Simons Iris A, Boerrigter Bart G, Hovestadt Maud C M, Mooij-Kalverda Kirsten A, Zhang Shiqi, Boers Leonoor S, van der Zee Anke H Maitland-, Nossent Esther J, Duitman Jan Willem
Pulmonary Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.
Experimental Immunology (EXIM), Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.
Respir Res. 2025 Apr 28;26(1):164. doi: 10.1186/s12931-025-03236-3.
Immunological bronchoalveolar lavage (iBAL) is a frequently employed diagnostic tool in interstitial lung disease (ILD). The association between iBAL cellular composition and disease progression remains elusive. We evaluated whether the alveolar cellular composition at initial diagnosis is predictive of the development of progressive pulmonary fibrosis (PPF) in patients with ILD.
A retrospective analysis of 111 patients diagnosed with ILD who underwent iBAL for diagnostic purposes between January 2018 and January 2023 was conducted. The identification of PPF was based on the criteria outlined in the ATS/ERS/JRS/ALAT clinical practice guidelines. Clinical data, pulmonary function tests, radiological imaging, and BAL cellular composition were collected. Groups were compared using the non-parametric Wilcoxon rank sum test. Linear mixed-effect modelling was used to assess the association between baseline cell composition and longitudinal lung function decline.
A total of 33.3% of patients exhibited a PPF phenotype. A significant association between baseline iBAL CD4 + and CD8 + T cell percentages and forced vital capacity (FVC) decline within the first year was observed. Other cell types were not associated with ILD progression within one-year of follow-up.
CD4 + and CD8 + T cell percentages significantly correlated with FVC changes in patients with fibrotic ILD. No further associations were found between the baseline iBAL cellular profiles and disease progression. These findings suggest that baseline iBAL cellular profiles may hold some promise in predicting fibrotic ILD disease progression. Further (prospective) studies using larger cohorts may be needed to elucidate the association between the cellular composition of iBAL fluid and pulmonary fibrosis progression.
免疫支气管肺泡灌洗（iBAL）是间质性肺疾病（ILD）中常用的诊断工具。iBAL细胞组成与疾病进展之间的关联仍不明确。我们评估了初诊时的肺泡细胞组成是否可预测ILD患者进行性肺纤维化（PPF）的发生。
对2018年1月至2023年1月期间因诊断目的接受iBAL的111例ILD患者进行回顾性分析。PPF的判定基于美国胸科学会（ATS）/欧洲呼吸学会（ERS）/日本呼吸学会（JRS）/拉丁美洲胸科协会（ALAT）临床实践指南中概述的标准。收集临床数据、肺功能测试、影像学检查和BAL细胞组成。使用非参数Wilcoxon秩和检验进行组间比较。采用线性混合效应模型评估基线细胞组成与肺功能纵向下降之间的关联。
共有33.3%的患者表现出PPF表型。观察到基线iBAL中CD4 +和CD8 + T细胞百分比与第一年内用力肺活量（FVC）下降之间存在显著关联。在随访的一年内，其他细胞类型与ILD进展无关。
CD4 +和CD8 + T细胞百分比与纤维化ILD患者的FVC变化显著相关。未发现基线iBAL细胞特征与疾病进展之间存在进一步关联。这些发现表明，基线iBAL细胞特征在预测纤维化ILD疾病进展方面可能具有一定前景。可能需要进一步（前瞻性）研究纳入更大队列，以阐明iBAL液细胞组成与肺纤维化进展之间的关联。
