Bronchoalveolar lavage fluid and progression of scleroderma interstitial lung disease
Bronchoalveolar lavage fluid and progression of scleroderma interstitial lung disease
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DOI：
10.1111/j.1752-699x.2010.00228.x
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发表时间：
2012-01-01
影响因子：
1.7
通讯作者：
Ferraccioli, Gianfranco
中科院分区：
文献类型：
--
作者：
De Santis, Maria;Bosello, Silvia Laura;Ferraccioli, Gianfranco
简介：到目前为止，还没有临床或实验证据清楚地解释系统性硬化症 (SSc) 患者如何以及哪些会经历间质性肺疾病 (ILD) 的功能性和放射学进展。目的：本研究的目的是调查与临床、功能和放射学参数相比，任何支气管肺泡灌洗液 (BALF) 特征是否与 ILD 进展风险和 SSc 患者较差的生存率相关。方法：对 110 名 SSc 患者进行了肺部受累评估。对 SSc 患者连续进行肺功能测试（PFT）和高分辨率计算机断层扫描（HRCT）检查； 73 名 HRCT 上有 ILD 证据的患者接受了 BAL。 1 年随访后通过 PFT 和 HRCT 评估 ILD 的进展情况。评估了 36 个月的生存分析。结果：患有肺泡炎的 ILD 患者患限制性肺病和蜂窝状症状、蜂窝状症状恶化或出现蜂窝状症状的风险较高。 ILD 进展与 HRCT 上蜂窝状的证据、嗜酸性粒细胞的存在、CD4/CD8 比率倒置、BALF 中 CD19 百分比计数较高或 BALF 微生物培养阳性相关。 ILD 患者的总生存期较差。弥漫性疾病是总体死亡率的唯一独立危险因素，HRCT 上的蜂窝状程度是肺部疾病相关死亡率的唯一独立危险因素。结论：我们的研究表明，通过 HRCT 和 BAL 评估 ILD 以表征 SSc 肺部受累进展的危险因素非常重要。
Introduction: So far no clinical or experimental evidences clearly explain how and which systemic sclerosis (SSc) patients will experience a functional and radiological progression of interstitial lung disease (ILD).Objectives: The aim of the study was to investigate whether any bronchoalveolar lavage fluid (BALF) characteristic, compared with clinical, functional and radiological parameters, is associated with the risk of progression of ILD and worse survival in SSc patients.Methods: Lung involvement was evaluated in 110 consecutively examined SSc patients with pulmonary function tests (PFTs) and high-resolution computed tomography (HRCT); 73 patients with evidence of ILD on HRCT underwent BAL. The progression of ILD was evaluated with PFTs and HRCT after 1-year follow-up. A 36-month survival analysis was assessed.Results: ILD patients with alveolitis had a higher risk to have restrictive lung disease and honeycombing, to experience a worsening in honeycombing score or to develop honeycombing. ILD progression was associated with the evidence of honeycombing on HRCT, with the presence of eosinophils, with an inverted CD4/CD8 ratio and with a higher CD19 percentage count in the BALF or with a positive BALF microbiological culture. The patients with ILD had a worse overall survival. The diffuse disease was the only independent risk factor of overall mortality, and the extent of honeycombing on HRCT was the only independent risk factor of lung disease-related mortality.Conclusion: Our study suggests the importance of evaluating ILD with HRCT and BAL in order to characterize the risk factors of SSc lung involvement progression.