Rossi G A, Vassalo F, Sacco O, Cerri E, Degl'Innocenti L
Divisione di Pneumologia, Ospedale San Martino, Genova, Italie.
Rev Mal Respir. 1988;5(5):511-8.
Modern studies undertaken to aid the understanding of the pathogenesis of pulmonary sarcoidosis have shown that the initial lesions of this disease are characterised by an accumulation of T lymphocytes and of macrophages in the alveolar structure (the alveolitis). In patients with active disease these cells are seen to be not only increased but apparently "activated". In effect, in sarcoidosis the greater part of the T lymphocytes of the lung express surface markers associated with helper/inducer phenotype and they spontaneously secrete mediators which seem to play a central role in the formation of the typical lesions of this disease: a lymphocytic alveolitis, granulomas and interstitial fibrosis. As with the T lymphocytes, the alveolar macrophages of patients suffering from active sarcoidosis appear to be activated and are important in the initiation and maintenance of the inflammatory phenomena which lead to a modification of alveolar structures which are typical of this disease. However, although the immune and inflammatory cells situated in the lung modulate the lesions in the respiratory tree, it may be reasonable to propose the hypothesis that the evaluation of the clinical state of patients with sarcoidosis might take into account the degree of the alveolitis. The parameters of this alveolitis, which may help to establish the prognosis and need for therapy in pulmonary sarcoidosis, have not yet been discovered.
为了帮助理解肺结节病的发病机制而进行的现代研究表明，该疾病的初始病变特征是肺泡结构中T淋巴细胞和巨噬细胞的积聚（肺泡炎）。在患有活动性疾病的患者中，这些细胞不仅数量增加，而且明显“被激活”。实际上，在结节病中，肺内大部分T淋巴细胞表达与辅助/诱导型表型相关的表面标志物，并且它们自发分泌的介质似乎在该疾病典型病变的形成中起核心作用：淋巴细胞性肺泡炎、肉芽肿和间质纤维化。与T淋巴细胞一样，患有活动性结节病的患者的肺泡巨噬细胞似乎也被激活，并且在引发和维持导致该疾病典型肺泡结构改变的炎症现象中起重要作用。然而，尽管位于肺内的免疫和炎症细胞调节呼吸道的病变，但提出结节病患者临床状态的评估可能考虑肺泡炎程度这一假设可能是合理的。尚未发现有助于确定肺结节病预后和治疗需求的这种肺泡炎参数。
