RESUMEN
The aim of the study was to evaluate the concentrations of TNF-alpha and GM-CSF in double BAL (2 x 120 ml) from two different lung segments: (s.A) from upper lobe with the most and (s.B) from lower lobe with the least extensive involvement estimated by high resolution computed tomography (HRCT). Examined group consisted of 28 non-smoking sarcoid patients with homogenous, regular distribution of nodular opacities in conventional chest X-ray (14 F, 14M aged 19-54). In examined patients 16 had nonhomogenous distribution (ND) and 12 had regular distribution (RD) of HRCT changes. Eleven healthy volunteers served as controls. In patients with sarcoidosis we observed the significantly higher concentrations (p < 0.01) of TNF-alpha (3.18 pg/ml, 2.64 pg/ml) and GM-CSF (1.01 pg/ml, 0.95 pg/ml) respectively in BAL fluid from s.A and s.B in comparison with BAL from s.Abis and s.Bbis in control group (TNF-alpha: 0.46 pg/ml, 0.47 pg/ml and GM-CSF: 0.28 pg/ml, 0.31 pg/ml respectively). Mean concentration of TNF-alpha in BAL from s.A (3.77 pg/ml) in ND group was significantly higher than in BAL from s.B in RD group (2.91 pg/ml). TNF-alpha in BAL from s.A in active sarcoidosis was higher than in BAL from s.A and s.B in non-active sarcoidosis. Concentrations of TNF-alpha in BAL from both s.A and s.B correlated positively with CD4/CD8 ratio, percentage of lymphocytes, lymphocytes HLA-DR+ and absolute number of CD4 cells and negatively with CD8 cells estimated in BAL from these lung segments. In patients with indications to therapy the level of GM-CSF in BAL from s.A (1.44 pg/ml) was significantly higher (p < 0.05) than in BAL from s.A (0.64 pg/ml) in patients without indications to treatment. We conclude that TNF-alpha and GM-CSF may be involved in sarcoidosis pathogenesis and TNF-alpha may be useful in estimation of sarcoidosis activity.