Lin Y H, Haslam P L, Turner-Warwick M
Thorax. 1985 Jul;40(7):501-7. doi: 10.1136/thx.40.7.501.
Thirty three consecutive untreated patients with pulmonary sarcoidosis, confirmed histologically or by Kveim test, were investigated to correlate cell counts in bronchoalveolar lavage fluid with clinical features, the chest radiograph, and results of lung function tests. A persistently abnormal radiograph had been observed for one year or more in 26 (79%) and for two years or more in 20 (61%), but only 24% had dyspnoea. Twenty (61%) of 33 patients showed an increased percentage of lymphocytes in bronchoalveolar lavage fluid, although only eight (24%) exceeded 28%. A moderate increase of neutrophils, up to 12%, was found in 14 (42%). Lymphocyte percentage counts were higher in the group of patients without evidence of radiographic contraction suggesting fibrosis, and this contrasted with higher percentage neutrophil counts in those with contraction. There was also a correlation between the percentages of neutrophils and increasing radiographic profusion scores (p less than 0.001), suggesting that neutrophils may reflect the severity of the parenchymal legions as well as fibrotic distortion, and an inverse correlation with vital capacity (p less than 0.001) and transfer factor (TLCO) (p less than 0.1 greater than 0.05). No significant correlation was found between the lymphocyte counts and radiographic profusion scores, vital capacity or TLCO; but it was noted that all eight patients with high lymphocyte counts (greater than 28%) had radiographic profusion scores less than 12. This study shows that, especially in sarcoidosis with more extensive radiographic shadows of long duration, bronchoalveolar lavage neutrophils may be important as well as lymphocytes in clinical assessment of "activity" of disease. These observations are important because they throw doubt on whether the lavage lymphocyte count alone can be used as an indicator of the need to start corticosteroid treatment.
对33例经组织学确诊或Kveim试验证实的未经治疗的肺结节病患者进行了研究，以探讨支气管肺泡灌洗液中的细胞计数与临床特征、胸部X线片及肺功能测试结果之间的相关性。26例（79%）患者的异常胸片持续观察到1年或更长时间，20例（61%）持续观察到2年或更长时间，但只有24%的患者有呼吸困难。33例患者中有20例（61%）支气管肺泡灌洗液中淋巴细胞百分比增加，尽管只有8例（24%）超过28%。14例（42%）患者中性粒细胞有中度增加，最高达12%。在无提示纤维化的放射学收缩证据的患者组中，淋巴细胞百分比计数较高，而有收缩的患者组中性粒细胞百分比计数较高。中性粒细胞百分比与放射学渗出评分增加之间也存在相关性（p<0.001），提示中性粒细胞可能反映实质病变的严重程度以及纤维化变形，且与肺活量（p<0.001）和转运因子（TLCO）呈负相关（p<0.1，>0.05）。淋巴细胞计数与放射学渗出评分、肺活量或TLCO之间未发现显著相关性；但注意到所有淋巴细胞计数高（>28%）的8例患者放射学渗出评分均低于12。本研究表明，尤其是在有长期更广泛放射学阴影的结节病中，支气管肺泡灌洗中性粒细胞在疾病“活动度”的临床评估中可能与淋巴细胞同样重要。这些观察结果很重要，因为它们对仅用灌洗淋巴细胞计数作为开始皮质类固醇治疗必要性的指标提出了质疑
