摘要目的 探讨结节病患者BALF中性粒细胞增多的临床意义.方法 回顾性分析2000年1月至2014年10月北京大学第三医院收治的具有BALF细胞学分析结果并经病理确诊且未经治疗的72例结节病患者临床资料,其中男18例,女54例,年龄26~75岁,平均(50±10)岁,病程0.5个月至12年,中位数3个月,根据BALF中性粒细胞数量将患者分为中性粒细胞增多组(>3%)与非增多组(≤3%).分别比较2组患者临床表现、胸部影像学、肺功能、支气管镜下黏膜病变及BALF细胞分类等方面的差异.随访67例患者,随访时间为6~240个月,中位时间36个月,记录并比较2组治疗后胸部影像学变化及疾病复发情况.结果 72例患者中性粒细胞增多16例,其中Ⅰ/Ⅱ/Ⅲ期分别为4/10/2例;非增多56例,其中Ⅰ/Ⅱ/Ⅲ期分别为9/45/2例.与非中性粒细胞增多组患者比较,增多组肺部网格状影较多见(6/16,8/56),弥散功能障碍更常见(7/13,11/46),DLCO占预计值%下降更显著[(70±19)%,(89±23)%],BALF中CD8+淋巴细胞比例较高[(19±4)%,(11±4)%](P<0.05).中性粒细胞增多组与非增多组分别有16例(Ⅰ/Ⅱ/Ⅲ期为4/10/2例)和51例(Ⅰ/Ⅱ/Ⅲ期为9/41/1例)患者完成随访.与非增多组比较,增多组患者病情在糖皮质激素治疗后更倾向于发生恶化,且疾病更易复发.结论 结节病BALF中性粒细胞增多患者肺纤维化病变相对加重,弥散功能障碍更突出;糖皮质激素疗效欠佳,且疾病复发率增加,应更加严密监测此类患者病情变化.

abstractsObjective To investigate the clinical implications of increased neutrophils in bronchoalveolar lavage fluid ( BALF) in sarcoidosis.Methods A retrospective analysis was performed for 72 cases of histologically diagnosed , treatment-n?ive sarcoidosis admitted to Peking University Third Hospital from January 2000 to October 2014.The patients included 18 men and 54 women, 26 to 75 years of age [(50 ±10) years], with the disease course 0.5 month to 12 years (median disease course, 3 months). Results of cell count and differentials of BALF were analyzed and the patients were grouped based on the percentage of neutrophils:those with increased neutrophils ( >3%) and those without (≤3%) .Clinical manifestations , pulmonary function tests , radiological features , bronchoscopic findings , and other laboratory data were compared between the 2 groups.Finally 67 patients were followed for 6 to 240 months ( median 36 months).The subsequent changes of radiological manifestations and relapses after therapy were recorded and compared.Results There were 72 patients in the study , including 16 with increased BALF neutrophils ( stage Ⅰ/Ⅱ/Ⅲ, 4/10/2 ) and 56 without ( stage Ⅰ/Ⅱ/Ⅲ, 9/45/2 ) .Compared with patients without increased neutrophils, those with increased neutrophils had more reticular changes in the lungs (6/16, 8/56), more common diffusion dysfunction (7/13,11/46) with lower DLCO% [(70 ±19)% vs (89 ± 23)%], higher percentage of CD8+lymphocytes [(19 ±4)%vs (11 ±4)%, P<0.05] in BALF.Sixteen ( stage Ⅰ/Ⅱ/Ⅲ, 4/10/2 ) and 51 ( stage Ⅰ/Ⅱ/Ⅲ, 9/41/1 ) patients with and without increased neutrophils were followed respectively .Compared with patients without increased neutrophils , those with increased neutrophils tended to deteriorate and relapse despite corticosteroid therapy . Conclusions Sarcoidosis patients with BALF neutrophilia had more severe pulmonary fibrosis and diffusion dysfunction ,poorer response to corticosteroid therapy and higher relapse rate .These patients, therefore, should be monitored more closely during therapy or follow-up.