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目的探讨支气管肺泡灌洗液(BALF)细胞分类及T细胞亚群测定对弥漫性实质性肺疾病(DPLD)的诊治价值。方法对25例DPLD患者(COP4例、IPF8例、CVD-ILD5例、EAA5例、ABPA3例)进行支气管肺泡灌洗(BAL),回收肺泡灌洗液(BALF)完善细胞分类、T细胞亚群检查。结果各组患者BALF细胞总数普遍增多,以炎性细胞为主。中性粒细胞:IPF组明显升高,与COP、EAA、ABPA比较均有统计学意义(P<0.05)。CVD-ILD组轻度升高,但与IPF比较差异无统计学意义(P>0.05),激素治疗效果差,预后差。淋巴细胞:EAA明显升高,与其他各组比较均差异有统计学意义(P<0.01),激素治疗效果好,预后佳。ABPA组嗜酸细胞明显升高,与其他各组比较差异有统计学意义(P<0.01),激素效果好。IPF及CVD-ILD有部分患者嗜酸细胞轻度升高,预后不良。COP患者CD4减少,CD8增多,EAA患者CD4在正常水平,CD8增多;COP患者CD4/CD8低于正常,EAA患者CD4/CD8升高。结论 BALF细胞学测定对DPLD的诊断及鉴别诊断有一定的临床意义,并可以协助评价预后。
Objective To investigate the diagnostic value of bronchoalveolar lavage fluid (BALF) cell sorting and T cell subsets in the diagnosis and treatment of diffuse substantial pulmonary disease (DPLD). Methods Bronchoalveolar lavage (BAL) was performed in 25 patients with DPLD (COP4, IPF8, CVD-ILD5, EAA5, ABPA3) and the BALF recovery was performed to classify the cells. T cell subsets . Results The total number of BALF cells in each group generally increased, mainly inflammatory cells. Neutrophils: IPF group was significantly higher, with COP, EAA, ABPA were statistically significant (P <0.05). CVD-ILD group was slightly elevated, but no significant difference compared with IPF (P> 0.05), hormone therapy is poor, the prognosis is poor. Lymphocytes: EAA increased significantly, compared with the other groups were significantly different (P <0.01), hormone therapy is good, the prognosis is good. ABPA group eosinophils increased significantly, compared with the other groups, the difference was statistically significant (P <0.01), good hormone effect. Some patients with IPF and CVD-ILD mild increase in eosinophils, the prognosis is poor. COPD patients with decreased CD4, CD8 increased, EAA patients with normal levels of CD4, CD8 increased; COPD patients with CD4 / CD8 lower than normal, EAA patients CD4 / CD8 increased. Conclusions BALF cytology has some clinical significance for the diagnosis and differential diagnosis of DPLD and can help to evaluate the prognosis.