结节病胸部X线和CT所见与支气管肺泡灌洗液细胞…

鉴于结节病胸部表现的多样性和多变性，对２５例结节病的胸部Ｘ线和ＣＴ所见与支气管肺泡灌洗液（ＢＡＬＦ）细胞学变化的相关性进行了研究。结果表明：ＣＴ对胸片０￣Ｉ期患者能发现纵隔区更多组肿大淋巴结和多处肺实质病变；肺内病变多沿支气管肺纹理分布；ＣＴ肺扫描所见与ＢＡＬＦ细胞总数呈直线相关，ＣＴ表现有纤维化病变者多伴有ＢＡＬＦ中性粒细胞增多。提示ＣＴ对于结节病患者作为重要的补充检查手段，能对纵隔和肺部病变作     

结节病患者肺功能与支气管肺泡灌洗液细胞学关系的研究

目的 探讨结节病患者不同影像分期之间肺功能指标、支气管肺泡灌洗液细胞学的改变以及两者的相关性.方法 回顾性调查71例结节病患者肺功能以及支气管肺泡灌洗液检查的资料.结果 在结节病患者不同影像分期之间肺功能指标用力肺活量(FVC)占预计值%、第1秒用力呼气容积(FEV1)占预计值%、肺总量(TLC)占预计值%以及肺一氧化...     

肺结节病患者支气管肺泡灌洗液中细胞因子水平的变化

为探讨细胞因子在肺结节病发病机制中的作用，本研究检测了肺结节病患者支气管肺泡灌洗液(BALF)中白细胞介素(IL)-13和肿瘤坏死因子(TNFα)水平，现报告如下。     

哮喘支气管肺泡灌洗液的研究

本文综述近年对哮喘病人支气管肺泡灌洗液的研究情况;包括细胞学和炎性介质成份和量的变化及其临床意义。     

支气管肺泡灌洗及灌洗液的细胞计数分类技术规范

支气管肺泡灌洗及灌洗液的细胞计数分类技术规范支气管肺泡灌洗（ＢＡＬ）检查是一项比较新的肺部疾病检查方法，主要应用于以下几方面：①肺部感染，特别是免疫受损、免疫缺陷肺部感染的病原学诊断；②肺癌和其他恶性肿瘤，特别是周围型肺癌肿瘤细胞诊断；③肺间质性疾病...     

支气管肺泡灌洗液细胞学检测技术规范(草案)

支气管肺泡灌洗 (ＢＡＬ)能直接获取肺内炎症免疫效应细胞 ,是探讨肺局部免疫病理过程的一种比较安全和有用的检查方法。对某些肺疾病 ,特别是弥漫性间质性肺疾病 (如特发性肺纤维化、结节病、外源性过敏性肺泡炎、肺泡蛋白沉积症、风湿性疾病伴肺纤维化和Ｌａｎｇｅｒｈａｎｓ组织细胞增生症等 )、肺部肿瘤以及免疫受损患者的肺部感染等 ,ＢＡＬ已成为辅助临床诊断和预后判断的重要检测手段。近 2 0年间支气管肺泡灌洗液 (ＢＡＬＦ)检测无论从检测范围和检测项目上都有了长足的进展。由于ＢＡＬＦ检测受诸多因素的影响 ,如ＢＡＬ操作时混血…     

肺结节病患者支气管肺泡灌洗液中白细胞介素-2及其可溶性受体的表达

肺结节病下呼吸道的表现为淋巴细胞性肺泡炎 ,支气管肺泡灌洗液 (ＢＡＬＦ)中ＣＤ4 /ＣＤ8 比值增高 ;ＣＤ4 细胞不仅数量增加而且功能活跃 ;肺组织中Ⅰ型Ｔ辅助细胞 (Ｔｈ1)占优势[1] 。但对血清和ＢＡＬＦ中白细胞介素 (ＩＬ) 2的研究结果不尽相同[2 ,3] ,更缺乏对可溶性ＩＬ 2受体 (ｓＩＬ 2Ｒ)的同步研究。本研究同步测定了肺结节病患者ＢＡＬＦ中ＩＬ 2和ｓＩＬ 2Ｒ水平 ,探讨其在发病机制中的作用。一、对象与方法1.对象 :结节病组 :11例 ,男 4例 ,女 7例 ,年龄 2 3～ 49岁 ,诊断符合 1993年中华医学会呼吸病学分会第三次修订的结…     

