Verstraeten A, Demedts M, Verwilghen J, van den Eeckhout A, Mariën G, Lacquet L M, Ceuppens J L
Department of Internal Medicine, University of Leuven, Belgium.
Chest. 1990 Sep;98(3):560-7. doi: 10.1378/chest.98.3.560.
We investigated whether analysis of cellular composition (including lymphocyte subsets) in bronchoalveolar lavage (BAL) fluid at the start of follow-up in patients with untreated sarcoidosis has any predictive value for further evolution of the disease. The outcome was evaluated by the chest roentgenograms, the lung volumes, and the single breath diffusing capacity for CO (DCO) after 22 to 36 months. In contrast to the general belief, patients who improved radiologically had a significantly higher T4 cell count (as percentage of BAL lymphocytes) (p less than 0.02) and a higher T4-T8 ratio in the initial BAL sample (9.3 vs 3.2; p less than 0.05) than those whose chest roentgenogram showed deterioration or remained unchanged. Total cell count and the percentage of lymphocytes in BAL fluid were not different between both groups. The change in DCO at the end of the follow-up period correlated positively with the baseline BAL T4 cells (Rs = 0.44; p less than 0.05) and with the BAL T4-T8 ratio (Rs = 0.51; p less than 0.03) and negatively with the baseline BAL T8 cells (Rs = -0.48; p less than 0.04). In only three patients progression of the disease necessitated steroid therapy, and they all had a low to normal T4-T8 ratio in the initial BAL sample. Bronchoalveolar lavage was repeated at least once in ten patients. Improvement of the chest roentgenograms in these patients was accompanied by a decrease of the BAL T4 cell count (as percentage of lymphocytes) and of the T4-T8 ratio. We conclude that a high lymphocyte count, a high T4 cell count (as percentage of lymphocytes), and a high T4-T8 ratio in BAL fluid reflect an intense alveolitis at the time of the procedure, but they are not indicators of poor prognosis on which therapeutic decisions can be based.
我们研究了在未治疗的结节病患者随访开始时，分析支气管肺泡灌洗（BAL）液中的细胞组成（包括淋巴细胞亚群）对疾病进一步发展是否具有任何预测价值。在22至36个月后，通过胸部X线片、肺容积和单次呼吸一氧化碳弥散量（DCO）评估结果。与普遍看法相反，放射学上病情改善的患者在初始BAL样本中的T4细胞计数（占BAL淋巴细胞的百分比）显著更高（p小于0.02），T4-T8比值也更高（9.3对3.2；p小于0.05），而胸部X线片显示病情恶化或无变化的患者则不然。两组之间BAL液中的总细胞计数和淋巴细胞百分比无差异。随访期末DCO的变化与基线BAL T4细胞呈正相关（Rs = 0.44；p小于0.05），与BAL T4-T8比值呈正相关（Rs = 0.51；p小于0.03），与基线BAL T8细胞呈负相关（Rs = -0.48；p小于0.04）。只有3例患者疾病进展需要类固醇治疗，他们在初始BAL样本中的T4-T8比值均处于低至正常水平。10例患者至少重复进行了一次支气管肺泡灌洗。这些患者胸部X线片的改善伴随着BAL T4细胞计数（占淋巴细胞的百分比）和T4-T8比值的降低。我们得出结论，BAL液中淋巴细胞计数高、T4细胞计数高（占淋巴细胞百分比）和T4-T8比值高反映了操作时存在严重的肺泡炎，但它们并非预后不良的指标，不能作为治疗决策的依据。
