Feng Haoshen, Yan Lili, Zhao Yabin, Li Zhenhua, Kang Jian
Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China.
Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China.
Front Med (Lausanne). 2022 Feb 2;8:787681. doi: 10.3389/fmed.2021.787681. eCollection 2021.
Pulmonary sarcoidosis is a highly heterogeneous granulomatous disease without any specific symptoms and manifestations. Neutrophils in bronchoalveolar lavage fluid (BALF) have been proposed to indicate the severity and prognosis of pulmonary sarcoidosis, but this needs confirmation in patients from different populations due to the heterogeneity of the disease. This study aimed to determine the characteristics of patients with pulmonary sarcoidosis in northeastern China and to explore the relationship between neutrophils in BALF and the severity of pulmonary sarcoidosis.
We enrolled 432 patients who were diagnosed with pulmonary sarcoidosis in this retrospective study. The symptoms, extrapulmonary involvement, forced vital capacity percentage predicted (FVC % pred), and diffusing capacity of the lung for carbon monoxide percentage predicted (DLco % pred) were recorded. BAL was performed in 319 patients, and the results of a cellular examination of BALF were collected. A total of 123 patients who received corticosteroid treatment were followed up for at least 12 months, and the outcomes were recorded.
Cough was the most common symptom, and cutaneous involvement was the most common extrapulmonary manifestation in 304 (70.4%) and 82 (19.0%) patients, respectively. The percentages of patients with high neutrophil counts in BALF (>3%) were higher at Stages 2 and 3 compared with Stages 0 and 1 (33.2 vs. 19.4%, = 0.007), although the percentages of neutrophils in BALF showed no difference between patients at Stages 0, 1, 2, and 3. Patients with high neutrophil counts in BALF had lower FVC % pred compared with the other patients (79.5 ± 18.2 vs. 84.9 ± 14.5%, = 0.025) and were prone to relapse after corticosteroids were tapered. High neutrophil counts in BALF were independently associated with relapse after corticosteroids were tapered in a binary logistic regression analysis ( = 0.027).
Patients with pulmonary sarcoidosis lacked specific symptoms and manifestations. The neutrophil count in BALF could indicate the severity and outcomes of pulmonary sarcoidosis.
肺结节病是一种高度异质性的肉芽肿性疾病，无任何特异性症状和表现。支气管肺泡灌洗液（BALF）中的中性粒细胞已被提出可指示肺结节病的严重程度和预后，但由于该疾病的异质性，这需要在不同人群的患者中得到证实。本研究旨在确定中国东北地区肺结节病患者的特征，并探讨BALF中中性粒细胞与肺结节病严重程度之间的关系。
在这项回顾性研究中，我们纳入了432例被诊断为肺结节病的患者。记录症状、肺外受累情况、预计用力肺活量百分比（FVC % pred）和预计一氧化碳弥散量百分比（DLco % pred）。对319例患者进行了支气管肺泡灌洗，并收集了BALF的细胞检查结果。对123例接受皮质类固醇治疗的患者进行了至少12个月的随访，并记录了结果。
咳嗽是最常见的症状，皮肤受累是最常见的肺外表现，分别见于304例（70.4%）和82例（19.0%）患者。与0期和1期相比，2期和3期BALF中中性粒细胞计数高（>3%）的患者百分比更高（33.2%对19.4%，P = 0.007），尽管0、1、2和3期患者BALF中的中性粒细胞百分比无差异。BALF中中性粒细胞计数高的患者与其他患者相比，FVC % pred较低（79.5±18.2%对84.9±14.5%，P = 0.025），并且在皮质类固醇减量后容易复发。在二元逻辑回归分析中，BALF中中性粒细胞计数高与皮质类固醇减量后复发独立相关（P = 0.027）。
肺结节病患者缺乏特异性症状和表现。BALF中的中性粒细胞计数可指示肺结节病的严重程度和预后。
