We studied the prognostic value of the initial radiologic stage, the serum-angiotensin-converting enzyme (SACE) and T helper cells in blood (OKT-4-Bl) and in bronchoalveolar lavage (OKT-4-BAL) for patients with biopsy-proven pulmonary sarcoidosis. Thirty-seven patients without prior treatment were followed up for a period of 2 years. A BAL was performed in 22 of them as part of the diagnostic workup. Clinical examination, chest radiographs, vital capacity, diffusion capacity for CO, airway resistance and PaO₂ at rest and during exercise were determined initially and after 6, 12 and 24 months. According to these results, patients were classified as having progressive or nonprogressive disease. The radiologic stage and the initial SACE (38.3 ± 10.2 vs. 43.7 ± 13.0 nmol/ml/min) could not discriminate between the two groups. Patients with progressive disease had significantly fewer OKT-4-B1 cells (403.3/μl ± 146.7/μl vs. 842.0/μl ± 430.1/μl) and more OKT-4-BAL cells (24.5 ± 15.4% vs. 7.0 ± 2.6%) than patients with stable disease (p < 0.01). A negative correlation between OKT-4-Bl and OKT-4-BAL cells was shown (R_s = -0.79; p < 0.001). We conclude that the number of OKT-4-Bl and OKT-4-BAL cells can be used as prognostic parameter for patients with sarcoidosis.

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