Wilsher M L, Hallowes M, Birchall N M
Department of Respiratory Medicine, Green Lane Hospital, Auckland, New Zealand.
Thorax. 1996 Nov;51(11):1123-6. doi: 10.1136/thx.51.11.1123.
Because gamma/delta T lymphocytes (gamma delta cells) respond to myco-bacterial antigens in vitro and accumulate in the skin lesions of patients with certain granulomatous infections (leprosy, leishmaniasis), it was hypothesised that these cells might have a role in the pathogenesis of sarcoidosis, a disease also characterised by granuloma formation. Having failed to demonstrate an increase in gamma delta cells in the blood of patients with sarcoidosis, the aim of this study was to examine samples of bronchoalveolar lavage (BAL) fluid and biopsy tissue.
Samples from 23 patients (13 women) with newly diagnosed sarcoidosis, of mean age 31 years and median percentage of lymphocytes in the BAL fluid of 31%, were studied. Controls included normal subjects and patients with other interstitial lung diseases (ILD). Cytopreparations of BAL fluid (n = 13) and cryostat sections (five mediastinal nodes, 14 transbronchial biopsies) were stained with alkaline phosphatase-antialkaline phosphatase and monoclonal antibodies to CD3, CD4, CD8, CD25, and gamma delta T cell receptor (TCR).
All patients had typical chest radiographs (16 stage I, four stage II, three stage III). All were Mantoux negative with negative tuberculosis cultures. Compared with normal controls and patients with other interstitial lung diseases there was no increase in gamma delta cells in the BAL fluid (sarcoidosis, 1% (range 0-4%) total cells; ILD, 1% (0-2%); controls, 0.5% (0-2%); p > 0.05, Kruskal-Wallis). Likewise, there was no increase in gamma delta cells in the transbronchial biopsy specimens (sarcoidosis, 1/high power field (hpf) (range 0-2); ILD, < 1/hpf (0-4); controls < 1/hpf (0-2); p > 0.05). gamma delta cells were rarely seen in the lymph nodes in spite of the presence of numerous granulomas.
These results provide further evidence that gamma delta cells are not increased in most patients with sarcoidosis.
由于γ/δ T淋巴细胞（γδ细胞）在体外可对分枝杆菌抗原产生反应，并在某些肉芽肿性感染（麻风病、利什曼病）患者的皮肤病变中聚集，因此有人推测这些细胞可能在结节病的发病机制中起作用，结节病也是一种以肉芽肿形成为特征的疾病。由于未能证明结节病患者血液中γδ细胞增加，本研究旨在检查支气管肺泡灌洗（BAL）液样本和活检组织。
研究了23例新诊断的结节病患者（13名女性）的样本，平均年龄31岁，BAL液中淋巴细胞的中位数百分比为31%。对照组包括正常受试者和其他间质性肺疾病（ILD）患者。用碱性磷酸酶-抗碱性磷酸酶和针对CD3、CD4、CD8、CD25和γδ T细胞受体（TCR）的单克隆抗体对BAL液的细胞涂片（n = 13）和低温切片（5个纵隔淋巴结、14个经支气管活检）进行染色。
所有患者胸部X线片均典型（16例I期，4例II期，3例III期）。所有患者结核菌素试验均为阴性，结核培养也为阴性。与正常对照组和其他间质性肺疾病患者相比，BAL液中γδ细胞没有增加（结节病，占总细胞的1%（范围0 - 4%）；ILD，1%（0 - 2%）；对照组，0.5%（0 - 2%）；p > 0.05，Kruskal - Wallis检验）。同样，经支气管活检标本中γδ细胞也没有增加（结节病，每高倍视野（hpf）1个（范围0 - 2个）；ILD，< 1/hpf（0 - 4个）；对照组< 1/hpf（0 - 2个）；p > 0.05）。尽管有大量肉芽肿，但在淋巴结中很少见到γδ细胞。
这些结果进一步证明，大多数结节病患者的γδ细胞没有增加。
