Sterclova Martina, Paluch Peter, Skibova Jelena, Vasakova Martina
Department of Respiratory Diseases, Thomayer Hospital, Prague, Czech Republic.
Clin Respir J. 2015 Jan;9(1):39-44. doi: 10.1111/crj.12102. Epub 2014 Feb 10.
Immune response probably changes during human life, being influenced by cumulative exposure to environmental factors and individual genetic background.
Patients investigated for suspected interstitial lung disease were prospectively enrolled. After completing the diagnostic process, 121 patients were diagnosed extrinsic allergic alveolitis (EAA) and 136 sarcoidosis. Three groups according to age were established (<30 years, 30-60 years, >60 years), clinical manifestation, vital capacity (VC), forced expired volume in 1 s (FEV1 ), lung diffusing capacity for carbon monoxide-transfer factor (TLCO ) and bronchoalveolar lavage fluid (BALF) differential cell count were compared among the groups.
Age subgroups of EAA patients did not significantly differ in lung functions. In the group above 60 years, non-significantly higher neutrophils and eosinophils counts and CD4/CD8 ratio were observed. Sarcoidosis patients were significantly younger than EAA group and had significantly better lung functions (VC, FEV1 , TLCO ). Patients with sarcoidosis above 60 years of age had significantly higher percentages of neutrophils in BALF compared with younger patients. BALF percentage of neutrophils positively correlated with age.
Presented results may support the hypothesis that reactivity of immune system changes during the life, which may result in different manifestation of interstitial lung diseases according to age.
免疫反应可能在人类生命过程中发生变化，受到对环境因素的累积暴露和个体遗传背景的影响。
对疑似间质性肺病的患者进行前瞻性招募。在完成诊断过程后，121例患者被诊断为外源性过敏性肺泡炎（EAA），136例为结节病。根据年龄分为三组（<30岁、30 - 60岁、>60岁），比较各组间的临床表现、肺活量（VC）、一秒用力呼气容积（FEV1）、肺一氧化碳弥散量-转运因子（TLCO）和支气管肺泡灌洗（BALF）细胞分类计数。
EAA患者的年龄亚组在肺功能方面无显著差异。在60岁以上的组中，观察到中性粒细胞和嗜酸性粒细胞计数及CD4/CD8比值无显著升高。结节病患者比EAA组明显年轻，肺功能（VC、FEV1、TLCO）明显更好。60岁以上的结节病患者BALF中的中性粒细胞百分比与年轻患者相比显著更高。BALF中中性粒细胞百分比与年龄呈正相关。
呈现的结果可能支持这样的假设，即免疫系统的反应性在生命过程中发生变化，这可能导致间质性肺病根据年龄出现不同表现。
