Immunosuppression by glucocorticoids leads to bronchoalveolar neutrophilia in patients with bronchial asthma

Cellular composition of bronchoalveolar lavage (BAL) fluid was compared　between two age-matched steroid-dependent　intractable asthma (SDIA) groups : 17 group A patients (serum IgG level < 1000mg/dℓ) whose immunity was regarded as being　suppressed by long-term glucocorticoid therapy and 17 group B patients (serum IgG level > 1200mg/dℓ). 1. The levels of serum IgA and IgM were significantly decreased in group A compared to the levels in group B patients. 2. The number of blood lymphocytes was also significantly lower in group A than in group B patients. However, the number of blood neutrophils was not different between the two asthma groups. 3.The number of BAL lymphocytes was significantly lower in group A than in group B patients. 4. BAL neutrophilia (more than 1.5×10 (4)/mℓ) was observed in 6 of the 17(35.3%) patients in group A, but not observed in any patients in group B. The number of BAL neutrophils was significantly greater in group A than in group B　patients. These results suggest that there is a correlation between immunosuppression by glucocorticoids and BAL neutrophilia in patients with bronchial asthma.

ステロイド依存性重症難治性喘息を,免疫抑制の見られる症例(血清IgG値1000mg/dℓ以下)(グループA)と抑制の見られない症例(血清IgG値1200mg/dℓ以上)(グループB)の2群に分け,気管支肺胞洗浄液中の細胞成分について比較検討した｡1.血清IgAおよびIgM値は,グループBに比べ免疫抑制の見られるグループAにおいて有意に低い値であった｡2.末梢血リンパ球数は,グループAにおいて,グループBに比べ有意に少ない傾向が見られた｡しかし,末梢血好中球数は両群間に有意の差は見られなかった｡3.BAL液中リンパ球数は,グループBに比べ免疫抑制の見られるグループAにおいて有意に少 ない数であった｡4.BAL液中好中球増多(1.5×10(4)/mℓ以上)を示す症例は, グループAの17例中6例(35.3%)に見られたが,グループBでは全く 見られなかった｡また,BAL液中好中球数は,グループAにおいてグループBに比べ有意に多い数であった｡以上の結果により,副腎皮質ホルモン長期投与 による免疫抑制とBAL液中好中球増多とはある程度関連があることが明らかにされた｡