<原著>サルコイドージスにおける気管支鏡検査の意義 : 気管支・肺生検, 内視鏡所見, 気管支肺胞洗浄

Abstract

71patients with clinical features of sarcoidosis, 68 cases that had not received steroid therapy and 3cases that had, underwent transbronchial lung biopsy (TBLB) via the fiberoptic bronchoscope. Bronchoscopic findings appeared normal in 18 (29.5%) and abnormal in 43 (70.5%) of the 61cases without steroid therapy. Abnormal findings consisted of yellow nodules in 18cases (29.5%), hypervascularity in 22cases (36.1%), reddness and swelling in 20 cases (32.8%), and bronchial narrowing and compression in 24 cases (39.3%). The 4 patients with positive biopsies obtained by hilar mucosal biopsies had yellow nodules in all 4cases and hypervascularity in 3cases. Both findings were recognized as specific to sarcoidosis. The percentages of the lavage fluids recovered when washed with 50ml of saline 4 times were higher than those when washed with 50ml of saline only one time. There was no significant difference in cell counts of BAL for sarcoidosis patients and controls, but in the sarcoidosis the percentage of lymphocytes was significantly higher compared to that of the controls (P<0.01). More over, the patients with non-smoking asrcoidosis had a significant higher percentage of lymphocytes when compared with smoking sarcoidosis patients (P<0.01). In the sarcoidosis cases, ACE in BAL was significantly higher compared to that of the controls (P<0.01). Non-caseating epitheloid cell granulomas obtained by TBLB were recognized in 42 of 71 patients (59.2%). Positive biopsies were obtained in 18 fo 42 patients (42.9%) with radiographic stage I disease, in 20 of 24 patients (83.3%) with stage II, and in 1 of 2 cases with stage III. 36 cases underwent hilar mucosal biopsy and only 4 positive biopsies were obtained. There were no significant differences in positive biopsy by TBLB between the factors of signs, PPD, and extrathoracic lesio, respectively. In patients with stage I sarcoidosis with yellow nodules and/or hypervascularity, the number of positive biopsies obtained by TBLB were greater compared to those found in patients without yellow nodules. The number of positive biopsies in patients where the percentage of lymphocytes in BAL was more than 30% was greater than for patients with under 30% lymphocytes.