Prior C, Barbee R A, Evans P M, Townsend P J, Primett Z S, Fyhrquist F, Grönhagen-Riska C, Haslam P L
Dept of Cardiothoracic Surgery, National Heart and Lung Institute, London, UK.
Eur Respir J. 1990 Nov;3(10):1146-54.
The aim of this study was to explore whether amounts of angiotensin converting enzyme (ACE) and lysozyme produced within the lungs correlate more closely than serum levels of these enzymes, or other inflammatory markers, with chest radiographic profusion scores, lung function and therapy response in patients with pulmonary sarcoidosis. We have studied 25 patients, and levels in bronchoalveolar lavage (BAL) were used to determine "local" enzyme production by reference to serum and lavage albumin. Before treatment, serum lysozyme levels were elevated in more patients (80%) than serum ACE levels (40%). They also gave the best overall correlation with clinical measurements prior to treatment and falls in serum lysozyme closely parallelled improvement in lung function (transfer factor for carbon monoxide (DLCO)) on therapy. The only other markers showing significant correlations with disease severity were lavage neutrophil counts per ml and "local" ACE measurements prior to treatment. The value of pre-treatment levels of the different inflammatory markers in predicting response to corticosteroid therapy was explored and the only significant finding was that BAL lymphocyte percentages and numbers.ml-1 were initially higher in patients with lower post-treatment chest X-ray scores (p less than 0.01 and p less than 0.05, respectively). We conclude that serum lysozyme levels appear to be a more useful marker of overall disease activity in sarcoidosis than measurements of other inflammatory markers. However, BAL lymphocyte counts were the best predictive marker of radiographic response to corticosteroids.
本研究的目的是探讨肺部产生的血管紧张素转换酶（ACE）和溶菌酶的量与这些酶的血清水平或其他炎症标志物相比，是否与结节病患者的胸部X线片渗出评分、肺功能及治疗反应更密切相关。我们研究了25例患者，通过支气管肺泡灌洗（BAL）中的水平并参照血清和灌洗白蛋白来确定“局部”酶的产生。治疗前，血清溶菌酶水平升高的患者（80%）多于血清ACE水平升高的患者（40%）。血清溶菌酶水平在治疗前与临床指标的总体相关性也最佳，且血清溶菌酶水平的下降与治疗期间肺功能（一氧化碳转运因子（DLCO））的改善密切平行。唯一与疾病严重程度有显著相关性的其他标志物是治疗前每毫升灌洗中性粒细胞计数和“局部”ACE测量值。探讨了不同炎症标志物的治疗前水平对预测皮质类固醇治疗反应的价值，唯一显著的发现是治疗后胸部X线评分较低的患者，其BAL淋巴细胞百分比和每毫升数量最初较高（分别为p<0.01和p<0.05）。我们得出结论，血清溶菌酶水平似乎是结节病总体疾病活动比其他炎症标志物测量更有用的指标。然而，BAL淋巴细胞计数是对皮质类固醇放射学反应的最佳预测指标。
