Newman L S, Kreiss K, King T E, Seay S, Campbell P A
Department of Medicine, National Jewish Center for Immunology and Respiratory Medicine, Denver, CO 80206.
Am Rev Respir Dis. 1989 Jun;139(6):1479-86. doi: 10.1164/ajrccm/139.6.1479.
Beryllium lung disease is a chronic granulomatous disorder in which a beryllium-specific immune response plays a central role. By using a measure of cellular immune response to beryllium salts, bronchoalveolar lavage (BAL), and lung biopsy, we have identified 12 new cases of beryllium disease. Each of these individuals had pathologic changes on biopsy, lymphocytic alveolitis on BAL, and positive BAL lymphocyte transformation tests (LTT) in response to beryllium sulfate. This group of patients was remarkable for its paucity of clinical findings. At initial evaluation, seven had no respiratory symptoms, and four had normal physical examinations. Five had no increase in interstitial markings on chest radiograph. In eight cases, flow rates and lung volumes were normal. Diffusing capacity for carbon monoxide was low in only one case, and oxygen exchange during exercise was normal in six of nine subjects studied. In addition to the 12 cases, we evaluated eight beryllium-exposed workers who had other (nonberyllium) lung diseases; two of these eight demonstrated beryllium sensitization based on BAL LTT. We conclude that use of fiberoptic bronchoscopy with transbronchial biopsy and BAL facilitates diagnosis of beryllium workers who have histopathologic and immunologic alterations consistent with chronic beryllium disease. These findings may precede frank clinical illness and physiologic impairment, having important implications for our understanding of the natural history of beryllium disease.
铍肺疾病是一种慢性肉芽肿性疾病，其中铍特异性免疫反应起核心作用。通过采用对铍盐的细胞免疫反应测量、支气管肺泡灌洗（BAL）和肺活检，我们已确诊12例新的铍病病例。这些个体每一个在活检时都有病理改变，BAL时有淋巴细胞性肺泡炎，并且对硫酸铍的BAL淋巴细胞转化试验（LTT）呈阳性。这组患者的临床症状非常少。在初次评估时，7人无呼吸道症状，4人体格检查正常。5人胸部X线片上无肺间质纹理增粗。8例患者的流速和肺容量正常。仅1例一氧化碳弥散量降低，在研究的9名受试者中，6人运动时的氧交换正常。除了这12例病例外，我们还评估了8名接触铍且患有其他（非铍）肺部疾病的工人；这8人中2人基于BAL LTT显示铍致敏。我们得出结论，使用纤维支气管镜进行经支气管活检和BAL有助于诊断那些具有与慢性铍病一致的组织病理学和免疫学改变的铍接触工人。这些发现可能先于明显的临床疾病和生理损害，对我们理解铍病的自然史具有重要意义。
