支气管肺泡灌洗术在儿科呼吸系统疾病中的应用

支气管肺泡灌洗术( bronchoalveolar lavage,BAL)在儿童呼吸系统疾病中已得到广泛应用,其在肺部疾病的诊断和治疗价值已得到普遍证实。施行BAL 后所得的支气管肺泡灌洗液( bronchoalve-olar lavage fluid,BALF)常用于微生物病原学鉴定、细胞及非细胞成分分析,指导临床用药、疾病诊断治疗和发病机制研究等。该文就近年来儿科领域BAL的操作技巧、标本转运处理以及在下呼吸道感染、间质性肺病等肺部疾患临床应用中的新进展作一论述。     

支气管肺泡灌洗在儿童呼吸系统疾病诊治中的作用

支气管肺泡灌洗是一种肺介入诊疗技术,它在儿童呼吸系统疾病的诊治中具有良好的应用前景,尤其在重症和疑难的呼吸系统疾病.本文重点介绍了支气管肺泡灌洗在儿童呼吸系统疾病诊断、治疗中的作用,对肺表面活性物质的影响等方面进行了阐述.     

支气管肺泡灌洗在儿科的应用

支气管肺泡灌洗是指通过获取肺泡内液体进行肺部疾病研究的一种方法，近年在国内外日益受到重视。支气管肺泡灌洗在成人肺科应用广旅游，但在儿科应用尚未推广。本文对儿科进行气气管肺泡灌洗的方法，临床应用，安全性等作一综述。     

支气管肺泡灌洗在小儿肺部疾病治疗中的作用

经纤维支气管镜对５０例慢性肺部疾病患儿进行支气管肺泡灌洗治疗。按年龄，灌洗液总量为２５～１２５ｍｌ不等，分５等份进行灌洗。对肺部有感染的，灌洗液前２份为３７℃的生理盐水，后３份为３７℃、０．１２５％～０．２５％甲硝唑。无明显感染者，５等份均为３７℃生理盐水。灌洗后，依病情可局部给药。结果，３２例肺不张中２０例复张，６例好转，６例无变化：１５例慢性肺炎中６例痊愈，９例好转；３例纤维性肺泡炎临床症状改善。提示支气管肺泡灌洗对上述肺部疾病是一种有效的治疗手段。     

支气管肺泡灌洗液细菌培养在小儿肺部感染中的应用

目的：探讨支气管肺泡灌洗液（bronchoalveolar lavage fluid, BALF）细菌培养在小儿肺部感染中的应用价值。方法：对2008年6月至2011年2月因肺部感染住院的80例患儿的痰和BALF进行普通细菌培养,并对两种标本的培养结果进行比较。结果：80例患儿BALF细菌培养中检出草绿色链球菌72例次（90%）,奈瑟氏菌41例次（51%）,肺炎链球菌11例次（14%）,金黄色葡萄球菌3例次（4%）,大肠杆菌3例次（4%）。与痰培养结果比较,BALF中检出草绿色链球菌阳性率差异无统计学意义,但BALF培养中肺炎链球菌阳性率（14%）明显高于痰培养（4%）（P<0.05）,且只有BALF培养中检出了大肠杆菌。结论：BALF细菌培养对小儿肺部感染的病原菌明确具有一定作用。由于BALF细菌培养直接取材于病变部位,能为临床提供相对可靠的诊治依据。     

支气管肺泡灌洗在儿科的应用

支气管肺泡灌洗是指通过获取肺泡内液体进行肺部疾病研究的一种方法，近年在国内外日益受到重视。支气管肺泡灌洗在成人肺科应用广泛，但在儿科应用尚未推广。本文对儿科进行支气管肺泡灌洗的方法、临床应用、安全性等作一综述。     

支气管肺泡灌洗在儿科中的应用进展

支气管肺泡灌洗(BAL)是一种非常有价值的诊疗手段,儿科领域已广泛应用,而且安全有效,可用于研究气道与肺部疾病的发病机制、在肺泡灌洗液中寻找疾病的标志、用药物直接进行灌洗治疗疾病、评价药物作用等.但BAL在技术方法上仍不完善,缺乏标准化的方法,需要更多的探索.该文就近年来国外儿科领域在BAL的方法学、安全性、组分分析及临床应用中的一些新进展作一综述.     

支气管肺泡灌洗在治疗儿童意外吸入类脂性肺炎的应用

目的 探讨支气管肺泡灌洗治疗儿童意外吸人类脂性肺炎的疗效.方法 采用Olympus BF3c-30.BF-482纤维支气管镜及BE-270S(外镜4.9 mm)、EB-270P(外镜3.8 mm)电子支气管镜对9例意外吸人类脂性肺炎患儿进行支气管肺泡灌洗术并观察疗效及随访.结果 9例中4例吸入煤油,1例吸入汽油,1例吸入柴油,1例吸入白电油,2例吸入缝纫机油.治疗后,9例均显效,总有效率100%,术中除短暂血氧饱和度(SaO2)降至85%以外,未见其他严重不良反应.结论 支气管肺泡灌洗治疗意外吸人类脂性肺炎的疗效确切可靠,可以在临床上推广应用,但术中须加强监护.     

