支气管肺泡灌洗对儿童难治性肺炎临床疗效、炎症因子及免疫功能的影响
Effect of bronchoalveolar lavage on the clinical efficacy, inflammatory factors, and immune function in the treatment of refractory pneumonia in children.
作者信息
Pei Minqing, Jiang Ping, Wang Tingting, Xia Caifeng, Hou Ruiying, Sun Ailing, Zou Hui
机构信息
Department of Pediatrics, Sunshine Union Hospital, Weifang, China.
Department of Pediatrics, Affiliated Hospital of Weifang Medical College, Weifang, China.
出版信息
Transl Pediatr. 2021 Apr;10(4):921-928. doi: 10.21037/tp-21-89.
BACKGROUND
Refractory pneumonia is a special type of pneumonia in children. This study aimed to analyze the effect of bronchoalveolar lavage (BAL) on the clinical efficacy, inflammatory factors, and immune function in the treatment of pediatric refractory pneumonia.
METHODS
A total of 196 children with refractory pneumonia admitted to our hospital from January 2017 to January 2020 were enrolled and allocated to a study group (n=99) and a control group (n=97). The study group was treated with BAL treatment plus conventional treatment, and the control group was treated with conventional treatment. The clinical efficacy, time of fever regression, time of cough relief, and length of hospital stay were compared between groups. Changes in inflammatory factors, immune function, pulmonary ventilation function, and complications were analyzed. The levels of inflammatory factors in BAL fluid were compared.
RESULTS
The times of fever remission, cough relief, and hospital stay of the study group was shorter than those of the control group, and the total clinical effective rate of the study group was higher. At any time after treatment, the levels of interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor-alpha (TNF-α) in the study group were lower than the control group. After 3-day of treatment, IL-6, CRP and TNF-α in BAL fluid in the study group were significantly decreased compared with before treatment. Immunoglobulin A (IgA) and immunoglobulin G (IgG) levels in the study group were higher than those in the control group at any time after treatment, and immunoglobulin M (IgM) levels were lower than in the control group. The levels of oxygenation index (OI), lung dynamic compliance (Cdyn), and work of breathing (WOB) in the study group were higher than those in the control group at any time after treatment.
CONCLUSIONS
BAL treatment can effectively relieve the inflammatory response, improve immune function and lung ventilation function in children with refractory pneumonia. The clinical effect is remarkable and worthy of promotion.
背景
难治性肺炎是儿童肺炎的一种特殊类型。本研究旨在分析支气管肺泡灌洗（BAL）对小儿难治性肺炎临床疗效、炎症因子及免疫功能的影响。
方法
选取2017年1月至2020年1月我院收治的196例难治性肺炎患儿，分为研究组（n = 99）和对照组（n = 97）。研究组采用BAL治疗联合常规治疗，对照组采用常规治疗。比较两组的临床疗效、退热时间、咳嗽缓解时间及住院时间。分析炎症因子、免疫功能、肺通气功能及并发症的变化。比较BAL液中炎症因子水平。
结果
研究组的退热时间、咳嗽缓解时间及住院时间均短于对照组，研究组的总临床有效率更高。治疗后任何时间，研究组白细胞介素-6（IL-6）、C反应蛋白（CRP）及肿瘤坏死因子-α（TNF-α）水平均低于对照组。治疗3天后，研究组BAL液中IL-6、CRP及TNF-α较治疗前显著降低。治疗后任何时间，研究组免疫球蛋白A（IgA）和免疫球蛋白G（IgG）水平均高于对照组，免疫球蛋白M（IgM）水平低于对照组。治疗后任何时间，研究组的氧合指数（OI）、肺动态顺应性（Cdyn）及呼吸功（WOB）均高于对照组。
结论
BAL治疗可有效缓解难治性肺炎患儿的炎症反应，改善免疫功能及肺通气功能。临床效果显著，值得推广。
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