Yoshizawa Y, Ohdama S, Ikeda A, Ohtsuka M, Masuda S, Tanaka M
Am Rev Respir Dis. 1984 Sep;130(3):507-9. doi: 10.1164/arrd.1984.130.3.507.
This report describes a case of lymphoid interstitial pneumonia (LIP) associated with polyclonal gammopathy and selective depression of cellular immunity. Enhanced humoral immunity is suggested because the patient exhibited increased levels of circulating immunoglobulin (chiefly IgG) and a positive test reaction for rheumatoid factor. When first examined, the patient displayed depressed cellular immunity in that the results of his skin test were negative to dinitrochlorobenzene and phytohemagglutinin (PHA), his peripheral lymphocytes responded suboptimally to PHA, and he had decreased numbers of circulating T cells. When examined 6 yr later, the patient was again hypergammaglobulinemic, but he had regained some of his cellular immune function. Eight years after the patient was initially seen, he showed further improvement in cellular immune function. Analysis of bronchoalveolar lavage cells showed that the patient had a normal proportion of OKT4+ (inducer/helper) cells, but a reduced number of OKT8+ (suppressor/cytotoxic) cells. Thus, his improvement may have been associated with a correction of an imbalance of immunoregulatory T cells. Furthermore, because the disease was active on initial examination but less active after the second evaluation, malfunction of his cellular immune functions may have been involved in the pathogenesis of LIP.
本报告描述了一例与多克隆丙种球蛋白病及细胞免疫选择性抑制相关的淋巴样间质性肺炎（LIP）。鉴于患者循环免疫球蛋白（主要为IgG）水平升高且类风湿因子检测反应呈阳性，提示体液免疫增强。初诊时，患者表现出细胞免疫抑制，其皮肤试验对二硝基氯苯和植物血凝素（PHA）呈阴性反应，外周淋巴细胞对PHA反应欠佳，且循环T细胞数量减少。6年后复查时，患者再次出现高丙种球蛋白血症，但部分细胞免疫功能已恢复。患者初诊8年后，其细胞免疫功能进一步改善。支气管肺泡灌洗细胞分析显示，患者OKT4 +（诱导/辅助）细胞比例正常，但OKT8 +（抑制/细胞毒性）细胞数量减少。因此，其病情改善可能与免疫调节性T细胞失衡的纠正有关。此外，由于初诊时疾病处于活动期，而二次评估后活动度降低，其细胞免疫功能异常可能参与了LIP的发病机制。
