Müller-Quernheim J
Medical Hospital, Research Centre Borstel, Germany.
Eur Respir J. 1998 Sep;12(3):716-38. doi: 10.1183/09031936.98.12030716.
Our understanding of the immunopathogenesis of sarcoidosis has been advanced by studies of bronchoalveolar lavage cells. Activated macrophages and T-cells have been identified in different compartments of the sarcoid lung and the characteristics of the activation suggest that the cells become activated in the course of a normal immune response. The immune cells communicate via a cytokine network and the measuring of cytokine levels yields subgroups of sarcoidosis patients with different courses of the disease indicating different states of activation of the disease-mediating immune cells. The causative agent of sarcoidosis has not yet been identified; however, some of the described mechanisms can be clinically applied either to detect patients at risk of deterioration or to develop new therapeutic strategies. Using these approaches methotrexate, pentoxifylline and thalidomide have been identified as drugs which effectively suppress sarcoid inflammation and the serum level of soluble interleukin-2 receptors has been delineated to be a serum marker of sarcoid inflammation. Furthermore, analysing the pulmonary cytokine network in sarcoidosis will yield new staging parameters possibly supplying prognostic information and guiding therapeutic intervention.
对结节病免疫发病机制的认识因支气管肺泡灌洗细胞研究而取得进展。在结节病肺脏的不同区域已鉴定出活化的巨噬细胞和T细胞，其活化特征表明这些细胞在正常免疫反应过程中被激活。免疫细胞通过细胞因子网络进行通讯，测量细胞因子水平可将结节病患者分为具有不同病程的亚组，这表明介导疾病的免疫细胞处于不同的激活状态。结节病的病原体尚未确定；然而，一些已描述的机制可在临床上用于检测有病情恶化风险的患者或制定新的治疗策略。采用这些方法，已确定甲氨蝶呤、己酮可可碱和沙利度胺为有效抑制结节病炎症的药物，可溶性白细胞介素-2受体的血清水平已被确定为结节病炎症的血清标志物。此外，分析结节病中的肺细胞因子网络将产生新的分期参数，可能提供预后信息并指导治疗干预。
