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[The clinical significance of increased neutrophils in bronchoalveolar lavage fluid in sarcoidosis].

Objective: To investigate the clinical implications of increased neutrophils in bronchoalveolar lavage fluid (BALF) in sarcoidosis. Methods: A retrospective analysis was performed for 72 cases of histologically diagnosed, treatment-näive sarcoidosis admitted to Peking University Third Hospital from January 2000 to October 2014. The patients included 18 men and 54 women, 26 to 75 years of age [(50±10) years], with the disease course 0.5 month to 12 years (median disease course, 3 months). Results of cell count and differentials of BALF were analyzed and the patients were grouped based on the percentage of neutrophils: those with increased neutrophils (>3%) and those without (≤3%). Clinical manifestations, pulmonary function tests, radiological features, bronchoscopic findings, and other laboratory data were compared between the 2 groups. Finally 67 patients were followed for 6 to 240 months (median 36 months). The subsequent changes of radiological manifestations and relapses after therapy were recorded and compared. Results: There were 72 patients in the study, including 16 with increased BALF neutrophils(stage Ⅰ/Ⅱ/Ⅲ, 4/10/2) and 56 without(stage Ⅰ/Ⅱ/Ⅲ, 9/45/2). Compared with patients without increased neutrophils, those with increased neutrophils had more reticular changes in the lungs(6/16, 8/56), more common diffusion dysfunction (7/13, 11/46) with lower DLCO% [(70±19)% vs (89±23)%], higher percentage of CD8＋ lymphocytes [(19±4)% vs (11±4)%, P<0.05] in BALF. Sixteen (stage Ⅰ/Ⅱ/Ⅲ, 4/10/2) and 51 (stage Ⅰ/Ⅱ/Ⅲ, 9/41/1) patients with and without increased neutrophils were followed respectively. Compared with patients without increased neutrophils, those with increased neutrophils tended to deteriorate and relapse despite corticosteroid therapy. Conclusions: Sarcoidosis patients with BALF neutrophilia had more severe pulmonary fibrosis and diffusion dysfunction, poorer response to corticosteroid therapy and higher relapse rate. These patients, therefore, should be monitored more closely during therapy or follow-up.