Marguet Christophe, Bocquel Nathalie, Benichou Jacques, Basuyau Jean Pierre, Hellot Marie France, Couderc Laure, Mallet Eric, Macé Bertrand
Pediatric Respiratory Disease Unit, Rouen University Hospital-Charles Nicolle, Rouen cedex, France.
Pediatr Allergy Immunol. 2008 Mar;19(2):157-65. doi: 10.1111/j.1399-3038.2007.00600.x. Epub 2007 Dec 18.
Acute bronchiolitis is the main cause of emergency visits and hospitalizations in infants. Recent data suggest that neutrophil- and eosinophil-mediated inflammations were part of bronchiolitis pathophysiology. Apart from the defined risk factors, few was known on the underlying pathophysiology, which might point out the differences observed in the severity of the disease. The aim of this study was to assess whether the clinical severity of acute epidemic bronchiolitis in young infants might be related to a specific underlying inflammatory process. Total and differential cell counts, IL-8, eotaxin, eosinophil cationic protein (ECP) and albumin levels were assessed at the time of admission in bronchial secretions from 37 infants (median age 17 wk) with acute bronchiolitis. Outcome severity variables were: hypoxemia, Silverman score, tachypnea, feeding alteration, and duration of hospitalization. Neutrophils predominated, and eosinophils were present in 54% of the infants. IL-8 levels strongly correlated with ECP and albumin levels. Albumin levels were correlated with ECP and eotaxin levels. IL-8 levels were higher in infants with hypoxemia and inversely related with SaO(2) levels. IL-8 and albumin levels significantly rose with respiratory rate, and Silverman score. IL-8, albumin and ECP levels were significantly higher in infants hospitalized >/=7 days. Furthermore, IL-8 levels were correlated with the duration of hospitalization. Neither cell counts nor eotaxin levels were related to the severity criteria studied. This study suggests that IL-8-associated airway inflammation significantly contributed to the severity of acute epidemic bronchiolitis.
急性细支气管炎是婴儿急诊就诊和住院的主要原因。近期数据表明，中性粒细胞和嗜酸性粒细胞介导的炎症是细支气管炎病理生理学的一部分。除了已明确的危险因素外，对于潜在的病理生理学知之甚少，这可能解释了在疾病严重程度上观察到的差异。本研究的目的是评估小婴儿急性流行性细支气管炎的临床严重程度是否可能与特定的潜在炎症过程有关。对37例（中位年龄17周）急性细支气管炎婴儿入院时支气管分泌物中的细胞总数及分类计数、白细胞介素-8（IL-8）、嗜酸性粒细胞趋化因子、嗜酸性粒细胞阳离子蛋白（ECP）和白蛋白水平进行了评估。结局严重程度变量包括：低氧血症、西尔弗曼评分、呼吸急促、喂养改变和住院时间。以中性粒细胞为主，54%的婴儿存在嗜酸性粒细胞。IL-8水平与ECP和白蛋白水平密切相关。白蛋白水平与ECP和嗜酸性粒细胞趋化因子水平相关。低氧血症婴儿的IL-8水平较高，且与血氧饱和度（SaO₂）水平呈负相关。IL-8和白蛋白水平随呼吸频率和西尔弗曼评分显著升高。住院≥7天的婴儿IL-8、白蛋白和ECP水平显著更高。此外，IL-8水平与住院时间相关。细胞计数和嗜酸性粒细胞趋化因子水平均与所研究的严重程度标准无关。本研究表明，IL-8相关的气道炎症显著促成了急性流行性细支气管炎的严重程度。
