Wert der Bestimmung der alkalischen Phosphatase (AP) und des AP/Albumin-Quotienten in der bronchoalveolären Lavage (BAL) für die Diagnostik interstitieller Lungenkrankheiten

Zusammenfassung:

Tierexperimentelle Befunde legen nahe, dass die in der BAL nachweisbare AP zu einem wesentlichen Teil im Pneumozyten II produziert wird und dass eine Schädigung der Pneumozyten II mit einer Erhöhung der AP in der BAL verbunden ist. Ziel unserer Untersuchung war die Klärung der Frage, ob die Bestimmung der AP in der BAL bei der Diagnostik interstitieller Lungenkrankheiten hilfreich sein kann. Zum Nachweis eines eventuellen Übertritts der AP aus dem Plasmaraum in die BAL wurde das Albumin in der BAL gemessen und der AP/Albumin-Quotient errechnet. In die Auswertung gingen 85 Patienten mit folgenden Diagnosen ein: 34 Sarkoidosen (Stadium I/II/III 14/7/13), 14 idiopathische Lungenfibrosen (IPF), 7-mal Bronchiolitis obliterans mit organisierender Pneumonie (BOOP), 6 exogen-allergische Alveolitiden (EAA), 24 Kontrollen (13 Nichtraucher, 11 Raucher). Wir sahen bei IPF und BOOP eine signifikante Erhöhung der AP in der BAL im Vergleich mit Kontrollen und Sarkoidose (42,4 ± 36,6 bzw. 35,6 ± 16 vs. 15,8 ± 12,7 bzw. 15,0 ± 9,8 jeweils U/l). Das Albumin in der BAL war bei Sarkoidose im Vergleich mit den Kontrollen signifikant erhöht (13,2 ± 10 vs. 5,7 ± 4 mg/dl), der AP/Albuminquotient erniedrigt (1,3 ± 0,9 vs. 3,6 ± 3,0 U/10 mg). Das diskordante Verhalten von AP und Albumin bei veschiedenen Krankheiten spricht gegen eine plasmatische Beimischung als Ursache der AP in der BAL. Ohne Einfluss auf AP und Albumin in der BAL war bei der Sarkoidose das Stadium der Erkrankung und bei der Kontrollgruppe die Tatsache eines Nikotinkonsums. Schlussfolgerung: Bei Patienten mit chronischen interstitiellen Lungenkrankheiten zeigen sich in Abhängigkeit vom Krankheitsbild unterschiedliche Konzentrationen von AP und Albumin in der BAL. Insbesondere für die Diagnostik einer IPF (erhöhte AP, normaler AP/Albuminquotient) und einer Sarkoidose (normale AP, erniedrigter AP/Albuminquotient) könnte deren Bestimmung hilfreich sein.

Concentration of Alkaline Phosphatase (AP) and AP-albumine-ratio in Bronchoalveolar Lavage (BAL) as a Diagnostic Tool in Interstitial Lung Diseases:

As a result of several studies with different animal models there is evidence that the concentration of AP in BAL is produced in the pneumocyte II and that an increase of AP in the BAL is a marker of tissue damage. By measuring AP in the BAL of patients with interstitial lung diseases we investigated its potential role as a diagnostic tool. To detect plasma leakage we also measured the concentration of albumine in the BAL. We studied 85 patients with following diagnoses: Sarcoidosis in 34 patients (Stage 1/2/3 14/7/13), idiopathic pulmonary fibrosis (IPF) in 14, bronchiolitis obliterans with organizing pneumonia (BOOP) in 7, hypersensitivity pneumonitis (HP) in 6. The control group consisted in 24 patients (13 nonsmokers, 11 smokers). In IPF and BOOP we observed significantly higher concentrations of AP than in controls and sarcoidosis (42.4 ± 36.6 and 35.6 ± 16 vs. 15.8 ± 12.7 and 15.0 ± 9.8 U/l, p < 0.05, ANOVA). Compared with controls in sarcoidosis higher concentrations of albumine (5.7 ± 4 vs. 13.2 ± 10 mg/dl, p < 0.05, ANOVA) and a lower AP/albumin-ratio (3.6 ± 3.0 vs. 1.3 ± 0.9 U/10 mg, p < 0.05, ANOVA) were seen. This result is an argument against plasma leakage as the source of AP in BAL. There were no differences in AP and albumine between the different stages of sarcoidosis and between smokers and nonsmokers in the control group. We conclude, that there are different concentrations of AP and albumine in BAL in different interstitial lung diseases. Compared with controls we observed higher concentrations of AP and an AP/albumine-ratio in the normal range in IPF, a normal concentration of AP and a lowered AP/albumine-ratio in sarcoidosis.

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