急性吸入高渗盐水并不能改善所有囊性纤维化患儿的黏液清除功能。
Acute inhalation of hypertonic saline does not improve mucociliary clearance in all children with cystic fibrosis.
机构信息
Eudowood Division of Pediatric Respiratory Sciences, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
出版信息
BMC Pulm Med. 2011 Sep 6;11:45. doi: 10.1186/1471-2466-11-45.
BACKGROUND
Little is known of how mucociliary clearance (MCC) in children with cystic fibrosis (CF) and normal pulmonary function compares with healthy adults, or how an acute inhalation of 7% hypertonic saline (HS) aerosol affects MCC in these same children.
METHODS
We compared MCC in 12 children with CF and normal pulmonary function after an acute inhalation of 0.12% saline (placebo), or HS, admixed with the radioisotope 99 mtechnetium sulfur colloid in a double-blind, randomized, cross-over study. Mucociliary clearance on the placebo day in the children was also compared to MCC in 10 healthy, non-CF adults. Mucociliary clearance was quantified over a 90 min period, using gamma scintigraphy, and is reported as MCC at 60 min (MCC60) and 90 min (MCC90).
RESULTS
Median [interquartile range] MCC60 and MCC90 in the children on the placebo visit were 15.4 [12.4-24.5]% and 19.3 [17.3-27.8%]%, respectively, which were similar to the adults with 17.8 [6.4-28.7]% and 29.6 [16.1-43.5]%, respectively. There was no significant improvement in MCC60 (2.2 [-6.2-11.8]%) or MCC90 (2.3 [-1.2-10.5]%) with HS, compared to placebo. In addition, 5/12 and 4/12 of the children showed a decrease in MCC60 and MCC90, respectively, after inhalation of HS. A post hoc subgroup analysis of the change in MCC90 after HS showed a significantly greater improvement in MCC in children with lower placebo MCC90 compared to those with higher placebo MCC90 (p = 0.045).
CONCLUSIONS
These data suggest that percent MCC varies significantly between children with CF lung disease and normal pulmonary functions, with some children demonstrating MCC values within the normal range and others showing MCC values that are below normal values. In addition, although MCC did not improve in all children after inhalation of HS, improvement did occur in children with relatively low MCC values after placebo. This finding suggests that acute inhalation of hypertonic saline may benefit a subset of children with low MCC values.
背景
人们对于囊性纤维化（CF）患儿和健康成人的黏膜纤毛清除（MCC）功能知之甚少，也不清楚吸入 7%高渗盐水（HS）气溶胶对这些患儿的 MCC 有何影响。
方法
我们采用双盲、随机交叉研究，比较了 12 例 CF 合并正常肺功能患儿在吸入 0.12%盐水（安慰剂）或混合放射性同位素 99m锝硫胶体的 HS 后，MCC 的变化。同时，我们还比较了这 12 例患儿在安慰剂日的 MCC 与 10 例健康非 CF 成人的 MCC。采用γ闪烁照相术在 90 分钟内定量评估 MCC，结果以 60 分钟（MCC60）和 90 分钟（MCC90）的 MCC 表示。
结果
在安慰剂日，患儿的 MCC60 和 MCC90 中位数（四分位距）分别为 15.4%（12.4-24.5）和 19.3%（17.3-27.8%），与成人的 17.8%（6.4-28.7%）和 29.6%（16.1-43.5%）相似。与安慰剂相比，HS 对 MCC60（2.2%[-6.2-11.8%]）或 MCC90（2.3%[-1.2-10.5%]）的改善均不显著。此外，HS 吸入后，12 例患儿中 5 例的 MCC60 下降，4 例的 MCC90 下降。对 HS 后 MCC90 变化的亚组分析显示，与 MCC90 较高的患儿相比，MCC90 较低的患儿在 HS 后 MCC 有显著改善（p = 0.045）。
结论
这些数据表明，CF 肺病患儿与肺功能正常的患儿之间的 MCC 百分比差异显著，一些患儿的 MCC 值在正常范围内，而另一些患儿的 MCC 值则低于正常值。此外，虽然 HS 吸入后并非所有患儿的 MCC 都有改善，但在安慰剂后 MCC 值相对较低的患儿中确实有改善。这一发现表明，急性吸入高渗盐水可能对一部分 MCC 值较低的患儿有益。
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