Snijders Deborah, Cattarozzi Andrea, Panizzolo Cristina, Zanardo Vincenzo, Guariso Graziella, Calabrese Fiorella, Faggian Diego, Monciotti Carlamaria, Barbato Angelo
Department of Paediatrics, University of Padova, Padova, Italy.
Allergy Asthma Proc. 2007 Jul-Aug;28(4):462-7. doi: 10.2500/aap.2007.28.3019.
Chronic cough can be a complicated and frustrating diagnostic dilemma. The aim of this study was to identify the possible causes of chronic nonspecific cough in seemingly healthy children using fiberoptic bronchoscopy (FOB) and bronchoalveolar lavage (BAL). Eighteen children responded to criteria of selection for chronic cough. The average age was 5.8 years (range, 1.7-10.7 years) and BAL findings were compared with those of 16 nonatopic controls. Children with chronic cough had an increased percentage of BAL neutrophils in comparison with the control group (p = 0.098). Using a BAL neutrophil percent cutoff of 17%, 6 children had high BAL neutrophils (HBNs; median, 77%; range, 27-96%) and 12 children had normal BAL neutrophils (NBNs; median, 3%; range, 0-13%). In the HBN group, FOB showed endoscopic abnormalities in four patients, BAL culture was positive in three patients, and chest x-ray (CXRs) showed minimal densities in four. The IL-8 levels showed a significant increase with respect to the NBN group (p = 0.005). The combination of endoscopic anomalies, BAL culture, BAL IL-8 levels, and minor CXR changes can support the diagnosis of subclincal infection in seemingly healthy children with chronic nonspecific cough and HBN.
慢性咳嗽可能是一个复杂且令人沮丧的诊断难题。本研究的目的是使用纤维支气管镜检查(FOB)和支气管肺泡灌洗(BAL)来确定看似健康的儿童慢性非特异性咳嗽的可能原因。18名儿童符合慢性咳嗽的入选标准。平均年龄为5.8岁(范围1.7 - 10.7岁),并将BAL结果与16名非特应性对照者的结果进行比较。与对照组相比,慢性咳嗽儿童的BAL中性粒细胞百分比增加(p = 0.098)。使用BAL中性粒细胞百分比临界值17%,6名儿童的BAL中性粒细胞较高(HBNs;中位数为77%;范围27 - 96%),12名儿童的BAL中性粒细胞正常(NBNs;中位数为3%;范围0 - 13%)。在HBN组中,FOB显示4例患者有内镜异常,3例患者BAL培养阳性,4例患者胸部X线(CXR)显示密度轻微增加。IL - 8水平相对于NBN组有显著升高(p = 0.005)。内镜异常、BAL培养、BAL IL - 8水平以及轻微的CXR改变相结合,可支持对看似健康的慢性非特异性咳嗽且BAL中性粒细胞较高的儿童进行亚临床感染的诊断。
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