Kadota Jun-ichi, Mukae Hiroshi, Fujii Takeshi, Seki Masafumi, Tomono Kazunori, Kohno Shigeru
Division of Pathogenesis and Disease Control, Department of Infectious Diseases, Oita University Faculty of Medicine, Oita, Japan.
Chest. 2004 Apr;125(4):1239-47. doi: 10.1378/chest.125.4.1239.
Human T-cell lymphotropic virus type 1 (HTLV-1)-associated bronchiolitis and diffuse panbronchiolitis might overlap. We examined whether these conditions can be differentiated by comparing their clinical features and the effect of long-term macrolide treatment.
Fifty-eight Japanese patients, including 15 with HTLV-1-associated bronchiolitis and 43 with diffuse panbronchiolitis. Both conditions were clinically compared using the clinical criteria for diffuse panbronchiolitis, including findings from CT scans and BAL fluid testing. Pulmonary function, blood gas levels, and cold hemagglutinin (CHA) levels were assessed before and after long-term treatment with macrolides. Interleukin-2 receptor (IL-2R) expression in T cells obtained from the BAL fluid of patients with HTLV-1-associated bronchiolitis or diffuse panbronchiolitis was analyzed by flow cytometry.
Clinical, laboratory, radiologic, and bacterial features were strikingly similar in both groups, except for the fact that patients with HTLV-1-associated bronchiolitis had a higher ratio of IL-2R-positive cells in the BAL fluid. The histopathologic features were also similar. Long-term treatment with macrolides improved PaO(2), FEV(1), and CHA in patients with HTLV-1-associated bronchiolitis to a lesser extent than in those with diffuse panbronchiolitis, and PaO(2) and FEV(1) in the group of patients with HTLV-1-associated bronchiolitis who had high IL-2R levels did not respond after therapy.
These findings showed that the clinicopathologic features of the two conditions are quite similar, suggesting that diffuse panbronchiolitis is a chronic pulmonary manifestation of HTLV-1 infection. However, HTLV-1-associated bronchiolitis might be associated with conditions that are distinct from those of diffuse panbronchiolitis based on the different responses to macrolide treatment and the difference in the number of activated T cells bearing IL-2R in the lungs.
1型人类嗜T淋巴细胞病毒（HTLV-1）相关细支气管炎和弥漫性泛细支气管炎可能存在重叠。我们通过比较它们的临床特征以及长期大环内酯类药物治疗的效果，来研究这两种疾病是否可以区分。
58例日本患者，其中15例患有HTLV-1相关细支气管炎，43例患有弥漫性泛细支气管炎。使用弥漫性泛细支气管炎的临床标准对这两种疾病进行临床比较，包括CT扫描结果和支气管肺泡灌洗（BAL）液检测结果。在接受大环内酯类药物长期治疗前后，评估肺功能、血气水平和冷凝集素（CHA）水平。通过流式细胞术分析从HTLV-1相关细支气管炎或弥漫性泛细支气管炎患者的BAL液中获取的T细胞中白细胞介素-2受体（IL-2R）的表达。
两组患者的临床、实验室、放射学和细菌学特征非常相似，只是HTLV-1相关细支气管炎患者的BAL液中IL-2R阳性细胞比例较高。组织病理学特征也相似。与弥漫性泛细支气管炎患者相比，HTLV-1相关细支气管炎患者接受大环内酯类药物长期治疗后，动脉血氧分压（PaO₂）、第1秒用力呼气容积（FEV₁）和CHA的改善程度较小，且IL-2R水平较高的HTLV-1相关细支气管炎患者组在治疗后PaO₂和FEV₁无反应。
这些发现表明，这两种疾病的临床病理特征非常相似，提示弥漫性泛细支气管炎是HTLV-1感染的一种慢性肺部表现。然而，基于对大环内酯类药物治疗的不同反应以及肺部携带IL-2R的活化T细胞数量的差异，HTLV-1相关细支气管炎可能与弥漫性泛细支气管炎的情况不同。
