ± 0.0046 min^-1 without nitric oxide to -0.0051 ± 0.0041 min^-1 during nitric oxide and increased to 0.0046 ± 0.0111 min^-1 after nitric oxide. The decrease of the NSI correlated well with decrease of venous pulmonary resistance during inhalation of NO. Conclusion: Inhalation of NO reduces transvascular albuminflux in patients with ALI. Double isotope albuminflux measurement enables diagnosis of increased capillary permeability as well as monitoring therapeutic interventions.

Schlüsselwörter

Acute Lung Injury - transvaskulärer Albuminflux - Doppelisotopentechnik - Stickstoffmonoxid-Inhalation

Keywords

Acute lung injury - transvascular albuminflux - double isotope technique - nitric oxide inhalation

^* Herrn Prof. L. E. Feinendegen zum 70. Geburtstag.

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