Lin C C, Hung C C, Huang W C, Lin C Y
Department of Internal Medicine, Mackay Memorial Hospital, Taipei.
Zhonghua Min Guo Wei Sheng Wu Ji Mian Yi Xue Za Zhi. 1988 Feb;21(1):67-74.
Diffuse interstitial lung diseases include more than 100 varieties. Even for a chest specialist differential diagnosis is difficult; accurate diagnosis without transbronchial lung biopsy or open lung biopsy was particularly hard. Bronchoalveolar Lavage (BAL) is a new diagnostic procedure which is relatively safe and repeatable. It takes about 30 minutes more, during the usual bronchoscopic examination, to obtain fluid and cells from the lower respiratory tract. These specimens aid differential diagnosis and an understanding of pathogenesis in the early stage of diffuse interstitial lung disease. Two cases are reported. One was sarcoidosis, as proved by mediastinoscopic lymph node biopsy; the other one was hypersensitivity pneumonitis by clinical impression. Both patients received bronchoscopic examination with bronchoalveolar lavage. The bronchoalveolar lavage fluid showed an increase in total cell count, lymphocyte count and lymphocyte percentage. In sarcoidosis, the main T-lymphocyte subpopulation was helper T-lymphocytes while, in hypersensitivity pneumonitis, the main T-lymphocyte subpopulation was suppressor T-lymphocytes. We concluded that, if the patients of diffuse interstitial lung diseases had increased lymphocyte count and percentage in bronchoalveolar Lavage fluid, examination of the lymphocyte subpopulation would help differential diagnosis.
弥漫性间质性肺疾病包含100多种类型。即使对于胸部专科医生来说，鉴别诊断也很困难；没有经支气管肺活检或开胸肺活检很难进行准确诊断。支气管肺泡灌洗（BAL）是一种相对安全且可重复的新诊断方法。在常规支气管镜检查过程中，从下呼吸道获取液体和细胞大约需要多花30分钟。这些标本有助于弥漫性间质性肺疾病早期的鉴别诊断和对发病机制的理解。报告了两例病例。一例经纵隔镜淋巴结活检证实为结节病；另一例根据临床印象诊断为过敏性肺炎。两名患者均接受了支气管镜检查及支气管肺泡灌洗。支气管肺泡灌洗液显示总细胞计数、淋巴细胞计数及淋巴细胞百分比增加。在结节病中，主要的T淋巴细胞亚群是辅助性T淋巴细胞，而在过敏性肺炎中，主要的T淋巴细胞亚群是抑制性T淋巴细胞。我们得出结论，如果弥漫性间质性肺疾病患者支气管肺泡灌洗液中的淋巴细胞计数及百分比增加，检测淋巴细胞亚群将有助于鉴别诊断。
