Subclinical pulmonary involvement in collagen-vascular diseases assessed by bronchoalveolar lavage. Relationship between alveolitis and subsequent changes in lung function.
Subclinical pulmonary involvement in collagen-vascular diseases assessed by bronchoalveolar lavage. Relationship between alveolitis and subsequent changes in lung function.
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通过支气管肺泡灌洗评估胶原血管疾病的亚临床肺部受累。
DOI：
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发表时间：
1986
期刊：
影响因子：
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通讯作者：
C. Voisin
中科院分区：
文献类型：
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作者：
B. Wallaert;P. Hatron;J. Grosbois;A. Tonnel;B. Devulder;C. Voisin
胶原-血管疾病（CVD）通常与慢性间质性肺疾病相关。临床病理观察提示，下呼吸道的炎症过程可能出现在纤维化之前。通过支气管肺泡灌洗（BAL）对61例无临床肺部症状且胸部x线检查正常的各种CVD患者进行了亚临床肺受累评估。61人中有8人在研究开始时肺功能检查（PFT）异常。PFT异常的非吸烟者的BAL细胞总产量高于PFT正常的患者（p < 0.05）。61例患者中有29例（48%）出现BAL细胞差异计数异常。淋巴细胞肺泡炎（淋巴细胞大于或等于18%）是原发性Sjögren综合征（25例中有11例）或Sjögren综合征合并其他心血管疾病（8例中有4例）患者的特征性发现。中性粒细胞肺泡炎（中性粒细胞大于4%）伴或不伴淋巴细胞百分比升高发生在伴有肺纤维化的典型CVD患者中：进行性系统性硬化症（6 / 10）、类风湿关节炎（1 / 4）、皮肤多发性肌炎（2 / 3）和混合性结缔组织病（3 / 8）。在1例进行性系统性硬化症患者中检测到嗜酸性粒细胞百分比增加。支气管肺泡灌洗异常常见于活动性和重度肺外疾病患者。在12个月后的PFT随访中，11例BAL正常，10例淋巴细胞肺泡炎没有恶化。与此形成鲜明对比的是，在7名未接受治疗的患者中，有6名BAL中存在中性粒细胞与PFT的进行性恶化有关，而4名接受皮质类固醇治疗的中性粒细胞肺泡炎患者没有恶化。（摘要删节250字）
Collagen-vascular disorders (CVD) are commonly associated with chronic interstitial lung disease. Clinicopathologic observations suggest that inflammatory process of the lower respiratory tract may appear prior to fibrosis. Subclinical pulmonary involvement, as assessed by bronchoalveolar lavage (BAL) was evaluated in 61 patients with various CVD but free of clinical pulmonary symptoms and with normal chest roentgenograms. Eight of 61 had abnormal pulmonary function tests (PFT) at entry to the study. Total BAL cell yield from nonsmokers was greater in patients with abnormal than in those with normal PFT (p less than 0.05). Abnormal differential count of BAL cells was noted in 29 of 61 patients (48%). Lymphocyte alveolitis (lymphocytes greater than or equal to 18%) was a characteristic finding in patients with primary Sjögren's syndrome (11 of 25) or Sjögren's syndrome associated with another CVD (4 of 8). Neutrophil alveolitis (neutrophils greater than 4%) with or without increased percentage of lymphocytes occurred in patients with CVD classically associated with pulmonary fibrosis: progressive systemic sclerosis (6 of 10), rheumatoid arthritis (1 of 4), dermatopolymyositis (2 of 3), and mixed connective tissue disease (3 of 8). An increased percentage of eosinophils was detected in 1 patient with progressive systemic sclerosis. Bronchoalveolar lavage abnormalities were more frequently detected in patients with active and severe extrapulmonary disease. On follow-up PFT 12 months later, 11 patients with normal BAL and 10 patients with lymphocyte alveolitis had not deteriorated. In marked contrast, the presence of neutrophils in BAL was associated with a progressive deterioration of PFT in 6 of 7 untreated patients, whereas 4 corticosteroid-treated patients with neutrophil alveolitis had not deteriorated.(ABSTRACT TRUNCATED AT 250 WORDS)