Eklund A, van Hage-Hamsten M, Sköld C M, Johansson S G
Department of Thoracic Medicine, Karolinska Hospital, Stockholm, Sweden.
Sarcoidosis. 1993 Mar;10(1):12-7.
Sarcoidosis affecting the lungs may cause obstructive and/or restrictive lung function impairment. The bronchial reactivity is related to the release of histamine from the mast cells. Upon activation mast cells also release tryptase. This enzyme may activate latent collagenase and thus possibly contribute to the fibrosis formation observed in sarcoidosis. We analyzed the bronchoalveolar lavage fluid (BALF) from 13 nonsmoking and untreated patients with sarcoidosis and from 30 healthy volunteers (18 smokers) with regard to the number of mast cells and the tryptase concentration. Concomitantly albumin, fibronectin and hyaluronan were measured as markers of the inflammatory reaction in the alveoli and interstitium. The number of mast cells was higher (p < 0.001) in patients with sarcoidosis than in controls. Also, the concentration of tryptase was significantly higher in patients (225.3 +/- 83.9 [SEM] mU/L) compared to nonsmoking and smoking controls (34.7 +/- 7.8 and 44.7 +/- 13.0 mU/L, respectively; p < 0.01 for both). In addition, the concentrations of albumin, fibronectin and hyaluronan were higher in patients with sarcoidosis compared to the nonsmoking controls (p < 0.001 for all). However, there was no relationship between either the mast cell number or the tryptase concentration and the lung function parameters (VC, TLC, FEV1, FEV%, DLCO). As our patients did not show any functional signs of bronchial obstruction (FEV1 91.7% +/- 13.3 [SD] and FEV% 99.5% +/- 6.4 of predicted) the lack of correlation is not surprising. The high concentrations observed in the BALF of the noncellular components may just reflect an ongoing inflammatory process that may resolve or, if exaggerated, lead to fibrosis.
影响肺部的结节病可能导致阻塞性和/或限制性肺功能损害。支气管反应性与肥大细胞释放组胺有关。肥大细胞激活后还会释放类胰蛋白酶。这种酶可能会激活潜在的胶原酶，从而可能导致结节病中观察到的纤维化形成。我们分析了13名不吸烟且未经治疗的结节病患者以及30名健康志愿者（18名吸烟者）的支气管肺泡灌洗液（BALF）中的肥大细胞数量和类胰蛋白酶浓度。同时，测量了白蛋白、纤连蛋白和透明质酸，作为肺泡和间质炎症反应的标志物。结节病患者的肥大细胞数量高于对照组（p < 0.001）。此外，与不吸烟和吸烟对照组相比，患者的类胰蛋白酶浓度也显著更高（分别为225.3 +/- 83.9 [SEM] mU/L、34.7 +/- 7.8和44.7 +/- 13.0 mU/L；两者均p < 0.01）。此外，与不吸烟对照组相比，结节病患者的白蛋白、纤连蛋白和透明质酸浓度更高（所有p < 0.001）。然而，肥大细胞数量或类胰蛋白酶浓度与肺功能参数（肺活量（VC）、肺总量（TLC）、第1秒用力呼气容积（FEV1）、FEV1占预计值百分比（FEV%）、一氧化碳弥散量（DLCO））之间均无关联。由于我们的患者未表现出任何支气管阻塞的功能迹象（FEV1为预计值的91.7% +/- 13.3 [标准差]，FEV%为预计值的99.5% +/- 6.4），缺乏相关性并不令人惊讶。在BALF中观察到的非细胞成分的高浓度可能仅仅反映了一个持续的炎症过程，该过程可能会消退，或者如果过度，可能会导致纤维化。
