G. GÖRAL, E. DALKILIÇ, Kunt E. UZASLAN, N. ÖZYARDIMCI, F. ŞENGÜL, M. KARADAĞ, K. DİLEK

Sistemik sklerozda akciğer tutulumunun bronkoalveoler lavaj lenfosit altgruplarının analizi ile değerlendirilmesi

Sistemik sklerozda (SS) akciğer tutulumu morbidite de artışın ve mortalitenin ana nedenlerinden biridir. Değişik olgu tiplerinde farklı akciğer tutulum bulguları saptanmış ve SS'de akciğer interstisyumunda süregiden patojenik aktivitede lenfositlerin rol oynadığı gösterilmiştir. Amaç: Bu araştırmada BAL sıvısının flow sitometrik analizi yapılarak SS'de akciğer tutulumunda lenfosit altgruplarının rolünün belirlenmesi amaçlandı. Metod: Araştırma popülasyonunu sigara içmeyen 15 SS'li hasta oluşturmaktaydı. Olgular klinik, radyolojik bulguları ve solunum fonksiyon testlerine göre akciğer tutulumu olanlar Grup I (n= 8) ve akciğer tutulumu olmayanlar Grup II (n= 7) olarak iki gruba ayrıldılar. BAL sıvısı hücre sayımı, hücre dağılımı ve flow-sitometri kullanılarak lenfositlerin fenotipik analizi yapıldı. Bulgular: 1) Oniki olguda (%80) alveolit saptandı; bu olguların 7'si Grup I'de, 5'i Grup II'de yer alan olgulardı. 2) Lenfositlerin oranı Grup I'de (%35.1 ± 8.8), Grup II'den (%26 ± 5) yüksekti. Fakat aradaki fark istatistik olarak anlamlı değildi. 3) Her iki grup arasında CD3, CD4, CD16, CD19, CD25, CD56 lenfosit altgruplarının yüzdesi arasında ve CD4/CD8 oranında anlamlı fark yoktu. 4) HLA-DR+ lenfositlerin oranı Grup I'de (%29.5 ± 6.5), Grup II'den (%14.1 ± 3.2) yüksekti (p> 0.05). 5) CD8+ T lenfositlerin oranı Grup I'de (%37.2 ± 12), Grup II'den (%11.6 ± 3.1) anlamlı derecede yüksekti (p< 0.05). Sonuç: BAL'da CD8+ lenfositlerin yüksek oranda bulunması nedeniyle akciğer tutulumu olan sistemik sklerozlu olgularda hücresel immünregulatuar fonksiyonlarda farklılaşma olduğu, SS'de akciğerde gelişen patolojide CD8+ lenfositlerin rol oynadığı düşünüldü. Sistemik sklerozda akciğer tutulumunun tanı ve izlenmesinde BAL sıvısı lenfosit altgrupları analizinden yararlanılabileceği kanısına varıldı.

The evaluation of lung involvememt in systemic sclerosis by analysis of bronchoalveolar lavage (BAL) lympocyte subtypes

Lung involvement accounts for significant morbidity and is a leading cause of mortality in patients with systemic sclerosis (Ssc). It has been shown that different patterns of pulmonary involvement are seen in different subtypes of patients and lymphocytes play a major role in the ongoing pathogenic activity in the lung interstitium. Aim: The purpose of this study was to determine the role of lymphocyte subtypes in the pathogenesis of lung involvement in Ssc by flowcytometric analysis of lymphocytes in BAL fluid. Methods: The study population was consisted of 15 nonsmoker patients with Ssc. According to clinical, radiologic and lung function test findings, patients were divided in two groups; Group I (n= 8) patients with lung involvement, Group II (n= 7) patients without lung involvement. BAL fluid cell counts and differentials were determined and phenotypic analysis of lymphocytes were done by using flowcytometry. Results: 1) Alveolitis was detected in 12 patients (80%) 7 patients in Group I and 5 patients in Group II. 2) The proportion of lymphocytes was higher in Group I (35.1 ± 8.8%) compared to Group II (26 ± 5%), but the difference was not statistically significant (p> 0.05). 3)The percentages of lymphocyte subtypes CD3, CD4, CD16, CD19, CD25, CD56 and CD4/CD8 ratio were not different in two groups. 4) The proportion of HLA-DR+ lymphocytes was higher in Group I (29.5 ± 6.5%) than in Group II (14.1 ± 3.2%) (p> 0.05). 5) The percentage of CD8+T lymphocytes was significantly higher in Group I (37.2 ± 12%) compared to Group II (11.6 ± 3.1%) (p< 0.05). Conclusion: The high percentages of CD8+ lymphocytes in BAL may suggest a derangement of cellular immunoregulatory function in patients with lung involvement of Ssc, and CD8+ lymphocytes may play a role in development of pulmonary impairment in the disease. We concluded that BAL fluid lymphocyte subtypes analysis might be useful for the diagnosis and management of lung involvement in patients with Ssc.

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