Priftis Kostas N, Anthracopoulos Michael B, Mermiri Despina, Papadopoulou Athina, Xepapadaki Paraskevi, Tsakanika Constantina, Nicolaidou Polyxeni
Department of Allergy-Pneumonology, Penteli Children's Hospital, Penteli, Greece.
Pediatr Pulmonol. 2006 Sep;41(9):805-11. doi: 10.1002/ppul.20462.
Most cases of middle lobe syndrome (MLS) in children are considered to be due to asthma and may recover spontaneously; however, in persistent MLS, repeated episodes of infection often institute a vicious cycle that may lead to persistent symptoms and bronchial hyperresponsiveness (BHR). The present study was undertaken to investigate whether asthma, as an underlying diagnosis, is predictive of a favorable outcome of children with persistent MLS. We evaluated 53 children with MLS who underwent an aggressive management protocol that included fiberoptic bronchoscopy (FOB) and bronchoalveolar lavage (BAL). These patients were compared to two other groups: one consisting of children with current asthma but no evidence of MLS (N = 40) and another of non-asthmatic controls (N = 42), matched for age and sex. Prevalence of sensitization (>or=1 aeroallergen) did not differ between patients with MLS and "non-asthmatics" but was significantly lower than that of "current asthmatics." A positive response to methacholine bronchial challenge was observed with increased frequency among children with MLS when compared to "current asthmatic" and non-asthmatic children. Multivariate logistic regression analysis revealed a positive correlation between an increased number of eosinophils in the BAL fluid (BALF) and a favorable outcome, whereas no correlation was detected between sensitization or BHR and BAL cellular components. In conclusion, children with MLS have an increased prevalence of BHR, even when compared to asthmatics, but exhibit prevalence of atopy similar to that of non-asthmatics. An increased eosinophilic BALF count is predictive of symptomatic but not radiographic improvement of MLS patients after aggressive anti-asthma management.
儿童中叶综合征（MLS）的大多数病例被认为是由哮喘引起的，且可能会自发恢复；然而，在持续性MLS中，反复的感染发作往往会形成一个恶性循环，可能导致症状持续和支气管高反应性（BHR）。本研究旨在调查哮喘作为潜在诊断，是否可预测持续性MLS患儿的良好预后。我们评估了53例接受积极治疗方案的MLS患儿，该方案包括纤维支气管镜检查（FOB）和支气管肺泡灌洗（BAL）。将这些患者与另外两组进行比较：一组是目前患有哮喘但无MLS证据的儿童（N = 40），另一组是年龄和性别匹配的非哮喘对照组（N = 42）。MLS患者与“非哮喘患者”之间的致敏（≥1种气传变应原）患病率无差异，但显著低于“目前哮喘患者”。与“目前哮喘患者”和非哮喘儿童相比，MLS患儿对乙酰甲胆碱支气管激发试验的阳性反应频率更高。多因素逻辑回归分析显示，支气管肺泡灌洗液（BALF）中嗜酸性粒细胞数量增加与良好预后之间存在正相关，而致敏或BHR与BAL细胞成分之间未检测到相关性。总之，即使与哮喘患者相比，MLS患儿的BHR患病率也更高，但特应性患病率与非哮喘患者相似。BALF中嗜酸性粒细胞计数增加可预测积极抗哮喘治疗后MLS患者的症状改善，但不能预测影像学改善。
