Agusti C, Xaubet A, Luburich P, Ayuso M C, Roca J, Rodriguez-Roisin R
Departament de Medicina, Hospital Clinic, Universitat de Barcelona, Spain.
Thorax. 1996 Aug;51(8):841-5. doi: 10.1136/thx.51.8.841.
High resolution computed tomography (HRCT) is now recognised as a sensitive tool for predicting the histological characteristics of the lung parenchymal abnormalities in patients with idiopathic pulmonary fibrosis (IPF). A reticular pattern on HRCT scanning is indicative of fibrotic histology while a ground glass pattern has been associated with inflammatory disease. The purpose of the present study was to investigate whether the cell population in the bronchoalveolar lavage (BAL) fluid from different lobes differs according to HRCT characteristics in patients with IPF.
Twenty six patients with IPF (18 men) of mean (SE) age 67 (2) years were included in the study. A semiquantitative analysis of the extent of the abnormalities on the HRCT scan was applied by summing the proportion of both reticular and ground glass patterns in each lobe (expressed as percentage of total area evaluated) and 100 ml double BAL was then randomly performed in the lobe with the most extensive involvement (lobe A) and that with the least extensive involvement (lobe B).
Twenty three of the 26 patients (88%) had an abnormal cell count in the BAL fluid from lobe A compared with 18 patients (69%) with abnormalities in the BAL fluid from lobe B. The median (range) percentage of 8.5% (0-34%) and the absolute numbers of neutrophils (1.3 x 10(4)/ml, 0-14.6 x 10(4)/ml) in lobe A were significantly higher than those in lobe B (5% (0-26%) and 1.2 x 10(4)/ml (0-5 x 10(4)/ml), respectively). The percentage (3%, 0-19%) and absolute numbers (0.65 x 10(4)/ml, 0-4 x 10(4)/ml (0-4.8 x 10(4)/ml), respectively). For the group as a whole a correlation was found between the percentage and absolute numbers of neutrophils in the BAL fluid and the total score of abnormalities on the HRCT scan in the most involved lobe (lobe A). Multiple regression analysis indicated that both the percentage and absolute numbers of neutrophils were significantly and independently related to the extent of ground glass pattern.
In patients with IPF the cell population in the BAL fluid is not homogeneous and seems to be related to the characteristics of the abnormalities on the HRCT scan present in the lavaged lobe.
高分辨率计算机断层扫描（HRCT）如今被认为是预测特发性肺纤维化（IPF）患者肺实质异常组织学特征的敏感工具。HRCT扫描上的网状模式提示纤维化组织学表现，而磨玻璃样模式与炎症性疾病相关。本研究的目的是调查IPF患者不同肺叶支气管肺泡灌洗（BAL）液中的细胞群是否根据HRCT特征而有所不同。
本研究纳入了26例IPF患者（18例男性），平均（标准误）年龄为67（2）岁。通过计算每个肺叶中网状和磨玻璃样模式的比例总和（以评估总面积的百分比表示），对HRCT扫描上的异常程度进行半定量分析，然后在受累最严重的肺叶（A叶）和受累最轻的肺叶（B叶）中随机进行100 ml双份BAL。
26例患者中有23例（88%）A叶BAL液细胞计数异常，而B叶BAL液异常的患者有18例（69%）。A叶中性粒细胞的中位数（范围）百分比为8.5%（0 - 34%），绝对计数为（1.3×10⁴/ml，0 - 14.6×10⁴/ml），显著高于B叶（分别为5%（0 - 26%）和1.2×10⁴/ml（0 - 5×10⁴/ml））。百分比（3%，0 - 19%）和绝对计数（分别为0.65×10⁴/ml，0 - 4×10⁴/ml（0 - 4.8×10⁴/ml））。对于整个组，发现BAL液中中性粒细胞的百分比和绝对计数与受累最严重的肺叶（A叶）HRCT扫描上的异常总分之间存在相关性。多元回归分析表明，中性粒细胞的百分比和绝对计数均与磨玻璃样模式的程度显著且独立相关。
在IPF患者中，BAL液中的细胞群并非均匀一致，似乎与灌洗肺叶HRCT扫描上的异常特征有关。
