Planck A, Eklund A, Grunewald J
Department of Medicine, Karolinska Hospital, Stockholm, Sweden.
Sarcoidosis Vasc Diffuse Lung Dis. 2001 Mar;18(1):64-9.
We have previously shown that HLA DR17 is associated with a favourable prognosis in Scandinavian sarcoidosis patients. By studying inflammatory parameters in these patients we wished to increase the knowledge of the involved mechanisms that may underlie good prognosis.
BAL was performed in 118 sarcoidosis patients, 67 HLA DR17 positive and 51 DR17 negative. BAL cell profile was analysed. The CD4 and CD8 lymphocyte phenotype was determined by flow cytometry. BALF-albumin, BALF-fibronectin (FN) and BALF-procollagen III aminoterminal peptide (PIIINP) were analysed by nephelometric, ELISA and RIA methods respectively. Neopterin and soluble interleukin-2 receptor (sIL2R) in serum were also determined by ELISA. Angiotensin-converting enzyme (ACE) in serum was analysed by spectrophotometry.
In DR17+ patients, BAL lymphocytes and eosinophils were significantly decreased (median 30.2 and 0.19 x10(6)/L) compared to DR17- (median 50.2 and 0.64 x 10(6)/L respectively). However the BAL CD4/CD8 ratio was increased in the DR17+ group compared to DR17- (6.2 vs. 4.3). BALF-albumin, FN and PIIINP did not differ between the groups. Serum parameters were decreased in DR17+ patients compared to DR17- (ACE median 28.7 vs. 35.1 U/L, neopterin 9.1 vs. 12.7 nmol/L and sIL2R 296 vs. 605 U/L).
The study revealed that an increased BAL CD4/CD8 ratio, in contrast to BAL lymphocytosis, was seen in a subgroup of sarcoidosis patients earlier associated with a favourable prognosis. Our results support that an increased BAL CD4/CD8 ratio is a favourable parameter in sarcoidosis. The lower ACE activity in the DR 17+ group indicates a reduced granuloma burden in this patient subgroup.
我们之前已表明，HLA DR17与斯堪的纳维亚结节病患者的良好预后相关。通过研究这些患者的炎症参数，我们希望增加对可能构成良好预后基础的相关机制的了解。
对118例结节病患者进行了支气管肺泡灌洗（BAL），其中67例HLA DR17阳性，51例DR17阴性。分析了BAL细胞谱。通过流式细胞术测定CD4和CD8淋巴细胞表型。分别采用比浊法、酶联免疫吸附测定（ELISA）和放射免疫分析（RIA）方法分析BALF-白蛋白、BALF-纤连蛋白（FN）和BALF-前胶原III氨基末端肽（PIIINP）。血清中的新蝶呤和可溶性白细胞介素-2受体（sIL2R）也通过ELISA测定。血清中的血管紧张素转换酶（ACE）通过分光光度法分析。
与DR17阴性患者（中位数分别为50.2和0.64×10⁶/L）相比，DR17阳性患者的BAL淋巴细胞和嗜酸性粒细胞显著减少（中位数分别为30.2和0.19×10⁶/L）。然而，与DR17阴性组相比，DR17阳性组的BAL CD4/CD8比值升高（6.2对4.3）。两组之间的BALF-白蛋白、FN和PIIINP无差异。与DR17阴性患者相比，DR17阳性患者的血清参数降低（ACE中位数28.7对35.1 U/L，新蝶呤9.1对12.7 nmol/L，sIL2R 296对605 U/L）。
该研究表明，在结节病患者的一个亚组中，与BAL淋巴细胞增多症相反，观察到BAL CD4/CD8比值升高，该亚组患者之前与良好预后相关。我们的结果支持BAL CD4/CD8比值升高是结节病的一个良好参数。DR17阳性组中较低的ACE活性表明该患者亚组中的肉芽肿负荷降低。
