Abu-Hasan Mutasim, Elmallah Mai, Neal Dan, Brookes James
Division of Pediatric Pulmonary and Allergy, University of Florida , Gainesville, Florida.
Department of Neurosurgery, College of Medicine, University of Florida , Gainesville, Florida.
Pediatr Allergy Immunol Pulmonol. 2014 Sep 1;27(3):115-119. doi: 10.1089/ped.2014.0348.
Chronic pulmonary aspiration is a common cause of chronic respiratory symptoms in children. However, there is no gold standard diagnostic test for aspiration. In this study, we explore the diagnostic value of measuring salivary amylase in bronchoalveolar lavage (BAL) fluid as a marker of chronic aspiration in children with different chronic respiratory illnesses. Measurements of salivary amylase in BAL fluid were routinely done in patients undergoing flexible bronchoscopy. Patients' demographic and clinical data were extracted from records and reviewed by one of the investigators. Patients were classified into three different groups based on the reviewer's assessment of risk for aspiration. BAL amylase measurements were masked from the reviewer. Multiple regression analysis was used to determine the effect of the patients' clinical variables on BAL amylase. Sixty-four patients (median age 2 years; range 0-14 years) were included. Indications for bronchoscopy included chronic cough (=20), chronic wheezing (=27), Cystic Fibrosis (=6), recurrent pneumonia (=5), and lung infiltrate in immunocompromised patients (=6). Young age, history of excessive drooling, and wet cough were predictive of high BAL amylase. Thirteen patients were considered at no risk of aspiration, 41 patients were at low risk, and 10 patients were at high risk based on clinical symptoms and other diagnostic tests. No significant differences in BAL amylase levels were found between the three groups. However, when high and low risk groups were combined and compared to the no risk group, there was a significantly higher BAL amylase level in the combined at risk groups (1,722 vs. 307 U/L; =0.03). Receiver operator curve analysis demonstrated that amylase cutoff value of 250 U/L differentiates between the two risk groups with sensitivity of 66.7% and specificity of 69.2%. Salivary amylase level in BAL can help identify children at risk for chronic pulmonary aspiration.
慢性肺误吸是儿童慢性呼吸道症状的常见原因。然而，对于误吸尚无金标准诊断测试。在本研究中，我们探讨了检测支气管肺泡灌洗（BAL）液中唾液淀粉酶作为不同慢性呼吸道疾病患儿慢性误吸标志物的诊断价值。对接受可弯曲支气管镜检查的患者常规检测BAL液中的唾液淀粉酶。从记录中提取患者的人口统计学和临床数据，并由一名研究人员进行审查。根据审查者对误吸风险的评估，将患者分为三个不同组。BAL淀粉酶测量结果对审查者保密。采用多元回归分析确定患者临床变量对BAL淀粉酶的影响。纳入了64例患者（中位年龄2岁；范围0 - 14岁）。支气管镜检查的适应证包括慢性咳嗽（=20）、慢性喘息（=27）、囊性纤维化（=6）、复发性肺炎（=5）以及免疫功能低下患者的肺部浸润（=6）。年龄小、流涎过多史和湿性咳嗽可预测BAL淀粉酶水平高。根据临床症状和其他诊断测试，13例患者被认为无误吸风险，41例患者为低风险，10例患者为高风险。三组之间BAL淀粉酶水平无显著差异。然而，当将高风险组和低风险组合并与无风险组比较时，合并的风险组BAL淀粉酶水平显著更高（1722 vs. 307 U/L；=0.03）。受试者工作特征曲线分析表明，淀粉酶临界值为250 U/L可区分两个风险组，敏感性为66.7%，特异性为69.2%。BAL中的唾液淀粉酶水平有助于识别有慢性肺误吸风险的儿童。
