Enomoto Noriyuki, Watanuki Masayuki, Nakai Shogo, Yazawa Shusuke, Mochizuka Yasutaka, Fukada Atsuki, Tanaka Yuko, Naoi Hyogo, Inoue Yusuke, Yasui Hideki, Karayama Masato, Suzuki Yuzo, Hozumi Hironao, Furuhashi Kazuki, Toyoshima Mikio, Kono Masato, Imokawa Shiro, Fujii Masato, Akamatsu Taisuke, Koshimizu Naoki, Yokomura Koshi, Matsuda Hiroyuki, Kaida Yusuke, Nakamura Yutaro, Shirai Masahiro, Mori Kazutaka, Masuda Masafumi, Fujisawa Tomoyuki, Inui Naoki, Sugiura Hiroaki, Sumikawa Hiromitsu, Kitani Masashi, Tabata Kazuhiro, Ogawa Noriyoshi, Suda Takafumi
Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Health Administration Center, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan.
Sci Rep. 2025 Jul 19;15(1):26295. doi: 10.1038/s41598-025-12180-7.
Bronchoalveolar lavage (BAL) is crucial for the diagnosis of interstitial lung disease (ILD). Although BAL lymphocytosis is found in patients with connective tissue disease (CTD)-related ILD, the effects of CTD-associated features on BAL lymphocytosis have not been elucidated. To identify CTD-associated features that affect BAL lymphocyte fraction in patients with idiopathic interstitial pneumonia (IIP). This post hoc analysis of a prospective, multicentre cohort study was conducted between 2015 and 2020. Overall, 222 patients newly diagnosed with IIP were consecutively enrolled, and 74 autoimmune features were comprehensively analysed during IIP diagnosis. The median age was 71 years, and the median observation period was 36 months. The clinical characteristics related to a significant increase in BAL lymphocyte fraction were consolidation opacity on high-resolution computed tomography (HRCT), morphologic domain of interstitial pneumonia with autoimmune features (IPAF), serum CXCL10 concentration, and acute/subacute onset (all p < 0.05). In contrast, presence of joint lesion/mucocutaneous lesion/dry symptoms, autoantibodies, or other CTD-like features on HRCT and surgical lung biopsy did not affect the BAL lymphocyte fraction (all p ≥ 0.05). Furthermore, a high BAL lymphocyte fraction (≥ 8.5%) was related to a low proportion of progressive pulmonary fibrosis (p < 0.001) and favourable survival (log-rank, p = 0.020) in patients with non-idiopathic pulmonary fibrosis (IPF). IPAF morphologic domain especially with consolidation opacity on HRCT and high CXCL10 concentration, but not CTD-like symptoms, autoantibodies, or CTD-like features on lung biopsy, were related to a high BAL lymphocyte fraction with favourable survival in patients with non-IPF.
支气管肺泡灌洗（BAL）对于间质性肺疾病（ILD）的诊断至关重要。虽然在结缔组织病（CTD）相关的ILD患者中发现了BAL淋巴细胞增多，但CTD相关特征对BAL淋巴细胞增多的影响尚未阐明。为了确定影响特发性间质性肺炎（IIP）患者BAL淋巴细胞比例的CTD相关特征。这项对前瞻性、多中心队列研究的事后分析于2015年至2020年进行。总体而言，连续纳入了222例新诊断为IIP的患者，并在IIP诊断期间对74项自身免疫特征进行了全面分析。中位年龄为71岁，中位观察期为36个月。与BAL淋巴细胞比例显著增加相关的临床特征为高分辨率计算机断层扫描（HRCT）上的实变影、具有自身免疫特征的间质性肺炎形态学领域（IPAF）、血清CXCL10浓度以及急性/亚急性起病（均p<0.05）。相比之下，HRCT和外科肺活检上存在关节病变/黏膜皮肤病变/干燥症状、自身抗体或其他CTD样特征并不影响BAL淋巴细胞比例（均p≥0.05）。此外，在非特发性肺纤维化（IPF）患者中，高BAL淋巴细胞比例（≥8.5%）与进行性肺纤维化比例较低（p<0.001）和良好的生存率（对数秩检验，p=0.020）相关。IPAF形态学领域，尤其是HRCT上有实变影和高CXCL10浓度，但不是CTD样症状、自身抗体或肺活检上的CTD样特征，与非IPF患者中高BAL淋巴细胞比例及良好生存率相关。
