Sarcoidosis is a multi-organ disease and is characterized by sarcoidal noncaseating granuloma comprised of T-helper/inducer (CD4+) lymphocytes and scant cytotoxic (CD8+) T-lymphocytes. CD4+:CD8+ T-cell elevated ratio is a characteristic diagnostic parameter for sarcoidosis. This is the first report from Iran evaluating the CD4:CD8 ratio capability in differentiating pulmonary sarcoidosis from other interstitial lung diseases (ILDs) on a large cohort. Fifty pulmonary sarcoidosis patients and 50 non-sarcoidosis interstitial lung diseases (nsILDs) patients were included in the current study. Bronchoalveolar lavage (BAL) was performed using flexible fiberoptic bronchoscopy and flow cytometer. Non-sarcoidosis group was established by 50 components that were classified into eight subgroups. Fifty-two per cent of sarcoidosis patients and 62% of non-sarcoidosis interstitial lung disease patients had normal spirometric results. The CD4/CD8 ratio was significantly higher in sarcoidosis than in non-sarcoidosis interstitial lung diseases (p < 0.001). The CD4/CD8 ratio was found to be > 3.5 in 33.3%, 2.5–3.5 in 7.1%, 1.5–2.5 in 20.2% and < 1.5 in 39.4% of the entire study population. The best cut off point was 1.1 with the sensitivity of 92% and specificity of 80% for distinguishing sarcoidosis from other interstitial lung diseases. Performing bronchoalveolar lavage as the safe and rapid first step confirms the diagnosis of sarcoidosis in 92% of cases (current study sensitivity). Hence, performing an invasive procedure was required in a few patients only. Bronchoalveolar lavage flow cytometry in the assessment of clinical and radiological findings supplies an appropriate diagnostic adjunct for discriminating sarcoidosis from non-sarcoidosis interstitial lung diseases.
Ziegenhagen MW, Rothe ME, Schlaak M, Müller-Quernheim J. Bronchoalveolar and serological parameters reflecting the severity of sarcoidosis. European Respiratory Journal. 2003;21(3):407–13.
2.
Tanrıverdi H, Uygur F, Örnek T. Comparison of the diagnostic value of different lymphocyte sub-populations in bronchoalveolar lavage fluid in pati-ents with biopsy proven sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2016;32:305–12.
3.
Costabel U, Bonella F, Ohshimo S, Guzman J. Diagnostic Modalities in Sarcoidosis: BAL, EBUS, and PET. Seminars in Respiratory and Critical Care Medicine. 2010;31(04):404–8.
4.
Kantrow S, Meyer K, Kidd P, Raghu G. The CD4/CD8 ratio in BAL fluid is highly variable in sarcoidosis. European Respiratory Journal. 1997;10(12):2716–21.
5.
Bakhshayesh-Karam M, Tabarsi P, Mirsaiedi SM, Amiri MV, Zahirifard S, Mansoori SD, et al. Radiographic manifestations of Tuberculosis in HIV positive patients: Correlation with CD4+ T-cell count. International Journal of Mycobacteriology. 2016;5:S244–5.
6.
Kojima K, Maruyama K, Inaba T, Nagata K, Yasuhara T, Yoneda K, et al. The CD4/CD8 Ratio in Vitreous Fluid Is of High Diagnostic Value in Sarcoidosis. Ophthalmology. 2012;119(11):2386–92.
7.
Mortaz E, Masjedi MR, Abedini A, Matroodi S, Kiani A, Soroush D, et al. Common features of tuberculosis and sarcoidosis. International Journal of Mycobacteriology. 2016;5:S240–1.
8.
Bronchoalveolar lavage constituents in healthy indi-viduals, idiopathic pulmonary fibrosis, and selected comparison groups. The BAL Cooperative Group Steering Committee. Am Rev Respir Dis. 1990;141:169–202.
9.
Quanjer PhH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC. Lung volumes and forced ventilatory flows. European Respiratory Journal. 1993;6(Suppl 16):5–40.
10.
Mortaz E, Adcock IM, Ricciardolo FLM, Varahram M, Jamaati H, Velayati AA, et al. Anti-Inflammatory Effects of Lactobacillus Rahmnosus and Bifidobacterium Breve on Cigarette Smoke Activated Human Macrophages. PLOS ONE. 10(8):e0136455.
11.
Petković TR, Pejčić T, Borovac DN. Disease activity markers in sarcoidosis. Acta Fac Med Naiss. 2011;28:155–9.
12.
Jamaati H, Mansoori S, Najafizadeh K. T-lym-phocyte subsets inbronchoalveolar lavage: a flow cytometric analysis and itsimportance in the differ-ential diagnosis of sarcoidosis. Arch IranMed. 2003;6:204–7.
13.
Petruccioli E, Chiacchio T, Pepponi I, Vanini V, Urso R, Cuzzi G, et al. Characterization of the CD4 and CD8 T-cell response in the QuantiFERON-TB Gold Plus kit. International Journal of Mycobacteriology. 2016;5:S25–6.
14.
Ghamari E, Farnia P, Saif S, Marashian M, Ghanavi J, Tabarsi P, et al. Susceptibility to pulmonary tuberculosis: host genetic deficiency in tumor necrosis factor alpha (TNF-α) gene and tumor necrosis factor receptor 2 (TNFR2). International Journal of Mycobacteriology. 2016;5:S136–7.
15.
Chiacchio T, Petruccioli E, Pepponi I, Vanini V, Gualano G, Cirillo D, et al. Modulation of CD4 and CD8 response to QuantiFERON-TB Plus in patients with active tuberculosis and latent tuberculosis infection followed over time during treatment. International Journal of Mycobacteriology. 2016;5:S141–2.
16.
Selimović A, Dinarević S, T P. Lymphocyte subsets in bronchoalveolar lavage fluid of children with lung infiltrates. Acta Fac Med Naiss. 2012;29:139–44.
17.
Lj. T, O S, G N. Research on quality of life concept conducted at the Faculty of Medicine in Niš. Acta Fac Med Naiss. 2007;24:213–8.
18.
Filipović M, Živković Đ. Immunologic aspect of sarcoidosis. Acta Fac Med Naiss. 2001;18:229–34.
19.
Kahkouee S, Samadi K, Alai A, Abedini A, Rezaiian L. Serum ACE Level in Sarcoidosis Patients with Typical and Atypical HRCT Manifestation. Polish Journal of Radiology. 81:458–61.
20.
Mirsaeidi MS, Tabarsi P, Farnia P. Trends of drug resistant Mycobacterium tuberculosis in a ter-tiary tuberculosis center in Iran. Saudi Med J. 2007;28:544–50.
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