Am. J. Respir. Crit. Care Med., Vol 154, No. 3, Sep 1996, 707-712.
Prognostic value of Ia+ T lymphocytes in bronchoalveolar lavage fluid in pulmonary sarcoidosis
K Suzuki, N Tamura, A Iwase, T Dambara and S Kira
Department of Respiratory Medicine, Juntendo University School of Medicine, Tokyo, Japan.
We investigated the value of the la+ T-lymphocyte (CD3+ HLA-DR+) ratio in
bronchoalveolar lavage fluid (BALF) for predicting the outcome of pulmonary
sarcoidosis. Analysis of the BALF la+ T% in 166 patients with pulmonary
sarcoidosis by dual-color flow cytometry revealed a wide range of values,
of from 0.5 to 85.3%. Although the majority of patients had less than 40%
la+ T cells in their BALF, a minor peak was observed at 50 to 60%. The BALF
la+ T% value was not influenced by smoking, sex, or age, thus differing
from other BALF activation markers. Fifty patients could be followed up
precisely for 3 yr after their initial bronchoalveolar lavage (BAL) to
evaluate outcome with respect to chest X-ray findings, clinical symptoms,
serum angiotensin converting enzyme (ACE) activity, and extrapulmonary
involvement. The 50 patients were divided into two groups, with a BALF la+
T% < 40% (n = 34) and > or = 40% (n = 16), respectively. Serum ACE
activity returned to normal within 1 yr in the < 40% group, but remained
high for the entire follow-up period in the > or = 40% group. The
significant difference was observed in the persistence of pulmonary
involvement between the two groups except for four patients who showed
Stage 0 disease (p < 0.02). Thirteen of 31 patients in the < 40%
group showed normalization of chest X-ray findings after three years,
whereas only one out of 15 patients in the > or = 40% group showed
resolution of pulmonary involvement. Our results suggest that the BALF la+
T% may be a novel marker for predicting the long-term prognosis in
pulmonary sarcoidosis.