支气管肺泡灌洗在儿科中的应用进展

支气管肺泡灌洗 (BAL)是一种非常有价值的诊疗手段 ,儿科领域已广泛应用 ,而且安全有效 ,可用于研究气道与肺部疾病的发病机制、在肺泡灌洗液中寻找疾病的标志、用药物直接进行灌洗治疗疾病、评价药物作用等。但BAL在技术方法上仍不完善 ,缺乏标准化的方法 ,需要更多的探索。该文就近年来国外儿科领域在BAL的方法学、安全性、组分分析及临床应用中的一些新进展作一综述。     

慢性咳嗽和喘息性疾病支气管肺泡灌洗液成分分析

目的 分析慢性咳嗽及喘息性疾病患儿支气管肺泡灌洗液成分。方法 应用免疫组化及ELISA方法，对哮喘（13例）、慢性咳嗽（10例）、婴幼儿喘鸣（8例）患儿和对照组（8例）共39例的支气管肺泡灌洗液进行细胞学分析及上清液IL－5浓度测定。结果 哮喘患儿支气管肺泡灌洗液嗜酸性粒细胞为3．0％（0．7％－8．8％），上皮细胞为3．0％（0．7％－12．0％），IL－5为1．7ng/L(0－16.0ng/L)，与慢性咳嗽组及婴幼儿喘鸣组相比，差异有非常显著意义（P＜0．01）；2例慢性咳嗽及3例婴幼喘鸣儿哮酸性粒细胞亦有异常增多，与组内其他必相比差异有显著意义；婴幼儿喘鸣组中性粒细胞明显增多。结论 哮喘患儿支气管肺泡灌洗液以嗜酸性粒细胞和上皮细胞明显增多为其特征性改变；慢性咳嗽患儿中有嗜酸性粒细胞异常增多者，应注意与哮喘鉴别；婴幼儿喘鸣者以中性粒细胞增多为著，抗哮喘治疗应慎重。     

下呼吸道感染患儿支气管肺泡灌洗液的病原学研究

目的 研究下呼吸道感染患儿病原体特点,为临床医生合理使用抗生素提供依据。方法 选取2017年1月至2018年6月因下呼吸道感染住院且接受纤维支气管镜治疗的108例患儿为研究对象,收集其支气管肺泡灌洗液,通过多重实时荧光PCR检测其病原体。结果 在108例患儿中,检测出病原体85例（78.7%）,其中单一病原体感染检出52例（48.1%）,多重病原体感染检出33例（30.6%）。肺炎支原体检出率最高,共检出38例（35.2%）,其中36~ < 72月龄患儿检出率最高;其次为肺炎链球菌及流感嗜血杆菌,各检出29例（26.9%）,其中肺炎链球菌主要集中于24月龄以下患儿。检出率较低的为鲍曼不动杆菌、白色念珠菌及肺炎克雷伯杆菌,各检出3例（2.8%）。在31例支气管肺炎患儿中,流感嗜血杆菌检出率最高（9例,29%）。在34例大叶性肺炎患儿中,肺炎支原体检出率最高（22例,65%）。在22例支气管异物合并支气管肺炎患儿中,肺炎链球菌检出率最高（10例,45%）。结论 在下呼吸道感染患儿中,肺炎支原体检出率最高,其次为肺炎链球菌及流感嗜血杆菌。不同年龄、不同类型下呼吸道感染患儿的病原体检出率存在差异。     

80例大叶性肺炎患儿肺泡灌洗液病原及临床分析

目的了解儿童大叶性肺炎的主要病原及临床特点。方法选择2013年4月—2015年5月确诊为大叶性肺炎的患儿80例,应用纤维支气管镜行温盐水灌洗,收集肺泡灌洗液(BALF),采用荧光定量PCR(FQ-PCR)法检测并分析患儿BALF中的病原。结果 80例患儿的BALF中检出肺炎支原体(MP)59例,肺炎衣原体(CP)2例,肺炎链球菌(SP)12例,肺炎克雷伯杆菌(KP)1例,腺病毒(ADV)8例,呼吸道合胞病毒(RSV)1例,其中混合感染14例;MP大叶性肺炎儿童7~14岁年龄组多于其他年龄组。结论儿童大叶性肺炎的病原多样,MP是最多见的病原体。     

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??Objective To investigate the application of bronchoalveolar lavage of flexible bronchoscopy in diagnosis and treatment of children with Mycoplasma pneumoniae pneumonia??MPP??. Methods Clinical data of 155 pneumonia patients ??57 cases of MPP and 98 cases of non-MPP????who had examination in flexible bronchoscopy, MP-DNA of bronchoalveolar larlavage fluid(BALF),and the traditional blood serological test of Mycoplasma pneumoniae??were retrospectively analyzed from Aug.2011 to Apr.2012 in Anhui Provincial Children’s Hospital. Results Mycoplasma pneumoniae pneumonia often occur red in children over the age of 5 or with lobar pneumonia or atelectasis in the left lung. The accuracy of MP-DNA in BALF was higher than that of the blood serological test. After alveolar wash and administration of medicines, 95.7?? of the atelectasis cases were cured. Conclusions Flexible bronchoscopy and bronchoalveolar lavage should be applied to MPP and atelectasis cases as soon as possible to promote lung recruitment and improve the outcome.     

