Drent M, Grutters J C, Mulder P G, van Velzen-Blad H, Wouters E F, van den Bosch J M
Department of Pulmonology, University Hospital of Maastricht, The Netherlands.
Sarcoidosis Vasc Diffuse Lung Dis. 1997 Mar;14(1):31-8.
Sarcoidosis is generally characterized by a CD4+ lymphocyte predominance in bronchoalveolar lavage fluid (BALF), whereas in extrinsic allergic alveolitis (EAA) a CD8+ lymphocyte predominance is found. However, we have previously demonstrated an increase in CD4+ lymphocytes in BALF obtained from EAA patients as well. The aim of this study was to evaluate whether in sarcoidosis and EAA the BALF cellular profile-even without the help of cytokine detection-might reflect differences in the CD4+ T-lymphocyte subpopulations, i.e. T helper (TH)-1 and TH2 lymphocytes.
For this purpose, we analyzed BALF analysis results obtained from 77 nonsmoking patients with histologically proven sarcoidosis and 54 nonsmoking patients suffering from EAA.
Patients with EAA showed the highest mean absolute numbers of lymphocytes, CD8+ as well as CD4+ T lymphocytes, whereas the percentage of CD4+ T lymphocytes in BALF was low. In contrast, patients with sarcoidosis showed the lowest absolute and relative number of CD8+ T lymphocytes, the highest percentage of CD4+ T lymphocytes and CD4+/CD8+ ratio. Moreover, patients with Löfgren's syndrome demonstrated an alveolitis suggesting a TH1 lymphocyte-subset-like predominant related profile, characterized by lower numbers of eosinophils and mast cells, whereas sarcoidosis patients with respiratory symptoms formed a more mixed TH1/TH2 pattern. Patients with EAA showed a cellular BALF profile suggesting a functional predominance of TH2 lymphocytes.
These preliminary data suggest a different distribution of the CD4+ T lymphocyte subtypes characterized by a functional heterogeneity of CD4+ T lymphocytes between-as well as within-these various pulmonary disorders. The exact role of this imbalance of TH1 and TH2-like activity in the lung with regard to the pathogenesis and prognosis needs to be further elucidated.
结节病的特征通常是支气管肺泡灌洗液（BALF）中CD4+淋巴细胞占优势，而在变应性肺泡炎（EAA）中则以CD8+淋巴细胞占优势。然而，我们之前也证明了EAA患者的BALF中CD4+淋巴细胞也有所增加。本研究的目的是评估在结节病和EAA中，即使不借助细胞因子检测，BALF细胞谱是否可能反映CD4+T淋巴细胞亚群（即辅助性T细胞（TH）-1和TH2淋巴细胞）的差异。
为此，我们分析了77例经组织学证实的结节病非吸烟患者和54例患有EAA的非吸烟患者的BALF分析结果。
EAA患者的淋巴细胞、CD8+以及CD4+T淋巴细胞的平均绝对数量最高，而BALF中CD4+T淋巴细胞的百分比很低。相比之下，结节病患者的CD8+T淋巴细胞的绝对数量和相对数量最低，CD4+T淋巴细胞的百分比和CD4+/CD8+比值最高。此外，Löfgren综合征患者表现出一种肺泡炎，提示以TH1淋巴细胞亚群样为主的相关谱，其特征是嗜酸性粒细胞和肥大细胞数量较少，而有呼吸道症状的结节病患者形成了更混合的TH1/TH2模式。EAA患者的BALF细胞谱提示TH2淋巴细胞功能占优势。
这些初步数据表明，在这些不同的肺部疾病之间以及内部，CD4+T淋巴细胞亚型存在不同分布，其特征是CD4+T淋巴细胞功能异质性。TH1和TH2样活性失衡在肺部发病机制和预后方面的确切作用需要进一步阐明。
