INFLAMMATORY CYTOKINES IN BAL FLUID AND PULMONARY HEMODYNAMICS IN HIGH-ALTITUDE PULMONARY-EDEMA

To evaluate the pathogenesis of high-altitude pulmonary edema (HAPE), we performed bronchoalveolar lavage (BAL) and pulmonary hemodynamic st udies in seven patients with HAPE at its early stage. We measured cell counts, biochemical contents, and concentrations of pro-inflammatory cytokines including interleukin (IL)-1, IL-6, IL-8 and tumor necrosis factor (TNF)-alpha and of anti-inflammatory cytokines including IL-1 r eceptor antagonist (ra) and IL-10 in the BAL fluid (BALF). All patient s showed increased counts for total cells, alveolar macrophages, neutr ophils and lymphocytes, and markedly elevated concentrations of protei ns, lactate dehydrogenase, IL-1 beta, IL-6, IL-8, TNF-alpha and IL-1ra . The levels of IL-1 alpha and IL-10 were not increased. Patients also showed pulmonary hypertension with normal wedge pressure. Both the dr iving pressure obtained as pulmonary arterial pressure minus wedge pre ssure and the Pa-O2 under room air were significantly correlated with the concentrations of IL-6 and TNF-alpha in the BALF. These findings s uggest that the inflammatory cytokines play a role at the early stage of HAPE and might be related to pulmonary hypertension. (C) 1998 Publi shed by Elsevier Science B.V. All rights reserved.