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Vol. 45. Issue 3.
Pages 115-121 (March 2009)
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Vol. 45. Issue 3.
Pages 115-121 (March 2009)
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Bronchoalveolar Lavage Findings in Patients With Diffuse Interstitial Lung Disease: Prospective Study of a Cohort of 562 Patients
Hallazgos en el lavado broncoalveolar de pacientes con enfermedad pulmonar intersticial difusa. Estudio de una cohorte prospectiva de 562 pacientes
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Luis Jara-Palomaresa,
Corresponding author
luisoneumo@hotmail.com

Corresponding author.
, José Martín-Juanb, Lourdes Gómez-Izquierdoc, Aurelio Cayuela-Domínguezd, Eulogio Rodríguez-Becerrab, Francisco Rodríguez-Panaderob
a Neumología, Hospital Sierra Norte, Constantina, Sevilla, Spain
b Unidad Médico-Quirúrgica de Enfermedades Respiratorias (UMQER), Hospital Universitario Virgen del Rocío, Sevilla, Spain
c Servicio de Anatomía Patológica, Hospital Universitario Virgen del Rocío, Sevilla, Spain
d Unidad de Apoyo a la Investigación, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Abstract
Objective

Study of the bronchoalveolar lavage (BAL) fluid in some interstitial lung diseases can reveal patterns typical to each disease and that can support the diagnosis. The objective of this study was to perform a descriptive analysis of the cytologic study and of the lymphocyte subpopulations in BAL fluid from patients with interstitial lung disease.

Material and methods

In this prospective, observational study of 562 patients between January 1991 and January 2005, BAL fluid was analyzed to determine the distribution of cell populations and of lymphocyte subsets: CD3, CD4, CD8, CD3+CD4CD8, and CD56.

Results

The mean age was 53.4 years and 53.3% of the patients were women. The following diseases were studied: idiopathic pulmonary fibrosis (n=132), sarcoidosis (n=123), connective tissue diseases (n=133), cryptogenic organizing pneumonia (n=89), and extrinsic allergic alveolitis (n=85). Isolated lymphocytic alveolitis was common in sarcoidosis and extrinsic allergic alveolitis. Mixed alveolitis was the most common pattern in the other interstitial lung diseases. The CD4:CD8 ratio was the most useful parameter. It was high in sarcoidosis (median, 2.3); the ratio was low or inverted in the other interstitial lung diseases, with median values of 1.76 in idiopathic pulmonary fibrosis, 0.45 in extrinsic allergic alveolitis, 0.35 in cryptogenic organizing pneumonia, and 0.33 in the connective tissue diseases.

Conclusions

BAL parameters, in association with clinical and radiologic data, help to discriminate between interstitial lung diseases. BAL should therefore be considered a very useful tool in clinical management, particularly when pulmonary biopsy is not conclusive or is not possible.

Keywords:
Interstitial lung disease
Sarcoidosis
Bronchoalveolar lavage
Resumen
Objetivo

En determinadas enfermedades pulmonares intersticiales difusas (EPID), el estudio del lavado broncoalveolar (LBA) define patrones típicos de cada enfermedad y tiene valor como apoyo al diagnóstico. El objetivo del estudio ha sido realizar un análisis descriptivo del estudio citológico y de las subpoblaciones linfocitarias en el LBA efectuado a pacientes con EPID.

Pacientes y métodos

Estudio prospectivo de 562 pacientes con EPID desde 1991 hasta 2005. Se realizó un estudio de la distribución celular y de la subpoblaciones linfocitarias en el LBA: CD3, CD4, CD8, CD3+CD4 CD8 y CD56.

Resultados

La edad media de los pacientes era de 53,4 años y el 53,3% eran mujeres. Se estudiaron las siguientes enfermedades: fibrosis pulmonar idiopática (n=132), sarcoidosis (n=123), enfermedades del colágeno (n=133), neumonía organizada criptogenética (n=89) y alveolitis alérgica extrínseca (n=85). Tanto en los casos de sarcoidosis como en los de alveolitis alérgica extrínseca fue frecuente la alveolitis linfocitaria aislada. En el resto de enfermedades la alveolitis mixta fue el patrón habitual. El índice CD4/CD8 fue el parámetro más útil, con un incremento en la sarcoidosis (mediana: 2,3). En el resto de las enfermedades el índice estaba invertido, con una mediana para la fibrosis pulmonar idiopática, la alveolitis alérgica extrínseca, la neumonía organizada criptogenética y la enfermedad del colágeno de 1,76; 0,45; 0,35, y 0,33, respectivamente.

Conclusiones

Los parámetros del LBA, junto a los datos clinicorradiológicos, ayudan a discriminar entre las EPID. Por lo tanto, debe considerarse una técnica de gran utilidad en el manejo clínico, sobre todo cuando la biopsia pulmonar no resulta diagnóstica o no es posible realizarla.

Palabras clave:
Enfermedad pulmonar intersticial difusa
Sarcoidosis
Lavado broncoalveolar
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