支气管肺泡灌洗液中T淋巴细胞亚群测定和细胞分类在间质性肺病鉴别诊断中的意义

Determination of T lymphocyte subsets in bronchoalveolar lavage fluid and the significance of cell classification in the differential diagnosis of interstitial lung disease

目的观察支气管肺泡灌洗液(BALF)中细胞分类及淋巴细胞亚群在间质性肺疾病中的鉴别诊断意义。方法选取青海大学附属医院收治的间质性肺疾病患者22例,行支气管镜获取肺泡灌洗液,流式细胞仪测T淋巴细胞亚群,Neubauer计数盘进行细胞计数,涂片瑞氏-姬姆萨染色,显微镜下进行细胞分类。结果22例间质性肺病患者中肺泡型组13例,占59.10%,分布以肺泡型为主。肺泡型组,中性粒细胞明显增高(28.2±15.03)%,与结节型组比较,差异有统计学意义(P<0.05)。结节型组,淋巴细胞明显升高(39.33±19.73)%,与肺泡型组比较,差异有统计学意义(P<0.05)。囊状型组嗜酸性粒细胞比例升高(6.67±5.77)%,与其他组间比较,差异无统计学意义(P>0.05)。结节型组CD8^(+)增高(52.8±12.13)%,CD4^(+)/CD8^(+)比值(0.53±0.09)明显减低,与肺泡型组比较,差异有统计学意义(P<0.05)。结论支气管肺泡灌洗液中细胞分类及T淋巴细胞亚群测定,有助于间质性肺疾病的鉴别及治疗方案的选择。

Objective To observe the significance of cell classification and lymphocyte subgroup in bronchoalveolar lavage fluid(BALF)in the differential diagnosis of interstitial lung disease.Methods Twenty-two patients with interstitial lung disease admitted to the affiliated hospital of qinghai university were selected.Bronchoscopy was used to obtain alveolar lavage fluid,t-lymphocyte subgroup was measured by flow cytometry,cell count was performed by Neubauer plate,and the smears were stained with Wright Giemsa staining,and the cells were classified under the microscope.Results Among 22 patients with interstitial lung disease,13 cases(59.10%)were alveolar type.1.In the alveolar type group,the neutrophils increased significantly(28.2±15.03)%,compared with nodular group,the difference was statistically significant(P<0.05).In nodular type group,the number of lymphocytes was significantly increased(39.33±19.73)%,compared with the alveolar group,the difference was statistically significant(P<0.05).The percentage of eosinophils in the cystic group was increased(6.67±5.77)%,compared with other groups,the difference was not statistically significant(P>0.05).CD8^(+)was increased in nodular group(52.8±12.13)%,the ratio of CD4^(+)/CD8^(+)decreased significantly,compared with the alveolar group,the difference was statistically significant(P<0.05).Conclusion The classification of cells and the determination of T lymphocyte subsets in bronchoalveolar lavage fluid are helpful for the differentiation of interstitial lung disease and the choice of treatment.