肺结节病支气管肺泡灌洗液中肿瘤坏死因子和中性粒细胞趋化因子水平及临床意义

目的评价肺内炎症免疫效应细胞释放的细胞因子对肺结节病发病机理的影响。方法利用微孔滤膜和酶联免疫法,检测１１例肺结节病和７例特发性肺纤维化（ＩＰＦ）患者血清和支气管肺泡灌洗液（ＢＡＬＦ）中肿瘤坏死因子（ＴＮＦα）和中性粒细胞趋化因子（ＮＣＦ）水平,并与８名健康非吸烟者对照。结果肺结节病和ＩＰＦ患者ＢＡＬＦ中的ＴＮＦα为１１．９±３．２、１１．７±３．０ｎｇ·Ｌ１,ＮＣＦ水平以每１０个高倍视野细胞数表示,为１９１±５１、２０３±４４,明显高于正常对照组的６．５±１．４ｎｇ·Ｌ１和８２．５±４５．４（Ｐ＜０．０１）。肺结节病患者ＢＡＬＦ中ＴＮＦα与淋巴细胞、ＩＰＦ患者ＮＣＦ与中性粒细胞呈明显正相关（ｒ＝０．７３和ｒ＝０．８９Ｐ＜０．０１）。结论ＴＮＦα和ＮＣＦ在肺结节病和ＩＰＦ发病机理中起着重要作用,并可作为判定疾病活动性的一项重要参考指标。     

支气管肺泡灌洗在肺部疾病诊治中的应用

支气管肺泡灌洗是一种操作简便、安全的技术.随着医学科学的发展,其操作技术越来越规范,在临床中的应用越来越广泛,在肺部疾病的诊断和治疗中发挥了重要作用.     

Spontaneous interleukin 2 release of bronchoalveolar lavage cells in sarcoidosis is a codeterminator of prognosis

There is mounting evidence that activated interleukin 2 (IL-2)-releasing lymphocytes play a central role in the immunopathogenesis of sarcoidosis by directing inflammatory reactions and granuloma formation. In the context that a significant proportion of these cells accumulates in the lung and releases mediators, we hypothesized that different immunologically defined stages of sarcoidosis can be identified. A cohort of 89 sarcoidosis patients was allocated to four groups according to the following criteria: stage A, a low number of bronchoalveolar lavage (BAL) lymphocytes (<20%) without IL-2 release (<1 unit/ml in BAL cell culture supernatant); stage B, BAL lymphocytes <20%, with IL-2 release (1 unit/ml); stage C, BAL lymphocytes 20% with IL-2 release; and stage D, 20% BAL lymphocytes without IL-2 release. Although patients of stages C and D (n = 49) exhibited lymphocytic inflammation, only 20/49 of these patients had activated IL-2-releasing alveolar lymphocytes. BAL of groups A and B showed a low number of lymphocytes, but the lymphocytes were activated in 20/40 patients. Forty-four patients not receiving therapy were reevaluated by pulmonary function tests 8 ± 1 months after BAL. Progressive disease was found in 9/12 patients of group C and stable or regressing disease in 13/13 patients of group A. These results demonstrate that a combination of BAL parameters can yield prognostic information. Offprint requests to: Joachim Müller-Quernheim     

Relationship between the ratios of CD4/CD8 T-lymphocytes in the bronchoalveolar lavage fluid and lymph nodes in patients with sarcoidosis

BackgroundEvaluating the ratio of CD4/CD8 T-lymphocytes in the bronchoalveolar lavage fluid (BALF) is important for understanding the clinical and pathological conditions of patients with sarcoidosis. However, few studies have thus far demonstrated the usefulness of evaluating the relationship between the ratios of CD4/CD8 T-lymphocytes in the mediastinal lymph nodes and BALF. This study aimed to investigate and identify the relationships between CD4/CD8 T-lymphocyte ratio in the mediastinal lymph nodes and BALF in patients with sarcoidosis.MethodsThirty-three consecutive patients with sarcoidosis with enlarged mediastinal and/or hilar lymphadenopathy were enrolled in the study, and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and bronchoalveolar lavage (BAL) were simultaneously performed. The CD4/CD8 T-lymphocyte ratios in the mediastinal lymph nodes and BALF were evaluated using immunohistochemistry and flow cytometry, respectively.ResultsThe interobserver variability in the CD4/CD8 ratio in the mediastinal lymph nodes as determined by immunostaining was low, and the pathological and cytological profiles of T-lymphocytes in the mediastinal and/or hilar lymph nodes and BALF were correlated in patients with sarcoidosis. Additionally, the CD4/CD8 T-lymphocyte ratios in BALF were significantly higher than those in the mediastinal lymph nodes. Importantly, non-caseating granulomas were detected at a high rate by using EBUS-TBNA.ConclusionsPerforming EBUS-TBNA in patients with sarcoidosis allows correct diagnosis as well as the estimation of the ratio of CD4/CD8 T-lymphocytes in BALF.     

