结节病症状与支气管肺泡灌洗液相关性分析

摘要

Objective: To explore the relationship between clinical symptoms and immunoreactions in sarcoidosis patients. Methods:44 patients with obvious symptoms and 30 patients without symptoms at time of diagnosis were examined by bronchoscope and the BALF lymphocyte proportion, Tcell CD47 CD8+ ratio were measured respectively. Moreover, the data before and after empirical corticosteroid treatment of 17patients from symptomatic group were analyzed. Results: (1 )The average lymphocyte proportion and T cell CD47CD8+ ratio in the BALF of symptomatic group were higher than those of asymptomatic group significantly (P<0.05, P<0.05). ( 2 )The lymphocyte proportion and T cell CD47 CD8+ ratio in the BALF of symptomatic group decreased significantly after empirical corticosteroid treatment. Conclusion: (1 )A series of cellular immune dysfunction represented by increased CD4+ T cell proportion is mainly exhibited among sarcoidosis patients. The more active of immunoreactions, the more obvious symptoms are exhibited. Corticosteroid can modify this immune dysfunction in sarcoidosis. Measurement of BALF lymphocyte phenotype is helpful to judge the immune activity in sarcoidosis patients.%目的:通过对有或无临床症状的胸部结节病患者支气管肺泡灌洗液(BALF)中淋巴细胞袁型的分析,探讨结节病患者临床症状与肺部免疫反应之间的关系.方法:有明显症状就诊的结节病患者44例,无症状体检发现的结节病患者30例,分别行纤维支气管镜检查并肺泡灌洗测定BALF中淋巴细胞比例、T淋巴细胞CD4+/CD8+比值.另对有临床症状者17例进行激素治疗前后BALF中淋巴细胞比例、CD4+/CD8+比值的比较.结果:(1)结节病有临床症状的患者BALF中淋巴细胞比例、CD4+/CD8+比值显著高于无症状组(P＜0.05,P＜0.05).(2)有症状的结节病经激素治疗后BALF中淋巴细胞比例、CD4+/ CD8+比值较治疗前明显下降.结论:(1)结节病患者存在CD4+T细胞升高为主的细胞免疫异常,免疫活性高者多伴有明显临床症状,激素可调节结节病的免疫异常,BALF细胞学检测有助于判断结节病的免疫活动性.