Dorinsky P M, Davis W B, Lucas J G, Weiland J E, Gadek J E
Chest. 1985 Jul;88(1):58-63. doi: 10.1378/chest.88.1.58.
Four adult patients with biopsy-proven bronchiolitis were identified and prospectively evaluated. Each patient presented with the rapid onset (weeks to months) of severe respiratory disease that was clinically distinct from asthma, chronic bronchitis, bronchiectasis, cystic fibrosis, and emphysema. Bronchiolitis patients were evaluated by pulmonary function testing and bronchoalveolar lavage (BAL) before and after two months of treatment with 1 mg/kg/day of prednisone. Initial BAL results of bronchiolitis patients were compared to those of cigarette smokers with chronic bronchitis (n = 4), asymptomatic cigarette smokers (n = 5), and normal nonsmoking volunteers (n = 5). Neutrophils comprised 53 +/- 13 percent of the cells recovered by BAL in bronchiolitis patients but only 3 +/- 2 percent of the cells in chronic bronchitis patients, 1.5 +/- 0.6 percent of the cells in asymptomatic smokers, and 0.3 +/- 0.3 percent of the cells in normal volunteers (p less than 0.01, all comparisons). Moreover, prednisone produced a striking decrease in lower respiratory tract neutrophils (53 +/- 13 percent to 8 +/- 3 percent, p less than 0.05) in all bronchiolitis patients while lung function either improved (two patients) or remained unchanged (two patients). These findings suggest a central role for the neutrophil in bronchiolitis and argue that BAL may be clinically useful in the diagnosis and management of these patients.
确定了4例经活检证实的细支气管炎成年患者，并对其进行前瞻性评估。每位患者均表现为严重呼吸系统疾病的快速起病（数周至数月），临床上与哮喘、慢性支气管炎、支气管扩张症、囊性纤维化和肺气肿不同。在使用1mg/kg/天的泼尼松治疗两个月前后，通过肺功能测试和支气管肺泡灌洗（BAL）对细支气管炎患者进行评估。将细支气管炎患者的初始BAL结果与慢性支气管炎吸烟者（n = 4）、无症状吸烟者（n = 5）和正常非吸烟志愿者（n = 5）的结果进行比较。中性粒细胞在细支气管炎患者BAL回收细胞中占53±13%，而在慢性支气管炎患者中仅占3±2%，在无症状吸烟者中占1.5±0.6%，在正常志愿者中占0.3±0.3%（所有比较，p<0.01）。此外，泼尼松使所有细支气管炎患者下呼吸道中性粒细胞显著减少（从53±13%降至8±3%，p<0.05），而肺功能要么改善（2例患者），要么保持不变（2例患者）。这些发现表明中性粒细胞在细支气管炎中起核心作用，并表明BAL在这些患者的诊断和管理中可能具有临床实用性。
