Friday, 30 November 2007

ΔΙΑΓΝΩΣΤΙΚΗ ΑΞΙΑ ΤΟΥ ΒΡΟΓΧΟΚΥΨΕΛΙΔΙΚΟΥ ΕΚΠΛΥΜΑΤΟΣ (BAL) ΣΤΟ ΗΩΣΙΝΟΦΙΛΟ  ΚΟΚΚΙΩΜΑ

Μ. Δημητριάδου, Γρ.Γεωργουδάκης, Φ. Διαμαντέα, Δ. Μερμίγκης, Χ. Μερμίγκης, Κ. Τσακανίκα,

Ε. Πασσαλίδου, Ν. Καραγιαννίδης, Β. Πολυχρονόπουλος.

         Γ’ Πνευμονολογική Κλινική, Μονάδα Lavage, Σισμανόγλειο Γ.Ν.Α.

                                                                 Πνευμων-Χανιά.

 

 

ΕΙΣΑΓΩΓΗ: Η ιστιοκύττωση-Χ αποτελεί σπάνια νοσολογική οντότητα, αγνώστου αιτιολογίας που χαρακτηρίζεται από ιστική διήθηση κυττάρων Langerhans. Η διαγνωστική προσέγγιση του νοσήματος βελτιώθηκε με την ανίχνευση ανοσολογικών και ιστοχημικών δεικτών.

 

ΣΚΟΠΟΣ: Στην αναδρομική αυτή μελέτη παρουσιάζουμε την διαγνωστική αξία του BAL έχοντες σαν βάση τους  δείκτες CD1a και S-100 πρωτεΐνη ιστιοκυττάρων σε 10 ασθενείς με ιστιοκύττωση-Χ.

 

ΥΛΙΚΟ:   10 ασθενείς (5 άνδρες, 5 γυναίκες ηλικίας από 18 έως 79 ετών ) με ιστιοκύττωση-Χ. 8 στους 10 ήταν καπνιστές. Προσβολή άλλων οργάνων διαπιστώθηκε σε 4 ασθενείς  (δερματικές, οστικές αλλοιώσεις, διόγκωση λεμφαδένων, αδένωμα υπόφυσης).

Όλοι οι ασθενείς παρουσίαζαν τυπική ακτινολογική εικόνα με διάχυτες οζώδεις και κυστικές αλλοιώσεις καθ’ υπεροχή στους άνω λοβούς. 2 ασθενείς είχαν προχωρημένη νόσο με εκτεταμένη καταστροφή του πνευμονικού παρεγχύματος. Σπιρομέτρηση και διαχυτική ικανότητα ήταν εντός φυσιολογικών ορίων σε 4 ασθενείς, σε 4 διαπιστώθηκε αποφρακτικό πρότυπο και σε 2 περιοριστικό.

 

Η τελική διάγνωση τέθηκε σε 2 ασθενείς με ανοιχτή βιοψία πνεύμονα, σε έναν με θωρακοσκοπική βιοψία (VATS) και σε 2 με διαβρογχική βιοψία. Στους υπόλοιπους 5 η τελική διάγνωση τέθηκε με την κλινική εικόνα, τον απεικονιστικό έλεγχο (HRCT θώρακος) και την ανίχνευση των ιστιοκυτταρικών αντιγόνων CD1a και S-100 πρωτεΐνης στο BAL τους. Οι δείκτες CD1a και S-100 ήταν διαγνωστικά αυξημένοι στο BAL όλων των ασθενών της μελέτης.

 

 

ΣΥΜΠΈΡΑΣΜΑ: Το BAL αποτελεί μια ασφαλή και ευαίσθητη διαγνωστική μέθοδο που μπορεί να υποκαταστήσει άλλες πιο επεμβατικές μεθόδους στη διάγνωση του ηωσινόφιλου κοκκίωματος.

 

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