Casarini M, Ameglio F, Alemanno L, Zangrilli P, Mattia P, Paone G, Bisetti A, Giosuè S
Department of Cardiovascular and Respiratory Sciences, Lazzaro Spallanzani Institute,Roma, Italy.
Am J Respir Crit Care Med. 1999 Jan;159(1):143-8. doi: 10.1164/ajrccm.159.1.9803066.
Pulmonary tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. This microorganism is capable of inducing a delayed hypersensitivity reaction in the lung, with subsequent expression of the disease. This reaction depends on the presence of different cytokines that exert specific functions. The aim of this study was to evaluate the presence and the concentrations of nine different modulators in bronchoalveolar lavage fluid (BALF). For this purpose, 15 patients with active pulmonary tuberculosis were enrolled at the time of diagnosis, prior to institution of antituberculous therapy. All the patients demonstrated M. tuberculosis in the sputum, and their disease extention was defined by high-resolution computed tomography (HRCT) using a score which included the presence of six findings: miliary nodules, nodules < 10 mm, consolidation, ground glass, cavity and bronchial wall thickening. This score was more sensitive than an equivalent score calculated on the basis of chest radiology. HRCT score was calculated for each area of the two lungs in order to define the more and the less affected lung for each patient. The bronchoalveolar lavage (BAL) was performed in the more affected area for each lung. The HRCT total score for each washed area ranged between 1 and 15, and showed more significant differences between the more and less affected lungs (p = 0.0004) than those obtained with the individual radiologic findings (p ranged between 0.60 and 0. 004). The BAL concentrations of the nine cytokines evaluated for the more and less affected lungs were compared: interleukin-6 (IL-6), IL-8, IL-12, tumor necrosis factor-alpha (TNF-alpha), and interferon gamma (IFN-gamma) showed significant differences (p ranged between 0. 016 and 0.0007). In addition, each cytokine concentration was correlated with the HRCT score. Significant correlations were found with IL-12, IL-6, IL-8, IL-2, and TNF-alpha. The correlations between cytokines and HRCT total score were better than those observed with the individual radiologic findings. A correlation matrix for the different cytokines evaluated one against each other, has also been added to show common behavior of these modulators. A similar analysis was also performed for the radiologic abnormalities.
肺结核是由结核分枝杆菌引起的一种传染病。这种微生物能够在肺部引发迟发型超敏反应，随后导致疾病的表现。这种反应取决于发挥特定功能的不同细胞因子的存在。本研究的目的是评估支气管肺泡灌洗液（BALF）中九种不同调节因子的存在情况和浓度。为此，在诊断时、开始抗结核治疗之前，招募了15例活动性肺结核患者。所有患者痰液中均检出结核分枝杆菌，其疾病范围通过高分辨率计算机断层扫描（HRCT）确定，使用的评分包括六项表现：粟粒结节、直径<10mm的结节、实变、磨玻璃影、空洞和支气管壁增厚。该评分比基于胸部X线的等效评分更敏感。为确定每位患者受影响程度较重和较轻的肺，对两肺的每个区域计算HRCT评分。在每个肺受影响较重的区域进行支气管肺泡灌洗（BAL）。每个灌洗区域的HRCT总分在1至15之间，与受影响程度较轻的肺相比，受影响程度较重和较轻的肺之间的差异更显著（p = 0.0004），而单个影像学表现的差异（p在0.60至0.004之间）。比较了受影响程度较重和较轻的肺中评估的九种细胞因子的BAL浓度：白细胞介素-6（IL-6）、IL-8、IL-12、肿瘤坏死因子-α（TNF-α）和干扰素-γ（IFN-γ）显示出显著差异（p在0.016至0.0007之间）。此外，每种细胞因子浓度均与HRCT评分相关。发现与IL-12、IL-6、IL-8、IL-2和TNF-α存在显著相关性。细胞因子与HRCT总分之间的相关性优于单个影像学表现的相关性。还添加了一个针对彼此评估的不同细胞因子的相关矩阵，以显示这些调节因子的共同行为。对影像学异常也进行了类似分析。
