Belachew N, Jerkic S, Michel F, Schubert R, Zielen S, Rosewich M
Klinik für Kinder- und Jugendmedizin, Allergologie, Pneumologie und Mukoviszidose.
Pneumologie. 2019 Jul;73(7):399-406. doi: 10.1055/a-0853-0253. Epub 2019 Mar 20.
Bronchiolitis obliterans (BO) is a rare and severe pulmonary disease which can occur due to airway infection or as a result of stem cell or lung transplantation. Our goal was to study the lung function and airway inflammation among BO patients. Furthermore, we examined the potential of the lung clearance index (LCI) for BO diagnostics among that group.
16 BO patients (age: 16.7; 9.6 - 25.3 years) and 17 healthy controls (age: 16.6; 7.6 - 25.0 years) participated in the study. Lung function parameters (FVC, FEV, MEF, RV und RV/TLC) as well as airway reversibility after administration of 400 µg salbutamol was investigated. The lung clearance index was determined using the multiple-breath washout method (MBW). Additionally, induced sputum was analyzed for cytology and cytokine levels (IL-1ß, IL-6, IL-8, TNF-α) using the cytometric bead array (CBA).
BO patients had significantly lower FVC, FEV and MEF but increased RV and RV/TLC. Airway reversibility was observed in 3 patients. The LCI was significantly higher among BO patients compared to the healthy control group (median 10.24 vs. 7.1). Apart from a massive airway inflammation indicated by elevated numbers of total cells and neutrophils, the CBA analysis showed increased levels of IL-6 and IL-8 (p < 0.01).
In BO patients, lung function in childhood and adolescence is severely impaired. Furthermore, we were able to demonstrate the sensitivity and reproducibility of LCI and its value for the evaluation of small airway obstruction. In induced sputum, a neutrophil-dominated airway inflammation is detectable.
闭塞性细支气管炎（BO）是一种罕见且严重的肺部疾病，可因气道感染或干细胞移植或肺移植而发生。我们的目标是研究BO患者的肺功能和气道炎症。此外，我们还研究了肺清除指数（LCI）在该组患者中用于BO诊断的潜力。
16例BO患者（年龄：16.7岁；9.6 - 25.3岁）和17名健康对照者（年龄：16.6岁；7.6 - 25.0岁）参与了本研究。研究了肺功能参数（FVC、FEV、MEF、RV和RV/TLC）以及吸入400μg沙丁胺醇后的气道可逆性。使用多次呼吸冲洗法（MBW）测定肺清除指数。此外，使用细胞计数微珠阵列（CBA）分析诱导痰的细胞学和细胞因子水平（IL-1β、IL-6、IL-8、TNF-α）。
BO患者的FVC、FEV和MEF显著降低，但RV和RV/TLC升高。3例患者观察到气道可逆性。与健康对照组相比，BO患者的LCI显著更高（中位数10.24对7.1）。除了总细胞和中性粒细胞数量增加表明存在大量气道炎症外，CBA分析显示IL-6和IL-8水平升高（p < 0.01）。
在BO患者中，儿童和青少年时期的肺功能严重受损。此外，我们能够证明LCI的敏感性和可重复性及其在评估小气道阻塞方面的价值。在诱导痰中，可检测到以中性粒细胞为主的气道炎症。