结节病胸部影像学特征及其治疗后的变化

目的 探讨结节病胸部CT特征及其治疗后的变化.方法 回顾分析上海市肺科医院2000年1月至2006年3月收治的、经病理证实的90例结节病患者的临床资料及胸部CT表现.90例中男32例,女58例,年龄31～71岁,其中43例复查CT 2～8次,间隔时间最短5 d,最长1个月.随访时间最短3个月,最长4年.结果 CT影像表现为结节69例(77%),主要沿支气管血管束分布37例(41%),团块31例(34%),磨玻璃影39例(43%),支气管血管束增粗30例(33%),小叶间隔线58例(64%),纤维化17例(19%,包括支气管变形8例,条索影5例,蜂窝影4例),空气潴留3例(3%),支气管狭窄8例(9%),胸膜改变42例(47%),肺门纵隔淋巴结增大76例(84%),肺部病变并存83例(92%).结节、团块、磨玻璃影、支气管血管束增粗的患者治疗后随访复查5 d至4年,好转例数分别为25例(25/30)、9例(9/15)、11例(11/16)及10例(10/12);小叶间隔线、支气管变形、条索影、蜂窝影吸收好转例数分别为10例(10/22)、0例(0/4)、1例(1/3)及0例(0/2).结论 结节病胸部CT表现形式多样,具有一定特征,治疗中CT追踪检查可提高确诊率,且有利于观察治疗效果;结节、团块、磨玻璃影、支气管血管束增粗的患者治疗后吸收明显,表现为线状影、支气管变形、弥漫条索影、蜂窝影的患者治疗后吸收不佳.     

The immunocytochemical detection of angiotensin-converting enzyme in alveolar macrophages from patients with sarcoidosis

Angiotensin-converting enzyme (ACE) was detected in alveolar macrophages obtained by bronchoalveolar lavage (BAL), but not in lymphocytes and other cells, by immunofluorescence using anti-human ACE antibody. The enzyme was localized on the surface of plasma membrane and cytoplasmic processes of alveolar macrophages, as demonstrated by immunoelectron microscopy. The immunocytochemical staining for ACE in alveolar macrophages from patients with sarcoidosis was intense, which was consistent with the result that ACE activity in BAL cells from patients with sarcoidosis was significantly higher than in cells from normal subjects and from patients with nonsarcoid lung diseases. Part of this work was presented at the 8th Asia-Pacific Congress on Diseases of the Chest, Tokyo, July 11–15, 1983     

卡氏肺孢子虫肺炎肺灌洗液细胞和生化成分变化的研究

目的 研究卡氏肺孢子虫肺炎（ＰＣＲ）支气管肺泡灌洗液（ＢＡＬＦ）中细胞和生化成分的变化及与细菌性肺炎的差别。方法 采用清洁级Ｓｐｒａｇｕｅ－Ｄａｗｌｅｙ大鼠５０只,每周２次皮下注射泼尼松建立ＰＣＰ模型（１４只）,阴性对照组（６只）,细菌性肺炎组（１１只）为实验组,并设正常对照组（６只）。     

In vitro synthesis of angiotensin-converting enzyme by alveolar macrophages is increased in disseminated sarcoidosis

To determine the responsibility of alveolar macrophage (AM) for the increased concentration of angiotensin-converting enzyme (ACE) in bronchoalveolar fluid of patients with sarcoidosis, we cultured AM recovered by bronchoalveolar lavage of 30 subjects: 9 were normal control subjects (group C), 10 had intrathoracic localized sarcoidosis (group LS), and 11 had disseminated intrathoracic and extrathoracic sarcoidosis (group DS). Cells were cultured for 7 days and synthesis of ACE was evaluated according to the difference between final (ACEqe) and initial (ACEqi) ACE content. In groups C, LS, and DS, ACEqi were, respectively, 3.0 ± 1.7, 3.3 ± 1.9, and 4.8 ± 2.4 U/10⁶ AM, and ACEqe were 6.2 ± 1.7, 6.7 ± 2.5, and 11.3 ± 2.8 U/10⁶ AM. ACEqe was higher than ACEqi in all 3 groups (p < 0.01). When cycloheximide was added to the AM culture, ACEqe did not differ from ACEqi, in opposition to what was observed without cycloheximide (p < 0.002). ACEqi in group LS and DS did not differ from ACEqi in Group C, but ACEqe in Group DS was higher than in Groups C and LS (p < 0.01). We conclude that AM both from normal subjects and from subjects with sarcoidosis contain ACE, cultured AM synthesize ACE, and that a greater amount of ACE is produced when AM are obtained from patients with disseminated sarcoidosis.     

