支气管肺泡灌洗液中细胞及细胞因子对间质性肺病纤维化程度的诊断价值初探

The diagnostic value of cells and cytokines in bronchoalveolar lavage fluid to the degree of fibrosis in interstitial pulmonary disease

目的探讨支气管肺泡灌洗液(BALF)中细胞及细胞因子等实验室检查对间质性肺病(ILD)的诊断价值及其在评估疾病纤维化程度中的应用价值。方法回顾性分析。收集2021年1月1日至2023年12月31日在上海市第一人民医院治疗的ILD患者的临床资料[104例,男∶女=48∶56,(62.79±1.24)岁]。根据影像学评分将其分为轻度纤维化ILD组[53例,男∶女=26∶27,(61.32±1.71)岁]和中重度ILD纤维化组[51例,男∶女=22∶29,(64.31±1.88)岁]。选取同期HRCT提示无纤维化病变的社区获得性肺炎患者作为对照组[49例,男∶女=25∶24,(65.37±1.65)岁]。收集所有研究对象临床信息以及BALF淋巴细胞亚群分析、细胞因子及细胞学计数检测结果,采用Kruskal-WallisH检验筛选差异指标,采用受试者工作特征(ROC)曲线评价差异指标评估ILD肺纤维化程度的临床价值。结果与无纤维化肺炎组相比,IL-6、IL-8、CD4+CD45RO+细胞和巨噬细胞占比(M%)在轻度纤维化ILD组中分别为3.93(2.44,13.975),304.82(146.83,476.51),97.51(88.37,98.82)和35(19.5,63);在中重度纤维化ILD组中分别为14.65(4.72,52.21),393.60(177.08,1416.98),97.36(90.57,98.55)和44(14,72)。与无纤维化肺炎组相比,IL-1β和白细胞(WBC)计数仅在中重度纤维化ILD组中分别为:11.64(2.44,46.09)和190(72,490)。结论与无纤维化肺炎组相比,BALF来源的IL-1β、IL-6、IL-8、CD4+CD45RO+细胞、WBC计数和M%可作为评估纤维化程度的潜在生物标志物,联合IL-1β+IL-6+IL-8+CD4+CD45RO+细胞+巨噬细胞占比对中重度纤维化ILD具有较好的诊断效能。

ObjectiveTo explore the diagnostic value of laboratory examination in bronchoalveolar lavage fluid(BALF)for interstitial lung disease(ILD)and its application value in assessing the degree of fibrosis in the disease.MethodsRetrospective analysis.The clinical data of ILD patients treated in Shanghai First People′s Hospital from January 1,2021 to December 31,2023[104 cases,male︰female=48︰56,(62.79±1.24)years]were collected.According to the imaging scores,they were divided into a mild fibrosis ILD group[53 cases,male︰female=26︰27,(61.32±1.71)years]and a moderate to severe ILD fibrosis group[51 cases,male︰female=22︰29,(64.31±1.88)years].Patients with community-acquired pneumonia without fibrotic lesions by HRCTduring the same period were selected as the control group[49 cases,male︰female=25︰24,(65.37±1.65)years].The clinical information of all study subjects,as well as BALF lymphocyte subset analysis,cytokine and cytology count detection results were collected.Furthermore,the Kruskal-Wallis H test was used to screen the differential indexes,and the receiver operating characteristic(ROC)curve was used to evaluate the differential indexes to assess the degree of ILD pulmonary fibrosis.ResultsCompared with the non-fibrotic pneumonia group,IL-6,IL-8,CD4+CD45RO+cells and macrophages(M%)were significantly upregulated in the mild fibrosis ILD group(P<0.05),and significantly higher in the moderate to severe fibrosis ILD group(P<0.05).Compared with the non-fibrotic pneumonia group,IL-1βand white blood cell(WBC)count were significantly upregulated only in the moderate to severe fibrotic ILD group(P<0.05).The correction model was constructed by stepwise logistic regression analysis,and the differential indexes were combined,and the proportion of IL-1β+IL-6+IL-8+CD4+CD45RO+cells+macrophages was finally screened as the optimal combined diagnostic mode,with an area under the curve of 0.925,sensitivity of 92.3%,and specificity of 80.0%.ConclusionCompared with the non-fibrotic pneumonia group,BALF-derived IL-1β,IL-6,IL-8,CD4+CD45RO+cells,WBC count and M%can be used as potential biomarkers to assess the degree of fibrosis,and the combination of IL-1β+IL-6+IL-8+CD4+CD45RO+cells+macrophages has a better diagnostic efficacy for moderate to severe fibrotic ILD.