诱导痰与支气管肺泡灌洗液在特发性肺纤维化患者评估中的比较

Induced sputum versus bronchoalveolar lavage fluid in the evaluation of patients with idiopathic pulmonary fibrosis.

作者信息

Antoniou Katerina M, Alexandrakis Michaels, Tzanakis Nikolaos, Tsiligianni Ioanna, Tzortzaki Eleni G, Siafakas Nikolaos M, Bouros Demosthenes E

机构信息

Interstitial Lung Disease Unit, Department of Pneumonology, Medical School University of Crete and University Hospital, Heraklion, Greece.

出版信息

Respiration. 2005 Jan-Feb;72(1):32-8. doi: 10.1159/000083398.

DOI:10.1159/000083398

PMID:15753632

Abstract

BACKGROUND

Induced sputum (IS) has been proposed as a useful noninvasive method for the assessment of airway diseases. Bronchoalveolar lavage fluid (BALF), an important tool for evaluating interstitial lung diseases, has limited utility due to its invasiveness and the difficulties of performing it in severely ill patients, while it is impractical for follow-up evaluation.

OBJECTIVES

The aim of this study was to investigate the differences and the possible correlation of cell differential and lymphocyte subpopulations between BALF and IS samples in patients with idiopathic pulmonary fibrosis (IPF).

METHODS

We studied prospectively 20 patients (18 male, 2 female) of median age 67 years (range 40-75) with IPF and 10 normal subjects (5 female, 5 male) of median age 59 years (range 36-70). IS was performed with hypertonic saline solution using an ultrasonic nebulizer (Ultraneb 2000). BALF was performed by a conventional procedure using fiberoptic bronchoscopy within 3 days from IS. May-Grunewald-Giemsa-stained preps were differentially counted and T-lymphocyte subsets were analyzed by a flow-activated cell sorter.

RESULTS

The percentage of macrophages was significantly lower in IS than in BALF (p < 0.0001), while the neutrophils were lower in BALF (p < 0.0001). A significant correlation was found between BALF and IS eosinophil counts (r = 0.54, p = 0.01) and CD4+/CD8+ ratio (r = 0.74, p < 0.0001).

CONCLUSION

Our data suggest that different information is obtained by IS and BALF and thus, the two methods are complementary in IPF.

摘要

背景

诱导痰（IS）已被提议作为评估气道疾病的一种有用的非侵入性方法。支气管肺泡灌洗液（BALF）是评估间质性肺疾病的重要工具，但由于其具有侵入性且在重症患者中操作困难，同时用于随访评估也不切实际，因此其效用有限。

目的

本研究旨在调查特发性肺纤维化（IPF）患者BALF和IS样本之间细胞分类计数及淋巴细胞亚群的差异和可能的相关性。

方法

我们前瞻性地研究了20例IPF患者（男性18例，女性2例），中位年龄67岁（范围40 - 75岁），以及10名正常受试者（男性5例，女性5例），中位年龄59岁（范围36 - 70岁）。使用超声雾化器（Ultraneb 2000）用高渗盐溶液进行诱导痰操作。在诱导痰操作后3天内，通过常规纤维支气管镜检查方法获取支气管肺泡灌洗液。对May - Grunewald - Giemsa染色涂片进行分类计数，并通过流式细胞仪分析T淋巴细胞亚群。

结果

诱导痰中巨噬细胞的百分比显著低于支气管肺泡灌洗液（p < 0.0001），而支气管肺泡灌洗液中的中性粒细胞较低（p < 0.0001）。支气管肺泡灌洗液和诱导痰嗜酸性粒细胞计数之间存在显著相关性（r = 0.54，p = 0.01）以及CD4⁺/CD8⁺比值之间存在显著相关性（r = 0.74，p < 0.0001）。