间质性肺疾病患者血清和支气管肺泡灌洗液中内皮素1活性的变化

目的评价内皮素对肺纤维化发生、发展作用的影响。方法利用同位素放射免疫直接测定法,检测１０例肺结节病和８例特发性肺纤维化（ＩＰＦ）患者外周血和支气管肺泡灌洗液（ＢＡＬＦ）中内皮素１（ＥＴ１）的活性,并与８名健康非吸烟者进行对照。结果肺结节病和ＩＰＦ患者血清和ＢＡＬＦ中的ＥＴ１活性分别为（６２±２９）ｎｇ／Ｌ,（１７０±２４）ｎｇ／Ｌ和（７７±７１）ｎｇ／Ｌ、（１０±３）ｎｇ／Ｌ,与正常对照组（２０±８）ｎｇ／Ｌ、（４０±０６）ｎｇ／Ｌ比较,差异有显著性（Ｐ＜００１）;血清中ＥＴ１活性与动脉血氧分压（ＰａＯ２）呈明显负相关（ｒ＝－０５３８,Ｐ＜００１）;结节病组和ＩＰＦ组ＢＡＬＦ中的ＥＴ１水平与ＢＡＬＦ中细胞总数呈正相关（ｒ＝０６４９,Ｐ＜００１）,肺结节病患者、ＩＰＦ患者ＢＡＬＦ中ＥＴ１与淋巴细胞、中性粒细胞呈正相关（ｒ＝０７１２,０８１３,Ｐ均＜００１）。结论ＥＴ１在肺结节病和ＩＰＦ发病机制中起着重要作用,并可作为疾病活动性判定的一项重要参考指标。     

肺癌支气管肺泡灌洗液细胞端粒酶测定的临床意义

目的探讨端粒酶活性在肺癌支气管肺泡灌洗液（ＢＡＬＦ）细胞中的表达与肺癌发生机制的关系。方法应用银染多聚酶链方法对肺癌患者和支气管、肺良性疾病患者各３０例的ＢＡＬＦ细胞端粒酶活性的表达进行检测。结果肺癌患者ＢＡＬＦ细胞端粒酶活性８３％阳性表达，支气管、肺良性疾病ＢＡＬＦ细胞表达均阴性（Ｐ＜０．００１）。同一肺癌患者患侧肺端粒酶活性在ＢＡＬＦ细胞８３％表达，健侧肺阳性表达２７％。结论端粒酶活性是肺癌诊断的标志物之一，与肺癌的发生发展密切相关。     

单项和联合指标在结节病诊断中的预测价值评价

目的 评价结节病诊断中各单项和联合诊断指标的预测价值.方法 回顾性分析北京协和医院2001年1月至2007年9月间88例初步诊断为结节病的患者的临床资料,应用受试者工作特征曲线(ROC曲线)和Bayes方法 对BALF细胞分类中的淋巴细胞比例、淋巴细胞亚群CD4/CD8、血清血管紧张素转换酶(ACE)等3项指标及其联合指标的诊断预测价值进行评价.采用ROC曲线评价各指标的诊断价值并确定指标的界定值,采用判别分析和ROC曲线评价联合指标的诊断价值.结果 在88例初步诊断为结节病的患者中,经活检确诊结节病59例(67%),男性16例(27%),女性43例(73%),平均年龄(48±10)岁;排除结节病29例(33%),男性12例(41%),女性17例(59%),平均年龄(49±13)岁.单项指标淋巴细胞比例、CD4/CD8值和ACE的ROC曲线下面积分别为0.64、0.74和0.69,CD4/CD8值在3项指标中的诊断效率最高;通过ROC曲线的切点和坐标结合确定3项指标的最佳界定值是淋巴细胞比例≥30%,CD4/CD8值≥4.0,ACE≥40 U/L;其阳性预测值分别为76.7%、80.4%和76.8%,表明CD4/CD8值在3项指标中的预测价值最高.CD4/CD8值和ACE联合指标的曲线下面积为0.81,CD4/CD8值、ACE、淋巴细胞比例3项联合指标的曲线下面积为0.78,均大于单项指标的曲线下面积,前者的诊断效率优于后者.CD4/CD8值和ACE并联指标的阳性预测值为83.9%,串联指标的阳性预测值为90.5%,明显高于单项指标的相同评价指标,表明将CD4/CD8值和ACE联合起来诊断结节病的效率和预测价值均高于各单项指标.结论 BALF淋巴细胞亚群中CD4/CD8值仍然是辅助诊断结节病的有效单项指标,采用CD4/CD8值和ACE联合指标诊断结节病可提高诊断效率和预测价值.