D'Alessandro Miriana, Bergantini Laura, Carleo Alfonso, Cameli Paolo, Perrone Anna, Fossi Antonella, Sestini Piersante, Bargagli Elena
Unit of Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences and Neurosciences, University Hospital of Siena, Siena, Italy -
Unit of Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences and Neurosciences, University Hospital of Siena, Siena, Italy.
Minerva Med. 2022 Jun;113(3):526-531. doi: 10.23736/S0026-4806.20.06614-8. Epub 2020 May 14.
THIS is the first time that a bronchoalveolar lavage (BAL) neutrophil-to-lymphocyte ratio (NL-ratio) has been demonstrated in sarcoidosis and chronic hypersensitivity pneumonitis (cHP) than in idiopathic pulmonary fibrosis (IPF) patients.
Consecutive BAL samples from the 167 interstitial lung disease (ILD) patients were retrospectively enrolled in the study and clustered into three diagnostic categories: IPF, cHP and sarcoidosis.
NL-ratio which proved higher in IPF (mean±SD, 2.1±3.8) than sarcoidosis (mean±SD 0.7±1.9; P<1E-04) and cHP patients (mean±SD 1.6±3.1; P=7.7E-03). ROC curve analysis to discriminate between Sarcoidosis and other ILDs showed an area under the curve (AUC) of 83.7%, (56% sensitivity and 96% specificity) while IPF and the other ILD were discriminated with AUC of 73% using a NL-ratio threshold value of 0.48 (73% sensitivity and 63% specificity). Interestingly, the NL-ratio was significantly correlated with other prognostic parameters: it was inversely correlated with forced vital capacity (FVC) (r=-0.3; P=2.5E-02) and forced expiration volume in 1 second (FEV1) (r=-0.3; P=2E-02) percentages and directly correlated with composite pulmonary index (CPI) score (r=0.3; P=3.2E-02). A decision-tree statistical algorithm was applied.
This is the first time that a lower NL-ratio has been demonstrated in sarcoidosis and cHP than in IPF patients. The present preliminary report indicates a relationship between BAL NL-ratio and lung function parameters in patients with IPF: this ratio may help to optimize management of IPF patients and to improve follow-up and outcome.
这是首次证实在结节病和慢性过敏性肺炎（cHP）患者中支气管肺泡灌洗（BAL）中性粒细胞与淋巴细胞比值（NL比值）低于特发性肺纤维化（IPF）患者。
回顾性纳入167例间质性肺疾病（ILD）患者的连续BAL样本，并分为三个诊断类别：IPF、cHP和结节病。
IPF患者的NL比值（均值±标准差，2.1±3.8）高于结节病患者（均值±标准差0.7±1.9；P<1E - 04）和cHP患者（均值±标准差1.6±3.1；P = 7.7E - 03）。用于区分结节病与其他ILD的ROC曲线分析显示曲线下面积（AUC）为83.7%，（敏感性56%，特异性96%），而使用NL比值阈值0.48区分IPF与其他ILD时AUC为73%（敏感性73%，特异性63%）。有趣的是，NL比值与其他预后参数显著相关：它与用力肺活量（FVC）（r = -0.3；P = 2.5E - 02）和1秒用力呼气容积（FEV1）（r = -0.3；P = 2E - 02）百分比呈负相关，与综合肺指数（CPI）评分呈正相关（r = 0.3；P = 3.2E - 02）。应用了决策树统计算法。
这是首次证实在结节病和cHP患者中NL比值低于IPF患者。本初步报告表明IPF患者BAL的NL比值与肺功能参数之间存在关联：该比值可能有助于优化IPF患者的管理并改善随访及预后。
