Basic & Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, Alameda Professor Hernâni Monteiro, University of Porto, 4200-319, Porto, Portugal.
Department of Pulmonology, Hospital de São João and Faculty of Medicine, University of Porto, Porto, Portugal.
BMC Pulm Med. 2019 Feb 13;19(1):39. doi: 10.1186/s12890-019-0802-1.
Diffuse lung diseases (DLD) are characterized by different immunophenotypes in the bronchoalveolar lavage fluid (BALF). We aimed to evaluate the diagnostic value of BALF NK and NKT cell counts of patients with DLD and lymphocytic alveolitis.
We assessed 202 patients with DLD, who underwent BALF immunophenotyping. Samples were routinely processed by flow cytometry and lymphocyte subsets were compared between patients with sarcoidosis (n = 106), hypersensitivity pneumonitis (HP; n = 53), and other DLDs (n = 43). We compared absolute counts and percentages of NK and NKT cells between patients with HP versus the remaining DLD patients. To assess the accuracy of BALF lymphocyte subsets in the diagnosis of HP, we calculated the respective areas under the receiver operating characteristic curves (AUC-ROC).
Patients with HP had significantly higher numbers of BALF NK cells, and its percentage was significantly associated with a higher odds of HP, even after adjustment for the NKT and CD8 cells. For the absolute number of BALF NK cells, we found an AUC-ROC of 0.76 (95%CI = 0.68-0.84) when comparing patients with HP versus the remaining DLD. The cut-offs of 2000 NK cells/mL and of 2.4% NK cells in the BALF had a specificity and a negative predictive value over 80% for the diagnosis of HP. BALF NK cells absolute counts were significantly higher in HP patients with a restrictive pattern. No such differences were observed for NKT cells.
BALF NK immunophenotyping may be a helpful adjunct to the diagnostic work-up of DLD, particularly in the differential diagnosis of HP.
弥漫性肺疾病（DLD）的特点是支气管肺泡灌洗液（BALF）中的不同免疫表型。我们旨在评估 BALF NK 和 NKT 细胞计数对 DLD 和淋巴细胞性肺泡炎患者的诊断价值。
我们评估了 202 例 DLD 患者，他们接受了 BALF 免疫表型分析。样本通过流式细胞术常规处理，比较了结节病（n=106）、过敏性肺炎（HP；n=53）和其他 DLD 患者（n=43）之间的淋巴细胞亚群。我们比较了 HP 患者与其他 DLD 患者之间 BALF NK 和 NKT 细胞的绝对计数和百分比。为了评估 BALF 淋巴细胞亚群对 HP 诊断的准确性，我们计算了各自的接受者操作特征曲线（ROC）下面积（AUC-ROC）。
HP 患者的 BALF NK 细胞数量明显较高，其百分比与 HP 的更高患病几率显著相关，即使在调整了 NKT 和 CD8 细胞后也是如此。对于 BALF NK 细胞的绝对数量，我们发现比较 HP 患者与其他 DLD 患者时，AUC-ROC 为 0.76（95%CI=0.68-0.84）。BALF 中 2000NK 细胞/ml 和 2.4%NK 细胞的截止值对 HP 的诊断具有超过 80%的特异性和阴性预测值。在具有限制性模式的 HP 患者中，BALF NK 细胞绝对计数明显更高。对于 NKT 细胞，没有观察到这种差异。
BALF NK 免疫表型分析可能有助于 DLD 的诊断，特别是在 HP 的鉴别诊断中。
