De Boeck K, Willems T, Van Gysel D, Corbeel L, Eeckels R
Department of Pediatrics, Leuven (Belgium) University Hospital.
Chest. 1995 Jul;108(1):150-2. doi: 10.1378/chest.108.1.150.
The long-term pulmonary consequences of right middle lobe syndrome (RMLS) in childhood are not known. Therefore, outcome was evaluated in 17 children with RMLS diagnosed in early childhood (mean age, 3.3 years; SD, 1.1 year). Mean age at follow-up was 10.1 years (SD, 2.6 years). RMLS was defined as atelectasis of the right middle lobe (RML) of at least 1 month's duration and visible on the lateral view of the chest radiograph as a wedge-shaped density extending from the hilum anteriorly and downward. Seventeen children without personal history of allergy or respiratory tract disease were studied as control group. Five of 17 study group children had ongoing respiratory problems: symptoms of asthma were present in 4 patients, and cylindrical bronchiectasis was present in one patient. Chest radiograph at follow-up was abnormal in six patients. Pulmonary function tests, including mean and SEM for vital capacity (VC) (82% of predicted +/- 7 vs 94% predicted +/- 3), FEV1 (77% of predicted +/- 12 vs 96% of predicted +/- 4) and their ratio (75 +/- 5 vs 85 +/- 3) were significantly lower in patients with ongoing respiratory symptoms than in the control children. The provocative dose causing a 20% decrease in FEV1 (PD20) of methacholine was significantly lower in patients with ongoing symptoms at follow-up than in control children and in patients without symptoms at follow-up (2.8[2.2 to 3.1] vs 4.5[2.2 to 8.8] and 9.2[2.3 to 24] mg/mL; median and P25-75, p < 0.05). Age at initial diagnosis tended to be younger in patients with ongoing symptoms at follow-up (2.3 +/- 0.7 years vs 3.8 +/- 0.4 years; p < 0.08).
儿童期右中叶综合征（RMLS）的长期肺部后果尚不清楚。因此，对17例在幼儿期被诊断为RMLS的儿童（平均年龄3.3岁；标准差1.1岁）的预后进行了评估。随访时的平均年龄为10.1岁（标准差2.6岁）。RMLS被定义为右中叶（RML）肺不张持续至少1个月，在胸部X光片侧位片上可见为从肺门向前下方延伸的楔形密度影。17名无过敏或呼吸道疾病个人史的儿童作为对照组进行研究。研究组的17名儿童中有5名存在持续的呼吸问题：4例患者有哮喘症状，1例患者有柱状支气管扩张。随访时胸部X光片有6例异常。肺功能测试结果显示，有持续呼吸道症状的患者的肺活量（VC）（预测值的82%±7 vs预测值的94%±3）、第一秒用力呼气容积（FEV1）（预测值的77%±12 vs预测值的96%±4）及其比值（75±5 vs 85±3）显著低于对照组儿童。随访时有持续症状的患者，引起FEV1下降20%的乙酰甲胆碱激发剂量（PD20）显著低于对照组儿童和随访时无症状的患者（2.8[2.2至3.1] vs 4.5[2.2至8.8]和9.2[2.3至24] mg/mL；中位数和P25 - 75，p < 0.05）。随访时有持续症状的患者初始诊断时的年龄往往更小（2.3±0.7岁 vs 3.8±0.4岁；p < 0.08）。
