结节病患者肺功能检测和BALF淋巴细胞表型关系的研究

Pulmonary Diffusing Capacity and BALF Lymphocyte Phenotype in Sarcoidosis

目的 :通过测定结节病患者的肺通气功能、弥散功能、血气分析以及支气管肺泡灌洗液 (BALF)的细胞学 ,并就其之间的相关性进行分析 ,以探究肺功能测定指标与BALF检测之间的相关性。方法 :结节病患者及正常对照组各 18例 ,行肺通气功能和弥散功能及动脉血气分析检测 ,所有受试者均行支气管肺泡灌洗液 (BALF)细胞学检查。结果 :(1)与正常对照组相比 ,结节病组静息状态肺通气功能基本正常 (P >0 .0 5 ) ,单口呼吸法肺弥散功能(DLCO % )减低 (P <0 .0 5 ) ,并有小气道功能障碍 ,尤以FEF50 %减低明显 (P <0 .0 5 )。 (2 )结节病患者BALF中淋巴细胞 %明显增高 (P <0 .0 1) ,CD+4 /CD+8亦明显高于对照组 (P <0 .0 5 )。 (3)结节病患者DLCO %减低与BALF中淋巴细胞 %增加及CD+4 /CD+8比增加均呈负相关 (分别为 r=- 0 .6 7,P <0 .0 1和 r=- 0 .5 5 ,P <0 .0 5 ) ,且小气道功能中FEF50 %减低与BALF中淋巴细胞 %增加呈明显负相关 (r =- 0 .5 4,P <0 .0 5 )。结论 :肺弥散功能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 ,可作为早期结节病病情活动性判定的一项重要参考指标。

Objective:Our aim was to study whether the cellular bronchoalveolar lavage fluid (BALF) profile was associated with the parameters of pulmonary function tests. Methods:Lung function tests and BAL were carried out in 18 untreated, non smoking patients suffering from sarcoidosis and 18 normal subjects. Results:(1)Lung function tests were normal at rest in patients with sarcoidosis(P>0.05), the single breath carbon monoxide diffusing capacity decreased (P<0.05),and the small airway function decreased too (P<0.05).(2)The percentage of lymphocytes in BALF of sarcoidosis increased comparing with the normal subjects(P<0.01),and the ratio of CD + 4 to CD + 8 in BALF increased significantly in sarcoidosis(P <0.05), furthermore, the increase of both the percentage of lymphocytes and the ratio of CD + 4 to CD + 8 in BALF of sarcoidosis were well nagatively correlated with the decrease of the percentage of D LCO (r=-0.67, P< 0.01 and r=-0.55, P<0.05, respectively), the decrease of mid expiratory flow at 50% of vital capacity (FEF 50 %) 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(D LCO) was significently correlated with BALF lymphocyte phenotype,so was small airway function,and can act as the marker of activity of sarcoidosis.