Kishi M, Miyazaki Y, Jinta T, Furusawa H, Ohtani Y, Inase N, Yoshizawa Y
Department of Integrated Pulmonology, Tokyo Medical and Dental University, 1-5-45, Bunkyo-ku, Tokyo 113-8519, Japan.
Thorax. 2008 Sep;63(9):810-6. doi: 10.1136/thx.2007.086074. Epub 2008 Feb 14.
A Th1 predominant immune response has been shown in acute hypersensitivity pneumonitis. Predominance of Th2 appears to favour the development of pulmonary fibrosis through the profibrotic process and has been described as crucial in the progression of idiopathic pulmonary fibrosis. Chronic bird fancier's lung (cBFL) can present with a histological pattern of usual interstitial pneumonia (UIP)-like lesions. Little is known about the Th1/Th2 balance in the pathogenesis of cBFL.
To evaluate the relevance of Th1-type chemokines (interferon-inducible protein, IP-10) and Th2-type chemokines (thymus- and activation-regulated chemokine, TARC) and their receptors (CXCR3 and CCR4) to the histological patterns of cBFL, 40 patients with cBFL who underwent surgical lung biopsies, 12 with acute BFL (aBFL) and 10 healthy volunteers were analysed. IP-10 and TARC levels in serum and bronchoalveolar lavage (BAL) fluid were measured by ELISA. Immunohistochemistry for CXCR3 and CCR4 was performed on surgical lung specimens.
The ratio of TARC to IP-10 in the serum of patients with UIP-like lesions was significantly higher than in patients with cNSIP/OP-like lesions, aBFL and healthy volunteers. The ratio of CCR4 to CXCR3 in patients with UIP-like lesions was significantly higher than in those with cNSIP/OP-like lesions and fNSIP-like lesions. The ratio of CCR4-positive to CXCR3-positive cells correlated with the ratio of TARC to IP-10 in serum.
A Th2 predominant immune response may play an important role in the development of UIP-like lesions, as already observed in idiopathic pulmonary fibrosis. A Th1 predominance may play a role in the development of cNSIP/OP-like lesions in cBFL.
急性过敏性肺炎中已显示出以Th1为主导的免疫反应。Th2优势似乎通过促纤维化过程促进肺纤维化的发展，并且在特发性肺纤维化的进展中被认为至关重要。慢性养鸟人肺（cBFL）可呈现出普通间质性肺炎（UIP）样病变的组织学模式。关于cBFL发病机制中Th1/Th2平衡的了解甚少。
为评估Th1型趋化因子（干扰素诱导蛋白，IP-10）和Th2型趋化因子（胸腺和活化调节趋化因子，TARC）及其受体（CXCR3和CCR4）与cBFL组织学模式的相关性，分析了40例行手术肺活检的cBFL患者、12例急性养鸟人肺（aBFL）患者和10名健康志愿者。通过酶联免疫吸附测定法（ELISA）测量血清和支气管肺泡灌洗（BAL）液中的IP-10和TARC水平。对手术肺标本进行CXCR3和CCR4的免疫组织化学检测。
UIP样病变患者血清中TARC与IP-10的比值显著高于cNSIP/OP样病变患者、aBFL患者和健康志愿者。UIP样病变患者中CCR4与CXCR3的比值显著高于cNSIP/OP样病变患者和fNSIP样病变患者。CCR4阳性细胞与CXCR3阳性细胞的比值与血清中TARC与IP-10的比值相关。
正如在特发性肺纤维化中已经观察到的那样，以Th2为主导的免疫反应可能在UIP样病变的发展中起重要作用。Th1优势可能在cBFL中cNSIP/OP样病变的发展中起作用。
