Chronic cough in children: bronchoalveolar lavage findings
Chronic cough in children: bronchoalveolar lavage findings
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DOI：
10.1034/j.1399-3003.2000.16f15.x
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发表时间：
2000-12-01
影响因子：
24.3
通讯作者：
Shields, MD
中科院分区：
文献类型：
--
作者：
Fitch, PS;Brown, V;Shields, MD
儿童孤立性慢性咳嗽是一种常见的主诉。虽然咳嗽症状被包括在儿童哮喘的定义中，但对于这些儿童是否大多数患有哮喘存在争议。作者研究了孤立性慢性咳嗽患儿，寻找哮喘典型气道炎症的证据，支气管肺泡灌洗（BAL）评估气道嗜酸性粒细胞数量增加。调查对象是23名儿童（年龄中位数：6.7岁；范围：1.7-12.75岁），他们在贝尔法斯特皇家儿童医院接受选择性手术，同时患有慢性不明原因的硬伤。获得父母的书面知情同意，并进行非支气管镜BAL检查。分析BAL样本的总白细胞计数和差异白细胞计数，以及炎症介质，嗜酸性阳离子蛋白（ECP）和组胺。结果与一组正常的非特应性儿童和一组特应性哮喘儿童进行了比较，这些儿童被招募参加其他气道炎症研究。与非哮喘对照组相比，慢性咳嗽患儿BAL嗜酸性粒细胞百分比虽小但有统计学意义（0.28%比0.10%,p=0.03）。咳嗽患儿的嗜酸性粒细胞比例低于特应性哮喘对照组（0.28% vs 0.66%, p=0.01）。23例慢性咳嗽患儿中有3例BAL嗜酸性粒细胞高于BAL正常95%参考区间。与非哮喘对照组相比，咳嗽患儿中性粒细胞百分比虽小但有统计学意义（5.85%比3.21%,p=0.03）。23名儿童中有4名BAL中性粒细胞高于正常BAL的95%参考区间。作者得出结论，只有少数患有慢性不明原因咳嗽的儿童患有哮喘型气道炎症。据推测，咳嗽儿童支气管肺泡灌洗液中中性粒细胞百分比的增加可能与潜在的持续性气道感染有关。
Isolated chronic cough in childhood is a common complaint. Although the symptom cough is included in the definition of childhood asthma, there is debate as to whether the majority of these children have asthma. The authors studied children with isolated chronic cough looking for evidence of airway inflammation typical of asthma, with increased numbers of airway eosinophils as assessed from bronchoalveolar lavage (BAL).The investigations were carried out an 23 children (median age: 6.7 yrs; range: 1.7-12.75 yrs), attending the Royal Belfast Hospital for Sick Children for elective surgery, who also had a chronic unexplained tough. Written informed consent was obtained from the parent(s) and a nonbronchoscopic BAL was performed. BAL samples were analysed for total and differential white cell counts and also for the inflammatory mediators, eosinophil cationic protein (ECP) and histamine. Results were compared with a group of normal nonatopic children and also a group of atopic asthmatic children, who had been recruited for other studies on airway inflammation.There was a small but statistically significant increase in BAL percentage eosinophils in the children with chronic cough compared with nonasthmatic controls (0.28% versus 0.10%, p=0.03). However, the children with cough had lower percentage eosinophils than the atopic asthmatic controls (0.28% versus 0.66%, p=0.01). Three out of 23 children with chronic cough had BAL eosinophils greater than the normal upper 95% reference interval in BAL. There was a small but statistically significant increase in percentage neutrophils in the children with cough compared with the nonasthmatic controls (5.85% versus 3.21%, p=0.03). Four out of the 23 children had BAL neutrophils greater than the normal upper 95% reference interval in BAL.The authors conclude that only a minority of children with chronic unexplained cough have asthmatic-type airway inflammation. It is speculated that the increased percentage neutrophils in bronchoalveolar lavage from children with cough could relate to underlying persistent airways infection.