结节病支气管肺泡灌洗液细胞学与肺弥散功能

BALF cytology and pulmonary diffusing capacity in sarcoidosis

目的 测定结节病患者的肺通气功能和ＢＡＬＦ细胞学，并就其之间的相关性进行探讨，探究肺弥散功能（ＤＬＣＯ） 的减低与ＢＡＬＦ检测之间的相关性。方法 结节病患者２１例，行肺通气功能和弥散功能及ＢＡＬＦ细胞学检查。结果 结节病 组静息状态肺通气功能基本正常，单口呼吸法肺弥散功能减低［占预计值（７９．５４±２０．３６）％，Ｐ＜０．０１］，并有小气道功能障碍 （ＦＥＦ５０％ ６７．３３±３４．３３，Ｐ＜（０．０５）。我们还发现结节病患者 ＢＡＬＦ中 Ｌ％明显增高，ＣＤ４＋／ＣＤ８＋亦明显高于对照组，而且 ＤＬＣ ０％减低与ＢＡＬＦ中Ｌ％增加及ＣＤ＋４／ＣＤ＋８比增加均呈负相关（r=－０．６７，Ｐ＜０．０１和r=－０．５５，Ｐ＜０．０５），且小气道功能中ＭＥＦ５０％ 减低与 ＬＡＬＦ中 Ｌ％增加呈明显负相关（r＝０．５４， Ｐ＜０．０５）。结论 ＤＬＣＯ以及小气道功能的检查与 ＢＡＬＦ细胞学检测指标存在 较明显的相关性，可对结节病的早期诊断、动态观察及疗效判定提供实验依据。

Objective To study whether the cellular bronchoalveolar lavage fluid (BALF) profile was associated with the decrease in the siffusing capacity (DLCO). Methods lung function tests and BAL were carried out in 21 untreated,nonsmoking patients suffering from sarcoidosis. Resuts Lung function tests were normal at rest in patients with sarcoidosis, the single breath carbon monoxide diffusing capacity decreased [DLco/ Pred% (79.54?0.36)%,p＜O.05], and the small airway func tion also decreased [FEF5%/Pred% (67.33±134. 33)% P＜0.05]. We also found that the percentage of lymphocytes and the ratio of CD4+ to CD8+ in BALF significanly increased in sarcoidosis group (36.2±18.7, p<0.0l and 3.21±0.97, P<0.05, respective- ly); furdermore, the increase of both the Percentage of lymphocytes and the ratio of CD4+ to CD8+ in BALF of sarcoidosis were well nagatively correlated with the decrease of the percentage of DLCO (r=-0.67,P<0.01 and r=-0.55,P<0.55, respectively); in our study we also found that the decrease of mid-expiratory flow at 50% of vital capacity (MEF50) was well correlated with the increase of the Percentage of lymphocytes in BALF of Sarcoidosis (r=-0.54,P<0.05). Conclusion Pulmonary diffusing capacity (DLCO) was significendy correlated with BALF lymphocyte Phenotype, so was small airway function, and the findings was helpful in giving experimental evidence for the early diagnosis, dynamic Observation and judegement of cative effets of sarcoidosis.