Sobiecka Małgorzata, Kuś Jan, Jóźwik Adam, Demkow Urszula, Filewska Małgorzata, Szołkowska Małgorzata
I Klinika Chorób Płuc Instytutu Gruźlicy i Chorób Płuc w Warszawie.
Pneumonol Alergol Pol. 2011;79(1):6-15.
Induced sputum (IS) has been recently used to investigate pulmonary inflammation in patients with interstitial lung disease (ILD), but still little attention has been paid to its efficacy in diagnosing sarcoidosis and other ILD. The aim of this study was to evaluate the diagnostic value of IS differential cell count and CD4+/CD8+ ratio in sarcoidosis (SA) and nonsarcoidosis ILD (NSA ILD).
We studied prospectively newly diagnosed 59 patients: 36 SA and 23 NSA ILD [16 hypersensitivity pneumonitis (HP) and 7 idiopathic pulmonary fibrosis (IPF)]. IS was performed by inhaling a 5% NaCl solution for 4 periods of 5 minutes. Giemsa stained cytopreps were differentially counted and T-lymphocyte subsets were analyzed by flow cytometry method. The k-nearest neighbour rule (k-NN) or predictive value of CD4+/CD8+ ratio were used to discriminate between SA and NSA ILD. The variables of IS used in k-NN rule were: cells viability, total cell count, percentages of alveolar macrophages, lymphocytes, neutrophils, eosinophils, CD4+ and CD8+ subsets, and CD4+/CD8+ ratio.
33 patients were able to produce an adequate sputum sample (SA-15, HP-11, IPF-7). A CD4+/CD8+ ratio>2.6 had a sensitivity of 100% and a specificity of 72% with 84% of correctly classified cases in distinguishing SA from NSA ILD. However, using k-NN rule the probability of correct classification was 79% (classification error rate-21%).
To distinguish SA from NSA ILD cut off CD4+/CD8+ ratio>2.6 alone was superior to k-NN rule using all the parameters of IS.
诱导痰（IS）最近已被用于研究间质性肺疾病（ILD）患者的肺部炎症，但对其在结节病和其他ILD诊断中的有效性仍关注较少。本研究的目的是评估IS细胞分类计数和CD4+/CD8+比值在结节病（SA）和非结节病ILD（NSA ILD）中的诊断价值。
我们前瞻性地研究了59例新诊断患者：36例SA和23例NSA ILD[16例过敏性肺炎（HP）和7例特发性肺纤维化（IPF）]。通过吸入5%氯化钠溶液5分钟，共4个周期来获取IS。对吉姆萨染色的细胞涂片进行分类计数，并采用流式细胞术分析T淋巴细胞亚群。使用k近邻规则（k-NN）或CD4+/CD8+比值的预测值来区分SA和NSA ILD。k-NN规则中使用的IS变量包括：细胞活力、总细胞计数、肺泡巨噬细胞、淋巴细胞、中性粒细胞、嗜酸性粒细胞、CD4+和CD8+亚群的百分比以及CD4+/CD8+比值。
33例患者能够咳出足够的痰样本（SA-15例，HP-11例，IPF-7例）。CD4+/CD8+比值>2.6在区分SA与NSA ILD时，敏感性为100%，特异性为72%，正确分类病例占84%。然而，使用k-NN规则时，正确分类的概率为79%（分类错误率为-21%）。
单独使用CD4+/CD8+比值>2.6来区分SA与NSA ILD优于使用IS所有参数的k-NN规则。
