Vascular Involvement in Pulmonary Sarcoidosis : Correlation between Vascular Involvement and Clinical Manifestation

The findings of transbronchial lung biopsy （TBLB） of 121 patients with sarcoidosis were compared with the findings of high resolution computed tomography （CT） and flexible bronchofiberscopy （BF） and the data of laboratory examinations to clarify the role of granulomatous angitis （GA） confirmed by TBLB in the development of pulmonary changes in sar- coidisis. 1） Noncaseating epithelioid cell granuloma （EG） was proven by TBLB in 102 of the 121 cases （84.3%） of clinically diagnosed sarcoidosis. The ratio of detectable EG increased in terms of the stage of sarcoidosis. 2） GA was seen in 60 of the 121 cases （50.0%）, which corresponded to 58.8% of the cases with EG. The ratio of proven GA was 15.4% in stage O, 59.3% in stageI, 86.4% in stageII. GA consist- ed of venous （61.7%）, venous and arterial （31.7%） and arterial （6.7%） involvement. 3） Cases without CT findings were seen more often in the order of cases without EG by TBLB （group NG）, cases with EG by TBLB （group EG） and cases with GA by TBLB （group GA）. On the contrary, cases showing pulmonary involvement in CT were seen more often in the order of group GA, group EG and group NG. The findings of perivascular and peribronchial changes in CT, which are considered to be characteristic findings in sarcoidosis, were seen most often in group GA. 4） There were no significant differences between group GA and group EG in the value of serum angiotensin converting enzyme （S-ACE）. The values of both groups were higher than that of group NG. The value of serum lysozyme, the lymphocyte ratio of bronchoalveolar lavage fluid （BALF）, and the CD4/CD8 ratio of BALF of nonsmokers in group GA were higher than those of group EG and group NG. The positive ratio of vessel engorgement in the bronchial mucosa of group GA was higher than that of group EG and group NG. We concluded that detection of GA by TBLB is one of the good indications of activity in sarcoidosis and that GA plays an important role in pulmonary changes. GA may be one of the factors in the development of fibrous change in pulmonary sar- coidosis.departmental bulletin pape