Serum immunoglobulin levels and peripheral lymphocyte count related to changes in cellular composition of bronchoalveolar lavage fluid in patients with bronchial asthma

Changes in airway inflammation by glucocorticoids were examined in 26 patients with bronchial asthma, divided into two age groups ; 20-59 and 60+ years, in relation to serum immunoglobulin levels and peripheral lymphocyte count. 1. The levels of IgG, IgA and IgM were significantly lower in patients with steroid-dependent intractable asthma (SDIA) of age over 60 years than in those with non-SDIA of the same age group. In patients between the ages of 20 and 59, only serum IgG level was significantly lower in SDIA than in non-SDIA patients. 2. Peripheral lymphocyte count was significantly decreased in SDIA patients than in non-SDIA patients in age group over 60, but not in age group between 20 and 59. 3. Number of lymphocytes in bronchoalveolar lavage (BAL) fluid was significantly lower and number of BAL neutrophils was significantly higher in SDIA patients than in non-SDIA patients in age group over 60, but not in age group between 20 and 59. These results suggest that levels of IgG, IgA and IgM, and peripheral lymphocyte count were significantly suppressed in SDIA patients of age over 60, accompanied with decrease of BAL lymphocytes and increase of BAL neutrophils.

気管支喘息26例(ステロイド依存性重症難治性喘息,SDIA 13例,非SDIA 13例)を対象に,血清免疫グロブリン,IgG,IgAおよびIgM値,および末梢血リンパ球数との関連のもとに,副腎皮質ホルモン長期投与による気道炎症細胞の出現頻度の変化について検討を加えた｡なお,年齢による影響を観察する目的で,SDIAおよび非SDIA各13例を,20-59才と60才以上の2群に分けて,それ ぞれのグループの特徴について検討した｡1.血清IgG,IgAおよびIgM値は,60才以上の症例において,いずれも非SDIA症例に比べ,SDIA症例で有意に低い値を示した｡一方,20-59才の症例群においては,IgG値のみSDIA症例で有意の低下傾向が見られた｡2.末梢血リンパ球数は,60才以上の症例では,SDIA症例で,非SDIA症例に比べ有意の低値を示したが,20-59才の症例では両群間に有意の差は見られなかった｡3.気管支肺胞洗浄(BAL)液中のリンパ球数 は,60才以上のSDIA症例で,非SDIA症例に比べ有意に少なく,また同時にこれらの症例ではBAL液中好中球が有意に多い傾向が観察された｡しかし,20-59才の症例群では,SDIAと非SDIAの間にいずれも有意の差は見られなかっ た｡これらの結果より,60才以上の症例では,20-59才の症例群に比べ,副腎皮質ホルモンの長期投与により,血清IgG,IgAおよびIgM値,末梢血リンパ球数の減少とともに,BAL液中のリンパ球減少,好中球増加をきたしやすいことが明らかにされた｡