Wurzel Danielle F, Marchant Julie M, Yerkovich Stephanie T, Upham John W, Mackay Ian M, Masters I Brent, Chang Anne B
Queensland Children's Medical Research Institute, The University of Queensland, and Queensland Children's Respiratory Centre, Royal Children's Hospital, Brisbane, QLD.
Queensland Children's Medical Research Institute, The University of Queensland, and Queensland Children's Respiratory Centre, Royal Children's Hospital, Brisbane, QLD.
Chest. 2014 Jun;145(6):1271-1278. doi: 10.1378/chest.13-2442.
Prior studies on protracted bacterial bronchitis (PBB) in children have been retrospective or based on small cohorts. As PBB shares common features with other pediatric conditions, further characterization is needed to improve diagnostic accuracy among clinicians. In this study, we aim to further delineate the clinical and laboratory features of PBB in a larger cohort, with a specific focus on concurrent viral detection.
Children with and without PBB (control subjects) undergoing flexible bronchoscopy were prospectively recruited. Basic immune function testing and lymphocyte subset analyses were performed. BAL specimens were processed for cellularity and microbiology. Viruses were identified using polymerase chain reaction (PCR) and bacteria were identified via culture.
The median age of the 104 children (69% male) with PBB was 19 months (interquartile range [IQR], 12-30 mo). Compared with control subjects, children with PBB were more likely to have attended childcare (OR, 8.43; 95% CI, 2.34-30.46). High rates of wheeze were present in both groups, and tracheobronchomalacia was common. Children with PBB had significantly elevated percentages of neutrophils in the lower airways compared with control subjects, and adenovirus was more likely to be detected in BAL specimens in those with PBB (OR, 6.69; 95% CI, 1.50-29.80). Median CD56 and CD16 natural killer (NK) cell levels in blood were elevated for age in children with PBB (0.7 × 109/L; IQR, 0.5-0.9 cells/L).
Children with PBB are, typically, very young boys with prolonged wet cough and parent-reported wheeze who have attended childcare. Coupled with elevated NK-cell levels, the association between adenovirus and PBB suggests a likely role of viruses in PBB pathogenesis.
既往关于儿童迁延性细菌性支气管炎（PBB）的研究多为回顾性研究或基于小样本队列。由于PBB与其他儿科疾病有共同特征，因此需要进一步明确其特征以提高临床医生的诊断准确性。在本研究中，我们旨在通过更大的队列进一步描述PBB的临床和实验室特征，特别关注同时进行的病毒检测。
前瞻性招募接受可弯曲支气管镜检查的PBB患儿和非PBB患儿（对照受试者）。进行基本免疫功能检测和淋巴细胞亚群分析。对支气管肺泡灌洗（BAL）标本进行细胞计数和微生物学检查。采用聚合酶链反应（PCR）鉴定病毒，通过培养鉴定细菌。
104例PBB患儿（69%为男性）的中位年龄为19个月（四分位间距[IQR]，12 - 30个月）。与对照受试者相比，PBB患儿更有可能曾入托（比值比[OR]，8.43；95%置信区间[CI]，2.34 - 30.46）。两组喘息发生率均较高，气管支气管软化常见。与对照受试者相比，PBB患儿下呼吸道中性粒细胞百分比显著升高，PBB患儿的BAL标本中更有可能检测到腺病毒（OR，6.69；95% CI，1.50 - 29.80）。PBB患儿血液中CD56和CD16自然杀伤（NK）细胞水平的年龄校正中位数升高（0.7×10⁹/L；IQR，0.5 - 0.9细胞/L）。
PBB患儿通常为年龄很小的男孩，有持续湿性咳嗽且家长报告有喘息，曾入托。腺病毒与PBB之间的关联以及NK细胞水平升高表明病毒在PBB发病机制中可能起作用。
