Inflammatory rheumatic diseases (IRD) are often associated with interstitial lung disease (ILD). The aim of the present study was to establish a correlation between the findings on HRCT and the immunological bronchoalveolar lavage (BAL). The study included 74 patients with newly diagnosed IRD and evidence of ILD on HRCT with the following pattern: ground-glass opacities (GGO), non-specific interstitial pneumonia (NSIP) and usual interstitial pneumonia (UIP). Patients with other HRCT pattern were excluded. No patient received any immunosuppressive therapy. In addition to HRCT, immunological BAL was performed and the American Thoracic Society clinical practice guideline were used to define BAL patterns (lymphocytic cellular pattern, neutrophilic cellular pattern, eosinophilic cellular pattern and unspecified pattern). The main HRCT patterns were NSIP (47.3%), GGO (33.8%), and UIP (18.9%). BAL patterns showed the following distribution: 41.9% lymphocytic cellular pattern, 23.0% neutrophilic cellular pattern, 18.9% eosinophilic cellular pattern, and 16.2% unspecific cellular pattern. Placing these data in the context of the HRCT findings, the lymphocytic cellular BAL pattern (48%) was most commonly BAL pattern associated with GGO pattern in HRCT, whereas neutrophilic and lymphocytic cellular BAL patterns were the dominant feature in NSIP and UIP. In patients with new-onset IRD and ILD, inflammatory pulmonary changes are predominate, reflected by GGO on HRCT and a mainly lymphocytic cell profile in the immunological BAL. In NSIP or UIP on HRCT, the percentages of lymphocytes and neutrophils were higher in BAL fluid, representing a fibrotic component in addition to the inflammation. Consequently, patients with evidence of GGO on HRCT should primarily be treated with anti-inflammatory/immunosuppressive therapy, whereas in patients with NSIP and UIP a combination of anti-inflammatory and anti-fibrotic agents would be the appropriate treatment.

中文翻译：

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炎症性风湿性疾病发作时间质性肺疾病高分辨率计算机断层扫描和免疫支气管肺泡灌洗的相关性：对诊断和治疗策略的影响


炎症性风湿病（IRD）通常与间质性肺病（ILD）相关。本研究的目的是建立 HRCT 结果与免疫支气管肺泡灌洗 (BAL) 之间的相关性。该研究纳入了 74 名新诊断 IRD 的患者，HRCT 上有 ILD 证据，其模式如下：毛玻璃样混浊 (GGO)、非特异性间质性肺炎 (NSIP) 和普通间质性肺炎 (UIP)。排除其他 HRCT 模式的患者。没有患者接受任何免疫抑制治疗。除 HRCT 外，还进行了免疫学 BAL，并使用美国胸科学会临床实践指南来定义 BAL 模式（淋巴细胞模式、中性粒细胞模式、嗜酸性细胞模式和未特指模式）。主要HRCT模式为NSIP（47.3%）、GGO（33.8%）和UIP（18.9%）。 BAL 模式显示以下分布：41.9% 淋巴细胞细胞模式、23.0% 中性粒细胞模式、18.9% 嗜酸性细胞模式和 16.2% 非特异性细胞模式。将这些数据置于 HRCT 结果的背景下，淋巴细胞 BAL 模式 (48%) 是 HRCT 中与 GGO 模式相关的最常见 BAL 模式，而中性粒细胞和淋巴细胞 BAL 模式是 NSIP 和 UIP 中的主要特征。在新发 IRD 和 ILD 患者中，炎症性肺部变化占主导地位，HRCT 上的 GGO 和免疫学 BAL 中主要是淋巴细胞谱反映了这一变化。在 HRCT 上的 NSIP 或 UIP 中，BAL 液中淋巴细胞和中性粒细胞的百分比较高，代表除炎症之外的纤维化成分。 因此，HRCT 上有 GGO 证据的患者应主要接受抗炎/免疫抑制治疗，而对于 NSIP 和 UIP 患者，抗炎和抗纤维化药物的联合治疗将是适当的治疗。