Hidemasa Kuwabara

Intracellular Th1/Th2 Balance of Pulmonary CD4+ T Cells in Patients with Active Interstitial Pneumonia Evaluated by Serum KL-6

The balance between CD4+ T helper (Th1) lymphocytes producing interferon-γ or Interleukin-4 (Th2) in the lungs may vary among diseases and during the progression of interstitial pneumonia (IP). Both idiopathic pulmonary fibrosis (IPF) and collagen vascular diseases (CVD) are associated with IP, but the clinical course and the response to treatment are different. Since Th1 or Th2 modulating drugs have been proven to alter the lymphocyte balance in vitro, it is important to elucidate the Th1/Th2 profile in patients with active IP. Bronchoalveolar lavage (BAL) was performed in patients who had IPF (n = 12) or CVD (n = 12) with IP, as well as in patients who had bronchoectasis and bronchopneumonia (n = 12). The CVD patients had rheumatoid arthritis (n = 6), Sjogren’s syndrome (n = 2), dermatomyositis (n = 1), progressive systemic sclerosis (n = 2), and CREST syndrome (n = 1) as the underlying diseases. IP activity was evaluated by measuring serum KL-6, which is a clinically useful indicator for IP. The Th1/ Th2 balance and the CD4+/CD8+ ratio were determined for lymphocytes obtained from BAL by flow cytometric analysis. In IPF patients, the CD4+/CD8+ ratio was lower than in CVD patients. IPF patients showed Th2 dominance and CVD patients showed Th1 dominance when IP was active as evaluated by the serum KL-6 level. These data indicated that the Th1/Th2 balance of CD4+ T cells in the BAL differs between active IPF and CVD, even though KL-6 is elevated in both diseases. Therefore, the Th1/Th2 profile should be investigated to determine the use of Th1/Th2 modulator therapy for active IP with elevation of KL-6.

Report of a case of renal tubular acidosis complicated by CO2 narcosis

遠位尿細管アシドーシス(distal renal tubular asidosis, dRTA)による低カリウム血症のため,呼吸筋麻痺が生じてCO2ナルコーシスに陥った症例. CO2ナルコーシスにまで陥る尿細管アシドーシスは極めてまれであり,加えて多彩な自己免疫異常を認めた.橋本病および, Sjogren症候群を合併しており,抗dsDNA抗体も陽性であった.遠位尿細管アシドーシスの発症に免疫学的機序の関与を示唆する症例であり,自己免疫疾患の形質発現を考える上でも貴重な症例と考えられた.

[Paroxysmal hemoglobinuria following trimethoprim-sulphamethoxazole in a lung cancer case treated by radiation therapy].

肺癌患者の治療中に,合成抗菌剤により発作性ヘモグロビン尿症を生じたと思われた1例を経験した.本症例は3回にわたって著明なヘモグロビン尿が出現したが,合成抗菌剤の中止により消失した.クームス試験,手足冷却試験, Donath-Landsteiner抗体,さらにHam test, sugar water test等すべて陰性であった.本症例の溶血は何らかの赤血球膜の脆弱性亢進が薬物により生じた結果発症したものと考えられた.