Tüberküloz alveolitinde bronkoalveoler lavajın değeri /
Yazar: BİNNUR ÖNAL
Danışman: PROF.DR. ÖZDEN GÜNEL
Ege Üniversitesi / Tıp Fakültesi / Patoloji Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 1997
Konu: Patoloji = Pathology
Dizin: Bronkoalveolar lavaj sıvısı = Bronchoalveolar lavage fluid ; Tüberküloz = Tuberculosis

Özet:
ÖZET Bu araştırmada Tüberküloz alveolitinde bronkoalveoler lavajın değeri araştırıldı. Klinik, laboratuar ve radyolojik olarak aktif, lokalize tüberküloz tanısı konulan, erişkin yaşta 64 erkek hastanın hastalıktan etkilenmiş ve radyolojik olarak etkilenmemiş görünen bölgelerinden yapılan BAL materyalleri sitopatolojik ve immünolojik özellikler açısından incelendi. Tüm olgularda konvansiyonel diferansiyel sayım bulguları ve flow simetrik yöntem ile CD 3+, CD 19+, CD 4+, CD 8+ T lenfosit oranlan, CD 4+/ CİD 8+ oranı, NK hücreleri, HLA- DR ile İL- 2 R ekspresyonları değerlendirildi. Tüberküloz hastalığından etkilenmiş ve etkilenmemiş bölgelerden örneklenen BAL materyallerinin değerlendirilmesinde, CD 4/ CD 8 oranı, HLA- DR ve İL- 2 R ekpresyonları arasında istatistiksel olarak anlamlı farklılık saptandı. Söz konusu değişkenlerin bölgeler arasında farklı değerler gösterdikleri dikkati çekti. 66SUMMARY Limited report on the cellular composition and immunologic profile of blronchoalveolar lavage (BAL) fluid in pulmonary tuberculosis have been published. We therefore investigated 64 treated patients with active disease. All the patients were while males. The mean age was 33.6 (range 16 to 68) and 49 patients were smokers. The diagnosis was based on clinical features in combination with chest radiographs and either evidence of Mycobacterium tuberculosis in BAL, aspiration or sputum materials. Disease extention was defined by radiografic criteria. On this basis, 28 patients were found to have severe, 20 had moderately advanced and 16 had ntmimal lesions. The study comprised the cases which were assessed as infiltrative and / or cavitary lesions with one exceptional case of fibrotic changes. Resistance was detected in 3 cases. A BAL (5 x 20 ml) was performed by a fiberoptic bronchoscope. The site ot BAL in affected lung was infected segment and, in non- affected lung was the njght middle lobe or the lingula. BAL fluid differential cell counts and lymphocyte subsets were measured. Phenotypic analysis of lymphocytes were determined on the basis of CD 3, CD 4, OD 8, CD 19, CD3- / CD 16+56 (NK cells) and CD 3+ HLA- DR+ dual color rejagents in a Fluorescence activated cell sorter (FACS- Becton Dickinson). In addition we studied a lymphocyte marker, seldomly reported before (İD 25- IL~ 2R). 67

Abstract:
SUMMARY Limited report on the cellular composition and immunologic profile of blronchoalveolar lavage (BAL) fluid in pulmonary tuberculosis have been published. We therefore investigated 64 treated patients with active disease. All the patients were while males. The mean age was 33.6 (range 16 to 68) and 49 patients were smokers. The diagnosis was based on clinical features in combination with chest radiographs and either evidence of Mycobacterium tuberculosis in BAL, aspiration or sputum materials. Disease extention was defined by radiografic criteria. On this basis, 28 patients were found to have severe, 20 had moderately advanced and 16 had ntmimal lesions. The study comprised the cases which were assessed as infiltrative and / or cavitary lesions with one exceptional case of fibrotic changes. Resistance was detected in 3 cases. A BAL (5 x 20 ml) was performed by a fiberoptic bronchoscope. The site ot BAL in affected lung was infected segment and, in non- affected lung was the njght middle lobe or the lingula. BAL fluid differential cell counts and lymphocyte subsets were measured. Phenotypic analysis of lymphocytes were determined on the basis of CD 3, CD 4, OD 8, CD 19, CD3- / CD 16+56 (NK cells) and CD 3+ HLA- DR+ dual color rejagents in a Fluorescence activated cell sorter (FACS- Becton Dickinson). In addition we studied a lymphocyte marker, seldomly reported before (İD 25- IL~ 2R). 67ÖZET Bu araştırmada Tüberküloz alveolitinde bronkoalveoler lavajın değeri araştırıldı. Klinik, laboratuar ve radyolojik olarak aktif, lokalize tüberküloz tanısı konulan, erişkin yaşta 64 erkek hastanın hastalıktan etkilenmiş ve radyolojik olarak etkilenmemiş görünen bölgelerinden yapılan BAL materyalleri sitopatolojik ve immünolojik özellikler açısından incelendi. Tüm olgularda konvansiyonel diferansiyel sayım bulguları ve flow simetrik yöntem ile CD 3+, CD 19+, CD 4+, CD 8+ T lenfosit oranlan, CD 4+/ CİD 8+ oranı, NK hücreleri, HLA- DR ile İL- 2 R ekspresyonları değerlendirildi. Tüberküloz hastalığından etkilenmiş ve etkilenmemiş bölgelerden örneklenen BAL materyallerinin değerlendirilmesinde, CD 4/ CD 8 oranı, HLA- DR ve İL- 2 R ekpresyonları arasında istatistiksel olarak anlamlı farklılık saptandı. Söz konusu değişkenlerin bölgeler arasında farklı değerler gösterdikleri dikkati çekti. 66