Zannese Thibaut, Viallard Jean-François, Sridi-Cheniti Soumaya, Prot-Leurent Camille, Dupuy Henry, Léonard Cédric, Duffau Pierre, Lazaro Estibaliz, Greib Carine, Rivière Etienne
Internal Medicine and Infectious Diseases Unit, Haut-Leveque Hospital, University Hospital Centre of Bordeaux, Pessac Cedex, 33604, France.
INSERM U1034, Bordeaux University, Pessac Cedex, 33604, France.
BMC Pulm Med. 2025 May 9;25(1):227. doi: 10.1186/s12890-024-03428-5.
Sarcoidosis is a complex multisystemic disease with a wide range of clinical manifestations. Its severity and evolution are highly variable and the prognostic utility of paraclinical markers is debated. We analysed the utility of the CD4/CD8 T-cell ratio (R) in bronchoalveolar lavage (BAL) fluid as a marker of sarcoidosis severity.
We conducted an observational, retrospective, monocentric study involving patients with systemic sarcoidosis who underwent BAL for diagnostic purposes between June 2010 and April 2020.
Among 62 patients, half had a CD4/CD8 T-cell ratio (R) value ≥ 3.5. Patients with R < 3.5 had more extrapulmonary manifestations, mainly abdominal (32.3% vs. 6.5%, p = 0.01) and tended to have a higher frequency of cardiac/central nervous system involvement (19.4% vs. 6.5%, p = 0.25). They also had more frequent interstitial lung involvement (80.6% vs. 67.7%, p = 0.2) and tended to have more severe respiratory impairment. The activation (p = 0.01) of CD8 + T cells in peripheral blood was significantly higher in patients with R < 3.5. By contrast, patients with R ≥ 3.5 tended to have more frequent musculoskeletal-cutaneous involvement (48.4% vs. 32.3%, p = 0.2). Treatment was initiated more frequently in patients with R < 3.5 (71% vs. 35.5%, p = 0.01), who also more frequently required immunosuppressive agents (54.5% vs. 36.4%, p = 0.02).
An R value < 3.5 in BAL fluid has potential as a marker of sarcoidosis severity. Patients with a low R value had a worse prognosis with more severe respiratory impairment and more frequent multisystemic and extra-pulmonary involvement, and more frequently required immunosuppressive agents.
结节病是一种复杂的多系统疾病，临床表现广泛。其严重程度和病程高度可变，辅助检查指标的预后价值存在争议。我们分析了支气管肺泡灌洗（BAL）液中CD4/CD8 T细胞比值（R）作为结节病严重程度标志物的效用。
我们进行了一项观察性、回顾性、单中心研究，纳入2010年6月至2020年4月期间因诊断目的接受BAL的系统性结节病患者。
62例患者中，一半的CD4/CD8 T细胞比值（R）≥3.5。R<3.5的患者有更多肺外表现，主要是腹部表现（32.3%对6.5%，p=0.01），且心脏/中枢神经系统受累频率倾向于更高（19.4%对6.5%，p=0.25）。他们的间质性肺受累也更频繁（80.6%对67.7%，p=0.2），且呼吸功能损害倾向于更严重。外周血中CD8+T细胞的活化在R<3.5的患者中显著更高（p=0.01）。相比之下，R≥3.5的患者肌肉骨骼-皮肤受累倾向于更频繁（48.4%对32.3%，p=0.2）。R<3.5的患者更频繁开始治疗（71%对35.5%，p=0.01），且更频繁需要免疫抑制剂（54.5%对36.4%，p=0.02）。
BAL液中R值<3.5有潜力作为结节病严重程度的标志物。R值低的患者预后较差，呼吸功能损害更严重，多系统和肺外受累更频繁，且更频繁需要免疫抑制剂。
