Witt C, Dörner T, Hiepe F, Borges A C, Fietze I, Baumann G
Department of Medicine I, University Hospital Charité, Humboldt University, Berlin, Germany.
Lupus. 1996 Dec;5(6):606-12. doi: 10.1177/096120339600500609.
The diagnostic relevance of bronchoalveolar lavage (BAL) and associated non-invasive findings in connective tissue diseases (CTD) has not been established regarding alveolitis so far. The goal of the study was to determine the relations between BAL cell differential count and findings of non-invasive diagnostic procedures for alveolitis to predict the clinical value of BAL in CTD. One hundred-five patients (92 non-smokers; 13 smokers) with CTD (73 patients with systemic sclerosis, 19 with systemic lupus erythematosus, 13 with primary Sjögren's syndrome) had symptoms or signs of lung involvement and were further examined (lung function test, chest radiography, thoracic computed tomography, 67 gallium scintigraphy and BAL). The relations between BAL in middle lobe and cell count differentiation to non-invasive investigations were analyzed by logistic regression. In all CTD patients investigated a pulmonal involvement occurred based on non-invasive methods. Regarding non-invasive methods, alveolitis determined by BAL cell differential count was significantly associated with an increased 67-gallium uptake and late inspiratory crackles (P < 0.01), and to a lesser extent with an abnormal interstitial pattern in CT (P < 0.055). Parameters of lung function and laboratory parameters were related to alveolitis using multivariate testing. Considering the alveolitis subtype (granulo- or lymphocytosis), only a reduced FEV1 showed a relationship to granulocytic alveolitis (P < 0.01). Late inspiratory crackles and increased 67 gallium uptake as non-invasive diagnostic findings point out alveolitis in CTD remarkably. Therapeutic and prognostic aspects necessitate BAL to specify the type of alveolitis (lymphocytosis or granulocytosis or mixed forms) in CTD patients with lung manifestation. Non-invasive diagnostic procedures cannot predict the type of alveolitis sufficiently.
迄今为止，支气管肺泡灌洗（BAL）及相关非侵入性检查结果在结缔组织病（CTD）中对于肺泡炎的诊断相关性尚未明确。本研究的目的是确定BAL细胞分类计数与肺泡炎非侵入性诊断检查结果之间的关系，以预测BAL在CTD中的临床价值。105例患有CTD（73例系统性硬化症、19例系统性红斑狼疮、13例原发性干燥综合征）的患者（92例非吸烟者；13例吸烟者）有肺部受累的症状或体征，并接受了进一步检查（肺功能测试、胸部X线摄影、胸部计算机断层扫描、67镓闪烁显像和BAL）。通过逻辑回归分析中叶BAL与细胞计数分化和非侵入性检查之间的关系。在所有接受调查的CTD患者中，基于非侵入性方法均发现有肺部受累。关于非侵入性方法，由BAL细胞分类计数确定的肺泡炎与67镓摄取增加和吸气末啰音显著相关（P<0.01），与CT中异常间质模式的相关性较小（P<0.055）。使用多变量测试分析肺功能参数和实验室参数与肺泡炎的关系。考虑到肺泡炎亚型（粒细胞或淋巴细胞增多型），仅FEV1降低与粒细胞性肺泡炎相关（P<0.01）。吸气末啰音增加和67镓摄取增加作为非侵入性诊断结果可显著提示CTD中的肺泡炎。治疗和预后方面需要BAL来明确有肺部表现的CTD患者的肺泡炎类型（淋巴细胞增多型或粒细胞增多型或混合形式）。非侵入性诊断程序不能充分预测肺泡炎的类型。
