Bronchoscopic and High-Resolution CT Scan Findings in Children With Chronic Wet Cough-猫眼课题宝

DOI：

10.1378/chest.10-3050

发表时间：

2011-08-01

期刊：

CHEST

影响因子：

9.6

通讯作者：

中科院分区：

医学1区

文献类型：

作者：

Douros, Konstantinos;Alexopoulou, Efthymia;Priftis, Kostas N.

背景：慢性湿性咳嗽强烈提示支气管腔内感染，如果不及时治疗，可能进展为已确诊的支气管扩张。我们的目的是比较胸部高分辨率CT(HRCT)扫描和纤维支气管镜(FB)在检测慢性湿咳儿童呼吸道异常中的有效性，并探讨放射学和支气管镜/BAL发现之间的联系。方法：我们选择了93名湿咳儿童(0.6-16.4岁)，他们被转诊到专门的中心，被认为不太可能有哮喘，我们对他们进行了6周的回顾性评估。所有患者均接受血液学检查、胸部X线片、HRCT扫描和FB/BAL检查。结果：70例(75.2%)支气管炎患者HRCT扫描阳性(P=.76)。Bhala评分与咳嗽持续时间呈正相关(Rho=0.23，P=0.028)。FB/BAL在发现异常方面优于HRCT(P&lt；.001)。Bhala积分与III型(OR，5.44；95%CI，1.92~15.40；P=.001)和IV型(OR，8.91；95%CI，2.53~15.42；P=.001)支气管镜下病变呈正相关，与BAL中性粒细胞百分比呈正相关(Rho=0.23，P=0.036)。结论：HRCT扫描可发现气道壁增厚和支气管扩张，其严重程度与临床症状持续时间和中性粒细胞炎症程度呈正相关。然而，HRCT在发现呼吸道异常方面不如FB/BAL敏感。在评估延长的湿咳时，这两种模式应该被认为是互补的。2011年；140(2)：317-323

Background: Chronic wet cough strongly suggests endobronchial infection, which, if left untreated, may progress to established bronchiectasis. Our aim was to compare the effectiveness of chest high-resolution CT (HRCT) scanning and flexible bronchoscopy (FB) in detecting airway abnormalities in children with chronic wet cough and to explore the association between radiologic and bronchoscopic/BAL findings.Methods: We retrospectively evaluated a selected population of 93 children (0.6-16.4 years) with wet cough for > 6 weeks who were referred to a specialized center and deemed unlikely to have asthma. All patients were submitted to hematologic investigations, chest radiographs (CXRs), HRCT scanning, and FB/BAL. HRCT scans were scored with the Bhalla method, and bronchoscopic findings of bronchitis were grouped into five grades of severity.Results: Positive HRCT scan findings were present in 70 (75.2%) patients (P =.76). A positive correlation was found between Bhalla score and duration of cough (rho = 0.23, P =.028). FB/BAL was superior to HRCT scan in detecting abnormalities (P < .001). The Bhalla score correlated positively with type III (OR, 5.44; 95% CI, 1.92-15.40; P =.001) and type IV (OR, 8.91; 95% CI, 2.53-15.42; P =.001) bronchoscopic lesions; it also correlated positively with the percentage of neutrophils in the BAL (rho = 0.23, P =.036).Conclusions: HRCT scanning detected airway wall thickening and bronchiectasis, and the severity of the findings correlated positively with the length of clinical symptoms and the intensity of neutrophilic inflammation in the airways. However, HRCT scanning was less sensitive than FB/BAL in detecting airway abnormalities. The two modalities should be considered complementary in the evaluation of prolonged wet cough. CHEST 2011; 140(2):317-323

Bronchoscopic and High-Resolution CT Scan Findings in Children With Chronic Wet Cough

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