Alishlash Ammar Saadoon, Yu Zhihong, Lazrak Ahmed, Simpson Ryne, Ale Guillermo Beltran, Harris William T, Matalon Sadis
Department of Pediatrics, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Department of Anesthesiology and Perioperative Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Pediatr Pulmonol. 2025 Apr;60(4):e71070. doi: 10.1002/ppul.71070.
Low molecular-weight hyaluronic acid (LMW-HA) is produced by the degradation of high-molecular-weight hyaluronic acid at the pulmonary interstitium and alveolar epithelium by reactive intermediates following lung injury. We aimed to investigate the role of bronchoalveolar lavage (BAL) LMW-HA as a biomarker of pediatric chronic pulmonary aspiration (CPA).
Single-center prospective comparison of LMW-HA presence in BAL in pediatric Aerodigestive patients with and without CPA undergoing clinically indicated bronchoscopy. Pediatric pulmonologists diagnosed CPA based on video-fluoroscopic swallowing evaluation.
Fifteen children (mean age 6.1 years, male predominance at 73%, and 53% with CPA) were enrolled. Children with CPA have comparable baseline characteristics (age, sex, and race), but their BAL had higher white blood cell count, higher neutrophil percentages, higher bacterial culture positivity rates, and lower macrophage percentages than those without CPA. The two groups were comparable in sex, BAL lymphocyte percentages, eosinophil percentages, red blood cell counts, and lipid-laden macrophage positivity. Detection of BAL LMW-HA in the BAL had a 100% specificity and 88% sensitivity for CPA diagnosis. BAL protein levels were higher in the CPA group and in participants with positive LMW-HA.
We suggest BAL LMW-HA as a potential novel biomarker of pediatric CPA with high specificity and sensitivity. BAL LMW-HA is not detectable in subjects without CPA and is associated with increased BAL protein levels.
低分子量透明质酸（LMW - HA）是在肺损伤后，由肺间质和肺泡上皮中的高分子量透明质酸被反应性中间体降解产生的。我们旨在研究支气管肺泡灌洗（BAL）液中LMW - HA作为小儿慢性肺误吸（CPA）生物标志物的作用。
对接受临床指征支气管镜检查的患有和未患有CPA的小儿气道消化道疾病患者的BAL液中LMW - HA的存在情况进行单中心前瞻性比较。小儿肺科医生根据视频透视吞咽评估诊断CPA。
纳入15名儿童（平均年龄6.1岁，男性占73%，53%患有CPA）。患有CPA的儿童具有可比的基线特征（年龄、性别和种族），但与未患CPA的儿童相比，他们的BAL液白细胞计数更高、中性粒细胞百分比更高、细菌培养阳性率更高，巨噬细胞百分比更低。两组在性别、BAL液淋巴细胞百分比、嗜酸性粒细胞百分比、红细胞计数和载脂巨噬细胞阳性率方面具有可比性。BAL液中检测到LMW - HA对CPA诊断的特异性为100%，敏感性为88%。CPA组和LMW - HA阳性参与者的BAL蛋白水平更高。
我们建议将BAL液LMW - HA作为小儿CPA的一种具有高特异性和敏感性的潜在新型生物标志物。在未患CPA的受试者中检测不到BAL液LMW - HA，且其与BAL蛋白水平升高有关。
