Garcia J G, Wolven R G, Garcia P L, Keogh B A
Am Rev Respir Dis. 1986 Mar;133(3):444-9. doi: 10.1164/arrd.1986.133.3.444.
Alveolitis is thought to precede permanent lung derangement in a variety of interstitial lung diseases (ILD). Bronchoalveolar lavage (BAL) cell differentials can be used to evaluate the intensity of alveolitis, whereas clinical, roentgenographic, and functional studies are insensitive monitors of lung inflammation. As ILD is generally diffuse, unilobar lavage is widely used and presumed to gauge overall lung inflammation. Consistency of lobe to lobe cell differential findings has not been systematically addressed. We analyzed 53 bilateral lobar lavages (right middle lobe and lingula) in 34 patients with sarcoidosis, idiopathic pulmonary fibrosis-collagen vascular disease (IPF-CV) and a group of mixed interstitial diseases. Cellular differentials from each lobe were independently assessed and compared. The sarcoid group, with predominantly T-lymphocytes in BAL, showed excellent interlobar correlation (r = 0.92, p less than 0.001), with only 17% showing a discrepancy of greater than 10% in percentage of T-lymphocytes. In contrast, the IPF-CV group, with predominantly neutrophils in BAL, showed good interlobar correlation (r = 0.79; p less than 0.01), but 35% had a greater than 10% discrepancy in percentage of neutrophils. Finally, the mixed group, with lymphocytes as the predominant cell in BAL, showed poor interlobar correlation (r = 0.58; p greater than 0.10), with 42% showing a greater than 10% discrepancy in percentage of lymphocytes. These results were not explicable on the basis of differences in volume of lavage fluid or total cells recovered, these parameters being remarkably consistent between lobes in the 3 patient groups and in a control group of 8 subjects without ILD. The chest roentgenogram was markedly insensitive to lavage interlobar variation.(ABSTRACT TRUNCATED AT 250 WORDS)
在多种间质性肺疾病（ILD）中，肺泡炎被认为先于永久性肺功能紊乱出现。支气管肺泡灌洗（BAL）细胞分类可用于评估肺泡炎的强度，而临床、放射学和功能研究对肺部炎症的监测并不敏感。由于ILD通常是弥漫性的，单叶灌洗被广泛应用，并被认为可衡量整体肺部炎症。叶间细胞分类结果的一致性尚未得到系统研究。我们分析了34例结节病、特发性肺纤维化 - 胶原血管病（IPF - CV）患者及一组混合性间质性疾病患者的53次双侧叶灌洗（右中叶和舌叶）。对每个叶的细胞分类进行独立评估和比较。结节病组BAL中主要为T淋巴细胞，叶间相关性极佳（r = 0.92，p小于0.001），只有17%的患者T淋巴细胞百分比差异大于10%。相比之下，IPF - CV组BAL中主要为中性粒细胞，叶间相关性良好（r = 0.79；p小于0.01），但35%的患者中性粒细胞百分比差异大于10%。最后，混合组BAL中以淋巴细胞为主，叶间相关性较差（r = 0.58；p大于0.10），42%的患者淋巴细胞百分比差异大于10%。这些结果无法用灌洗液体积或回收的总细胞数差异来解释，这两个参数在3个患者组及8名无ILD的对照受试者的叶间非常一致。胸部X线片对灌洗叶间差异明显不敏感。（摘要截短于250字）
