Drent M, Jacobs J A, de Vries J, Lamers R J, Liem I H, Wouters E F
Dept. of Pulmonology, University Hospital Maastricht, The Netherlands.
Eur Respir J. 1999 Jun;13(6):1338-44. doi: 10.1183/09031936.99.13613459.
The aim of this study was to assess whether the cellular bronchoalveolar lavage fluid (BALF) profile, particularly the number of polymorphonuclear neutrophils (PMNs), is associated with disease severity of sarcoidosis and its usefulness in determining remission. Twenty-six nonsmoking outpatients with sarcoidosis were included in this study. The patients were divided into two subgroups according to the absolute number of PMNs in BALF: < or =0.2x10(4) cells x mL(-1) (group 1; n = 15) and >0.2x10(4) cells x mL(-1) (group 2; n = 11). The radiographic stage, high-resolution computed tomography (HRCT) findings, 67Ga lung uptake as well as lung function tests differed significantly between group 1 and 2. Follow-up revealed that 14 (93.3%) patients of group 1 compared to four (36.4%) of group 2 recovered spontaneously without the help of corticosteroids. In contrast, no differences were found in the number of lymphocytes in BALF nor in the serum angiotensin converting enzyme (sACE) level between both groups. The number of PMNs, the transfer factor of the lungs for carbon monoxide (TL,CO), the forced expiratory volume in one second (FEV1) and one of the HRCT subscores discriminated between patients with different disease progression. Of these parameters the PMNs appeared to be the only one which differentiated patients who demonstrated remission and those who deteriorated. In conclusion, these results indicate that the number of polymorphonuclear neutrophils in bronchoalveolar lavage fluid distinguish between sarcoidosis patients who demonstrated remission and those having a more severe course of the disease. Whether polymorphonuclear neutrophils may be considered as markers of disease activity and/or prognosis in sarcoidosis needs further investigation.
本研究的目的是评估细胞支气管肺泡灌洗液（BALF）特征，尤其是多形核中性粒细胞（PMN）数量，是否与结节病的疾病严重程度相关及其在确定缓解中的作用。本研究纳入了26例非吸烟结节病门诊患者。根据BALF中PMN的绝对数量将患者分为两个亚组：≤0.2×10⁴个细胞×mL⁻¹（第1组；n = 15）和＞0.2×10⁴个细胞×mL⁻¹（第2组；n = 11）。第1组和第2组在放射学分期、高分辨率计算机断层扫描（HRCT）结果、⁶⁷Ga肺摄取以及肺功能测试方面存在显著差异。随访发现，第1组14例（93.3%）患者与第2组4例（36.4%）患者在无皮质类固醇帮助的情况下自发康复。相比之下，两组之间BALF中淋巴细胞数量以及血清血管紧张素转换酶（sACE）水平均无差异。PMN数量、肺一氧化碳转运因子（TL,CO）、一秒用力呼气量（FEV1）以及HRCT分项评分之一可区分不同疾病进展的患者。在这些参数中，PMN似乎是唯一能区分病情缓解和病情恶化患者的指标。总之，这些结果表明支气管肺泡灌洗液中多形核中性粒细胞数量可区分病情缓解的结节病患者和病情更严重的患者。多形核中性粒细胞是否可被视为结节病疾病活动和/或预后的标志物需要进一步研究。