Increased eosinophil cationic protein levels in bronchoalveolar lavage from wheezy infants

Although studies examining the serum suggest a role for eosinophils in wheezing episodes in infants and toddlers, the presence of a chronic eosinophilic inflammation within their airways remains to be demonstrated. In this study we investigated whether eosinophil cationic protein (ECP) levels are increased in BAL fluid (BALF) from infants and toddlers with recurrent wheezing episodes, during an asymptomatic period. The levels of ECP in BALF were quantitated by radioimmunoassay in 61 children (36 with severe recurrent episodes of wheezing and 25 who were non-wheezy), aged 6–36 months, in whom flexible bronchoscopy was clinically indicated. BALF eosinophil counts were ≤ 1% in all patients and did not differ in wheezers, compared to non-wheezers. In contrast, ECP levels in BALF were ≥ 2.2 µg/l in 18 of 36 (50%) wheezy infants but in only three of 25 (12%) control infants (p < 0.01). Neutrophil counts were significantly higher in the wheezer group than in the non-wheezer group (8.1 × 10³ cells/ml vs. 3.0 × 10³ cells/ml). ECP levels in the BALF were not correlated with the absolute number of eosinophils ( r  = 0.03; p = 0.8) but were correlated with the absolute number of neutrophils ( r  = 0.54; p = 0.001). There was no association between high ECP levels in BALF and the atopic status of the wheezers. In conclusion, ECP levels are increased in BALF from young children with recurrent wheezing episodes, even during relatively quiescent periods, suggesting a chronic increased cell activation in the lower airways.     

Levels of matrix metalloproteinase-9 and its inhibitor in bronchoalveolar lavage cells of asthmatic children

Our objective was to investigate the role of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) and their cellular sources in childhood asthma. We used 12 controls and 16 asthmatic children. The levels of MMP-9 and TIMP-1 in bronchoalveolar lavage (BAL) cells of asthmatic children were measured immunocytochemically. The positive level index, defined as the percentage of positive-stained cells × average optical density, was used to assess the expressing levels of MMP-9 and TIMP-1. The percentages of eosinophils and mast cells in bronchoalveolar lavage fluid (BALF) of asthmatic children were increased. Levels of MMP-9 and TIMP-1 in BAL cell of asthmatic children were increased significantly at about 30- and 35-fold relative to the controls, respectively. These results suggest that both MMP-9 and TIMP-1 contribute to tissue remodeling. MMP-9, which mediates the degradation of extracellular matrix (ECM), is increased significantly in the early or acute stage and may play a role in ECM degeneration. Excessive TIMP-1 may be synthesized following MMP-9 production when the body tries to repair the damage, which results in excessive deposition of ECM component.     

Fiberoptic bronchoscopy and bronchoalveolar lavage for the evaluation of pulmonary disease in children with primary immunodeficiency and cancer

BACKGROUND: Patients with childhood cancer or primary immunodeficiencies (PID) are at high risk for developing pulmonary infections and non-infectious complications. The broad differential diagnoses and the critical condition of these patients often drive physicians to start broad-spectrum antibiotic therapy before a definite diagnostic procedure is performed. A definite diagnosis may be achieved in these situations by fiberoptic bronchoscopy (FOB) and bronchoalveolar lavage (BAL). PATIENTS AND METHODS: The records of 58 PIDs and cancer (immunocompromised group) pediatric patients who underwent 62 fiberoptic bronchoscopies between 2000 and 2004 were retrospectively reviewed and compared to 158 non-cancer patients who underwent 182 fiberoptic bronchoscopies during the same period. RESULTS: The overall diagnostic rate achieved by macroscopic inspection of purulent secretions or hemorrhage, abnormal cell count, and infectious agent isolation in the immunocompromised patients was 84%. A definite organism was recovered in 53.2% of the patients. Probable infection defined as purulent secretions or abnormal cell count without infectious agent isolation was diagnosed in another 21% of the patients. The rate of complications was 30.6%. In the control group, the overall diagnostic rate was 76.9% (n.s) and an infectious agent was demonstrated in 12.1% (P < 0.001). Probable infection was diagnosed in 24.2% (n.s) while the rate of complications was lower (15%) (P < 0.01). CONCLUSIONS: Rapid and accurate diagnoses were achieved in most procedures performed on immunocompromised patients. Although the rate of complications was higher in the immunocompromised group, they were usually very mild with no mortality. Based on these results, broncoalveolar lavage should be considered as an initial diagnostic tool in pediatric immunocompromised patients with pulmonary complications.