The Johns Hopkins Medical Institutions, Baltimore, MD.
The Johns Hopkins Medical Institutions, Baltimore, MD.
J Pediatr. 2014 Apr;164(4):839-45. doi: 10.1016/j.jpeds.2013.11.031. Epub 2013 Dec 24.
To determine if mucus removal is impaired in children with cystic fibrosis (CF) who have been recently infected with Pseudomonas aeruginosa.
We compared mucociliary clearance (MCC), cough clearance (CC), lung morphology, and forced expiratory volume in 1 second (FEV1) in 7- to 14-year-old children with CF and mild lung disease (FEV1 ≥ 80%). Children were either P. aeruginosa negative (n = 8), or P. aeruginosa positive (P. aeruginosa obtained from at least 1 airway culture in the preceding 18 months) (n = 10). MCC and CC were quantified from gamma camera imaging of the right lung immediately after inhalation of (99m)technetium sulfur-colloid (time 0), over the next 60 minutes (average percent clearance over the first 60 minutes [AveMCC60]), 60-90 minutes (average percent clearance between 70 and 90 minutes [AveMCC/CC90]), and after 24 hours (percent clearance after 24 hours [MCC24hrs]). Children coughed 30 times between 60 and 90 minutes. Lung morphology was assessed by high resolution computed tomography (HRCT) scores of both lungs (total score) and of the right lung, using the Brody scale. Percent AveMCC60, AveMCC/CC90, MCC24hrs, FEV1, and HRCT scores were compared across the 2 groups using unpaired t tests. Associations were assessed using Spearman correlation.
There were no differences between the 2 groups in AveMCC60, MCC24hrs, mean HRCT total scores, right lung HRCT scores, or mean FEV1. AveMCC/CC90 was significantly decreased in children with P. aeruginosa compared with those without (16.2% ± 11.0% vs 28.6% ± 7.8%, respectively; P = .016). There was a significant negative correlation of AveMCC60 and AveMCC/CC90 with total lung HRCT score (all P < .05) but not with FEV1.
Infection with P. aeruginosa is associated with a significant slowing of MCC/CC in children with mild CF and may be a more sensitive indicator of the effects of P. aeruginosa than measurements of FEV1.
确定近期感染铜绿假单胞菌的囊性纤维化（CF）患儿的黏液清除功能是否受损。
我们比较了 7 至 14 岁 CF 患儿（FEV1≥80%）的黏膜纤毛清除率（MCC）、咳嗽清除率（CC）、肺形态和 1 秒用力呼气量（FEV1），这些患儿分为铜绿假单胞菌阴性（n=8）和铜绿假单胞菌阳性（铜绿假单胞菌在过去 18 个月中至少从 1 个气道培养物中获得）（n=10）。MCC 和 CC 是在吸入（99m）锝硫胶体后立即通过右肺伽马相机成像（时间 0）定量的，在接下来的 60 分钟内（前 60 分钟的平均清除率[AveMCC60]），60-90 分钟（70 至 90 分钟之间的平均清除率[AveMCC/CC90]）和 24 小时后（24 小时后清除率[MCC24hrs]）。在 60 至 90 分钟之间，孩子们咳嗽了 30 次。通过 Brody 量表评估右肺和双肺的高分辨率计算机断层扫描（HRCT）评分来评估肺形态。使用配对 t 检验比较两组之间的 24 小时平均清除率百分比（MCC24hrs）、AveMCC60、AveMCC/CC90、FEV1 和 HRCT 评分。使用 Spearman 相关性评估关联。
两组之间的 AveMCC60、MCC24hrs、平均 HRCT 总分、右肺 HRCT 评分或平均 FEV1 无差异。与无铜绿假单胞菌组相比，铜绿假单胞菌组的 AveMCC/CC90 显著降低（16.2%±11.0%与 28.6%±7.8%，P=0.016）。AveMCC60 和 AveMCC/CC90 与总肺 HRCT 评分呈显著负相关（均 P<.05），但与 FEV1 无关。
在患有轻度 CF 的儿童中，铜绿假单胞菌感染与 MCC/CC 显著减慢有关，与 FEV1 测量相比，它可能是铜绿假单胞菌影响的更敏感指标。
