Novosadova Eva, Navratilova Zdenka, Ordeltova Marta, Zurkova Monika, Zatloukal Jaromir, Kolek Vitezslav, Petrek Martin
Department of Pathological Physiology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic.
Department of Immunology, Faculty of Medicine and Dentistry and University Hospital Olomouc, Olomouc, Czech Republic.
J Thorac Dis. 2019 Jun;11(6):2287-2296. doi: 10.21037/jtd.2019.06.05.
Bronchoalveolar lavage (BAL) as complementary method is still used as ancillary tool in diagnosis of interstitial lung diseases. Tobacco smoking has been described to affect the BAL lavage cellular profile. To our knowledge, only few reports have so far investigated CD3CD4 and CD3CD8 lymphocyte subsets in non-smoking sarcoidosis patients additionally stratified according to CXR stage, and compared them to other non-smoking patients with interstitial lung diseases (ILDs).
We compared lymphocytes immune phenotypes, subsets, with CD3, CD3CD4 and CD3CD8 cell markers, in the non-smoking subjects (n=297) including the patients with pulmonary sarcoidosis (S), idiopathic pulmonary fibrosis (IPF) (n=22), hypersensitivity pneumonitis (HP) (n=15), other interstitial idiopathic pneumonias (OIIPs) (n=39). According to prognosis, the patients with S were divided into four groups: 18 patients with Löfgren's syndrome (LS) in chest X-ray (CXR) ≤1 stage, 64 patients without LS in CXR ≤1 stage, 113 patients in CXR 2 stage and 26 patients with advanced CXR ≥3 stage.
After the use of false discovery rate (FDR) correction, relative numbers (%) of CD3, CD3CD4, CD3CD8 and CD3CD4/CD3CD8 ratio showed the most significant differences between the non-smokers with S (both with/without LS) and the non-smokers with other ILDs (IPF, OIIPs, HP). These lymphocytes subsets were further altered in the non-smokers with CXR stage 2 compared to the non-smokers with other ILDs (IPF, OIIPs, HP). We did not observe any differences in these lymphocyte subsets and CD3CD4/CD3CD8 ratio between the non-smokers with advanced sarcoidosis stage (CXR ≥3) and the non-smokers with IPF.
Our data on the non-smokers confirmed the presence of the typical BAL cellular profile in sarcoidosis. The BAL cellular profile was helpful namely for differentiation of less advanced sarcoidosis. Its definite diagnostic utility should be the subject of further clinical studies with large numbers of the well characterized patients taking into consideration other clinical factors influencing BAL cellular profile, such as smoking or treatment.
支气管肺泡灌洗（BAL）作为一种辅助方法，仍被用作间质性肺疾病诊断的辅助工具。吸烟已被描述会影响BAL灌洗细胞谱。据我们所知，迄今为止，仅有少数报告研究了非吸烟结节病患者中根据胸部X线（CXR）分期进一步分层的CD3CD4和CD3CD8淋巴细胞亚群，并将其与其他非吸烟间质性肺疾病（ILD）患者进行比较。
我们比较了包括结节病（S）、特发性肺纤维化（IPF）（n = 22）、过敏性肺炎（HP）（n = 15）、其他间质性特发性肺炎（OIIP）（n = 39）患者在内的非吸烟受试者（n = 297）中淋巴细胞免疫表型、亚群以及CD3、CD3CD4和CD3CD8细胞标志物。根据预后情况，将S患者分为四组：胸部X线（CXR）≤1期的18例 Löfgren综合征（LS）患者、CXR≤1期的64例无LS患者、CXR 2期的113例患者以及CXR≥3期的26例晚期患者。
在使用错误发现率（FDR）校正后，CD3、CD3CD4、CD3CD8的相对数量（%）以及CD3CD4/CD3CD8比值在非吸烟S患者（包括有/无LS）与非吸烟其他ILD患者（IPF、OIIP、HP）之间显示出最显著差异。与非吸烟其他ILD患者（IPF、OIIP、HP）相比，CXR 2期的非吸烟患者中这些淋巴细胞亚群进一步改变。我们未观察到晚期结节病（CXR≥3）的非吸烟患者与IPF的非吸烟患者在这些淋巴细胞亚群及CD3CD4/CD3CD8比值上存在任何差异。
我们关于非吸烟患者的数据证实了结节病中典型BAL细胞谱的存在。BAL细胞谱有助于鉴别病情较轻的结节病。其确切的诊断效用应成为进一步临床研究的主题，该研究纳入大量特征明确的患者，并考虑影响BAL细胞谱的其他临床因素，如吸烟或治疗情况。
