Condos R, Rom W N, Liu Y M, Schluger N W
The Bellevue Chest Service and the Division of Pulmonary and Critical Care Medicine, New York University Medical Center, New York, USA.
Am J Respir Crit Care Med. 1998 Mar;157(3 Pt 1):729-35. doi: 10.1164/ajrccm.157.3.9705044.
Local cellular immune responses may affect presentation and outcome in tuberculosis (TB). To investigate this hypothesis, we performed bronchoalveolar lavage (BAL) on 30 patients with untreated pulmonary tuberculosis and assessed the type of cellular inflammatory response and cytokine production. We then correlated BAL findings and cytokine production with clinical findings. We also performed BAL on a subset of patients to examine changes in cytokine production by BAL cells over time. We found that at presentation patients with less clinically and radiographically advanced TB (smear-negative, noncavitary disease) had a local immune response characterized by a predominance of lymphocytes. Furthermore, BAL cells from these patients secreted interferon (IFNgamma), and not Interleukin-4, suggesting a Th 1-type lymphocytic response. In patients with smear-positive and/or cavitary disease, macrophages or polymorphonuclear leukocytes were the predominant BAL cell type, but with treatment and clinical improvement these patients went on to recruit IFNgamma producing cells to the lung. We conclude that the type of cellular immune response that occurs locally in the lung may affect presentation and outcome in pulmonary TB, and an understanding of the development of this response may lead to insights into pathogenesis and novel therapies for TB.
局部细胞免疫反应可能影响结核病（TB）的表现及转归。为了验证这一假说，我们对30例未经治疗的肺结核患者进行了支气管肺泡灌洗（BAL），并评估了细胞炎症反应类型及细胞因子产生情况。然后我们将BAL结果及细胞因子产生情况与临床结果进行关联分析。我们还对部分患者进行了BAL，以检测BAL细胞产生的细胞因子随时间的变化情况。我们发现，初诊时临床及影像学表现较轻的肺结核患者（涂片阴性、非空洞性病变）具有以淋巴细胞为主的局部免疫反应特征。此外，这些患者的BAL细胞分泌干扰素（IFNγ），而非白细胞介素-4，提示为Th1型淋巴细胞反应。在涂片阳性和/或有空洞病变的患者中，巨噬细胞或多形核白细胞是主要的BAL细胞类型，但随着治疗及临床症状改善，这些患者肺部会募集产生IFNγ的细胞。我们得出结论，肺部局部发生的细胞免疫反应类型可能影响肺结核的表现及转归，了解这种反应的发展过程可能有助于深入了解结核病的发病机制及开发新的治疗方法。
