Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Ophthalmology. 2012 Nov;119(11):2386-92. doi: 10.1016/j.ophtha.2012.05.033. Epub 2012 Jul 17.
Sarcoidosis is an idiopathic inflammatory disorder involving multiple organs, and ocular manifestation (represented by granulomatous uveitis) is one of the common features. A well-known immunologic feature in sarcoidosis is an increased CD4+ helper T-cell type 1 lymphocyte subset in bronchoalveolar lavage (BAL) fluid. The current study investigated the vitreous lymphocyte subsets of ocular sarcoidosis to elucidate the immunologic features of this disorder in the eye.
Case-control study.
Fifty-one eyes of 38 patients with ocular sarcoidosis, confirmed by international diagnostic criteria, were enrolled in this study. Twenty-seven eyes of 26 patients with other causes of uveitis were enrolled as nonsarcoid controls.
Evaluation of diagnostic tests for cell profiles of ocular sarcoidosis. Lymphocytes in the vitreous samples were analyzed by cytology, polymerase chain reaction, and flow cytometry. Peripheral blood was also obtained from each patient and analyzed in comparison with the vitreous samples.
CD4/CD8 ratios of vitreal and peripheral T lymphocytes.
CD4/CD8 ratios of the vitreous T lymphocytes were significantly higher in ocular sarcoidosis than in nonsarcoidosis vitreous samples. In the patients with ocular sarcoidosis, the CD4/CD8 ratios of vitreal T lymphocytes were significantly higher than the CD4/CD8 ratios of peripheral T lymphocytes. No significant differences were found between the CD4/CD8 ratios of vitreal and peripheral T lymphocytes in the patients without sarcoidosis. Moreover, the CD4/CD8 ratios of peripheral T lymphocytes in the patients with ocular sarcoidosis were significantly higher than in patients without sarcoidosis. The sensitivity and specificity of the vitreal CD4/CD8 ratio were 100% and 96.3%, respectively, for the diagnosis of ocular sarcoidosis.
Our findings suggest that the CD4/CD8 ratio of vitreous-infiltrating lymphocytes has high diagnostic value in ocular sarcoidosis, comparable to that of the CD4/CD8 ratio in BAL fluid lymphocytosis for pulmonary sarcoidosis. Furthermore, a high CD4/CD8 ratio of peripheral blood T lymphocytes should be one of the laboratory findings for ocular sarcoidosis. Diagnostic vitrectomy using flow cytometric analysis may be a useful adjunct for the diagnosis of ocular sarcoidosis, particularly in complex cases.
结节病是一种累及多个器官的特发性炎症性疾病，眼部表现（表现为肉芽肿性葡萄膜炎）是其常见特征之一。结节病的一个众所周知的免疫学特征是支气管肺泡灌洗液（BAL）中 CD4+辅助 T 细胞 1 型淋巴细胞亚群增加。本研究调查了眼结节病的玻璃体液淋巴细胞亚群，以阐明该疾病在眼部的免疫学特征。
病例对照研究。
本研究纳入了 38 名患者的 51 只眼，这些患者均通过国际诊断标准确诊为眼结节病。作为非结节病对照，纳入了 26 名患者的 27 只眼，这些患者患有其他原因引起的葡萄膜炎。
评估用于眼结节病细胞谱诊断的试验。通过细胞学、聚合酶链反应和流式细胞术分析玻璃体液样本中的淋巴细胞。还从每位患者获得外周血，并与玻璃体液样本进行比较分析。
玻璃体液和外周血 T 淋巴细胞的 CD4/CD8 比值。
眼结节病患者的玻璃体液 T 淋巴细胞 CD4/CD8 比值明显高于非结节病患者的玻璃体液样本。在眼结节病患者中，玻璃体液 T 淋巴细胞的 CD4/CD8 比值明显高于外周血 T 淋巴细胞的 CD4/CD8 比值。在非结节病患者中，玻璃体液和外周血 T 淋巴细胞的 CD4/CD8 比值无显著差异。此外，眼结节病患者的外周血 T 淋巴细胞 CD4/CD8 比值明显高于非结节病患者。玻璃体液 CD4/CD8 比值对眼结节病的诊断具有 100%的敏感性和 96.3%的特异性。
我们的研究结果表明，玻璃体液浸润淋巴细胞的 CD4/CD8 比值对眼结节病具有较高的诊断价值，与肺结节病 BAL 液淋巴细胞增多症的 CD4/CD8 比值相当。此外，外周血 T 淋巴细胞的高 CD4/CD8 比值应成为眼结节病的实验室发现之一。使用流式细胞术分析进行诊断性玻璃体切除术可能是诊断眼结节病的有用辅助手段，特别是在复杂病例中。
