Kim Y, Kim K, Joe J, Park H, Lee M, Kim Y, Choi Y, Park S
Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea.
Respiration. 2007;74(2):202-7. doi: 10.1159/000097491. Epub 2006 Nov 23.
Endobronchial tuberculosis (EBTB) has been shown to frequently complicate bronchial stenosis, a condition which can induce dyspnea as a result of airway obstruction, and is also frequently misdiagnosed as either bronchial asthma or lung cancer.
This study attempted to determine whether there was a correlation between interferon-gamma (IFN-gamma) and transforming growth factor-beta (TGF-beta) levels in the serum and bronchial washing fluid (BWF), and the results of the treatment of EBTB patients.
Thirty patients, all of whom were diagnosed as EBTB, were enrolled, as were 10 healthy control subjects. IFN-gamma and TGF-beta levels were measured by the ELISA method in the serum and BWF of these 30 EBTB patients before and after treatment. The EBTB patients were divided into two groups: those who exhibited bronchial stenosis after treatment and those who did not. Chest computed tomography (CT) and pulmonary function test (PFT) were performed in 16 and 25 patients, respectively, at initial bronchoscopy.
IFN-gamma and TGF-beta levels in the BWF of the EBTB patients were elevated compared to the controls (p < 0.05). After 2 months of treatment, 13 of the 30 EBTB patients exhibited bronchial fibrostenosis and the other 17 cases had recovered without sequelae. In the bronchial stenosis group, the initial serum TGF-beta levels were lower than in the patients without bronchial stenosis (p < 0.05). Moreover, the levels of serum TGF-beta after treatment were shown to have decreased more than in the patients without bronchial stenosis (p < 0.05). On chest CT findings of 16 EBTB patients, bronchial narrowing was suspected except in 2 cases (1 edematous-hyperemic type, 1 actively caseating type of segmental bronchus). The common features of PFT in EBTB at the initial diagnosis were a restrictive pattern and normal ventilatory function.
Elevated IFN-gamma and TGF-beta levels in the BWF of the EBTB patients may be related to EBTB pathogenesis. Lowered initial serum TGF-beta levels as well as the observed changes in the levels of TGF-beta in the serum after treatment have been implicated in bronchial fibrostenosis during the course of the disease.
支气管内膜结核（EBTB）常并发支气管狭窄，这种情况可因气道阻塞导致呼吸困难，且常被误诊为支气管哮喘或肺癌。
本研究试图确定血清和支气管灌洗液（BWF）中γ-干扰素（IFN-γ）和转化生长因子-β（TGF-β）水平与EBTB患者的治疗结果之间是否存在相关性。
招募了30例均被诊断为EBTB的患者以及10名健康对照者。采用酶联免疫吸附测定（ELISA）方法检测这30例EBTB患者治疗前后血清和BWF中的IFN-γ和TGF-β水平。将EBTB患者分为两组：治疗后出现支气管狭窄的患者和未出现支气管狭窄的患者。分别对16例和25例患者在初次支气管镜检查时进行胸部计算机断层扫描（CT）和肺功能测试（PFT）。
与对照组相比，EBTB患者BWF中的IFN-γ和TGF-β水平升高（p<0.05）。治疗2个月后，30例EBTB患者中有13例出现支气管纤维狭窄，其他17例已康复且无后遗症。在支气管狭窄组中，初始血清TGF-β水平低于无支气管狭窄的患者（p<0.05）。此外，治疗后血清TGF-β水平的下降幅度大于无支气管狭窄的患者（p<0.05）。在16例EBTB患者的胸部CT检查结果中，除2例（1例水肿充血型，1例节段性支气管活动性干酪型）外，均怀疑有支气管狭窄。EBTB初诊时PFT的共同特征是限制性模式和通气功能正常。
EBTB患者BWF中升高的IFN-γ和TGF-β水平可能与EBTB的发病机制有关。初始血清TGF-β水平降低以及治疗后血清中TGF-β水平的变化与疾病过程中的支气管纤维狭窄有关。
