PURPOSE: Determining the activity of sarcoidosis is a difficult problem in absence of a definite marker.Numerous markers have been described with few having clinical significance. Levels of BAL Alkaline phosphatase (ALP) and Lactate dehydrogenase (LDH) in patients of sarcoidosis were measured and compared those with patients of noninflammatory lung disorders.Utility of these BAL fluid enzymes in determining activity and severity of sarcoidosis was also studied.
METHODS: 37 cases of newly diagnosed biopsy proven,treatment naive sarcoidosis were studied. BAL was done from the middle lobe in all patients. BAL fluid cell count, differential count and ALP and LDH estimation using Beckman synchron Cx-5 analyzer was performed . BAL samples of 30 patient's of other lung diseases (e.g. carcinoma lung) were taken as controls.
RESULTS: Sarcoidosis group had 18 males and 19 females,with mean age of 40.6 years. The median BAL fluid LDH, BAL fluid ALP and BAL fluid albumin, was 40 IU/L ( interquartile range) IQR 19-76), 59IU/L (IQR 39-87), 18.9mg/dl (IQR 8.5-38.4), respectively and in controls was 97 IU/L (IQR 23-172) (p=0.059), 68.5 IU/L(IQR 35-110). (p=0.72). 1.6mg/dl (IQR 0.6-5.72). (p=0.0000) repectively.In stage I sarcoidosis the median BAL fluid ALP,LDH were 58.5 (IQR 45-93.2) 48.5 (IQR 14.2-148) respectively and in stage II were 55 (IQR 27-88). (p=0.658), 38 (IQR 20-67) (p=0.486). Correlation of BAL lymphocyte with BAL ALP and LDH was r=0.365 (p=0.067) and r=0.272 (p=0.179) respectively Correlation of diffusion of carbon monoxide (DLCO) with BAL ALP and LDH was r=-0.253 (p=0.163) and r=-0.09 (p=0.607) respectively.No correlation was seen with other lung functions parameters also.
CONCLUSION: Although BAL fluid ALP and LDH are elevated in sarcoidosis,they are nonspecific, as they are also elevated in other pulmonary diseases. BAL ALP and LDH did not correlate with either activity or severity of sarcoidosis.
CLINICAL IMPLICATIONS: BAL fluid ALP and LDHare non specific markers of sarcoidosis and they show no correlation with disease activity.
DISCLOSURE: Ainapurapu Babu, None.