Bjermer L, Rosenhall L, Angström T, Hällgren R
Department of Pulmonary Medicine, University Hospital, Umeå, Sweden.
Thorax. 1988 Apr;43(4):284-8. doi: 10.1136/thx.43.4.284.
Patients with histopathologically proved sarcoidosis were studied serially by means of bronchoalveolar lavage, initially at the time of diagnosis and then six and 12 months later. Two years later they were evaluated by chest radiography and lung function tests and classified in terms of recovery or progression over the previous two years. The recovery of lymphocytes and granulocytes in lavage fluid was of limited prognostic value for persistent lung disease. In contrast, patients with increased numbers of mast cells recovered by lavage were more likely to deteriorate. Significantly increased mast cell counts (greater than or equal to 0.5% of total cells recovered) were seen in at least one lavage investigation in 15 of the 16 patients with more active and progressive disease, but in only eight of 23 patients with inactive disease (p less than 0.001). A persistent increase of mast cells on serial measurement occurred in nine of the 16 patients with active disease and in four of the 23 patients in whom the disease was inactive (p less than 0.02). The finding in the two subsequent lavages of lymphocytosis (lymphocytes greater than 30% of recovered cells) or neutrophilia (neutrophils greater than 15%) combined with mastocytosis (mast cells greater than or equal to 0.5%) occurred in nine of the 16 patients with active disease but in no patients with inactive disease.
对经组织病理学证实患有结节病的患者，通过支气管肺泡灌洗进行系列研究，最初在诊断时进行，然后在6个月和12个月后进行。两年后，通过胸部X线摄影和肺功能测试对他们进行评估，并根据前两年的恢复或进展情况进行分类。灌洗液中淋巴细胞和粒细胞的恢复对持续性肺部疾病的预后价值有限。相比之下，灌洗回收的肥大细胞数量增加的患者更有可能病情恶化。在16例病情更活跃和进展性疾病的患者中，有15例在至少一次灌洗检查中发现肥大细胞计数显著增加（大于或等于回收细胞总数的0.5%），而在23例非活动性疾病患者中只有8例出现这种情况（p<0.001）。在16例活动性疾病患者中有9例在系列测量中肥大细胞持续增加，在23例疾病非活动性患者中有4例出现这种情况（p<0.02）。在随后的两次灌洗中，16例活动性疾病患者中有9例出现淋巴细胞增多（淋巴细胞大于回收细胞的30%）或中性粒细胞增多（中性粒细胞大于15%）并伴有肥大细胞增多（肥大细胞大于或等于0.5%），而在非活动性疾病患者中未出现这种情况。
