肺泡灌洗液流式细胞学、HRCT在儿童重症肺炎的应用  

Utility of bronchoalveolar lavage fluid flow cytometry and HRCT for children with severe pneumonia

作　　者：杨伟健[1] 詹文丽 唐远平[1] 刘永熙[3] 朱欢欢[1] 吴松 郑亦男[1] YANG Wei-jian;ZHAN Wen-li;TANG Yuan-ping;LIU Yong-xi;ZHU Huan-huan;WU Song;ZHENG Yi-nan(Pediatric Intensive Care Unit,Guangdong Women and Children Hospital/Guangdong Children Hospital,Guangzhou,Guangdong 511400,China;Medical Genetics Center,Guangdong Women and Children Hospital/Guangdong Children Hospital,Guangzhou,Guangdong 511400,China;Department of Radiology,Guangdong Women and Children Hospital/Guangdong Children Hospital,Guangzhou,Guangdong 511400,China)

机构地区：[1]广东省妇幼保健院/广东省儿童医院儿童重症医学科,广东广州511400 [2]广东省妇幼保健院/广东省儿童医院医学遗传中心,广东广州511400 [3]广东省妇幼保健院/广东省儿童医院放射科,广东广州511400

出　　处：《临床肺科杂志》2021年第2期209-214,共6页Journal of Clinical Pulmonary Medicine

摘　　要：目的探讨肺泡灌洗液(BALF)流式细胞学、HRCT在儿童重症肺炎的应用价值。方法回顾分析2018年9月4日至2019年5月7日广东省妇幼保健院儿童重症医学科收治重症肺炎的临床资料。BALF:流式细胞学、培养及荧光定量(RT)-PCR;外周血:常规、T淋巴亚群分类及病原血清学。设置对照组:异物取出术后复查。影像学分组:中心气道改变(CAL)与次级肺小叶改变(SPLL)。BALF分组:CD^+4/CD^+8≥1与CD^+4/CD^+8<1。结果(1)重症肺炎N%高于对照组[42.6%(2.0%~92.8%)vs 12.7%(3.6%~23.6%),U=80.5,P<0.05],重症肺炎CD^+4/CD^+8低于对照组[0.8(0.2~7.3)vs 2.9(0.5~5.3),U=96,P<0.05]。(2)SPLL对比CAL:N%更高[52.6%(39.8%~92.8%)vs 11.2%(2%~38.4%),U=0,P<0.05;存在正相关性(r=0.9,P<0.05)],细菌感染率更高[64.7%(11/17例)vs 23.1%(3/13例),χ^2=5.1,P<0.05]。(3)CD^+4/CD^+8<1对比CD^+4/CD^+8≥1:病毒感染率更高[83.3%(20/24例)vs 31.3%(5/16例),χ^2=11.1,P<0.05]。结论儿童重症肺炎CT显示次级肺小叶改变时,N%、细菌感染率更高。CD^+8%优势,CD^+4/CD^+8倒置时,病毒感染率更高。除病原学检查,BALF流式细胞学提供有用的鉴别诊断信息。Objective To investigate the value of utilizing bronchoalveolar lavage fluid flow cytometry and HRCT for children with severe pneumonia.Methods The clinical data of PICU of Guangdong Women and Children Hospital from September 4th,2018 to May 7th,2019 were retrospectively analyzed.BALF was given flow cytometry,traditional culture and quantitative RT-PCR.Blood was given routine test,T lymphocyte subsets classification and etiological serology.The control group was set for examination after operation of extracting foreign body.Central airway lesion(CAL)and secondary pulmonary lobule lesion(SPLL)were observed in the imaging group.BALF grouping was based on CD^+4/CD^+8≥1/CD^+4/CD^+8<1.Results(1)N%was higher in the severe pneumonia group than in the control group[42.6%(2.0%~92.8%)vs 12.7%(3.6%~23.6%),U=80.5,P<0.05],and CD^+4/CD^+8 was lower in the severe pneumonia group than in the control group[0.8(0.2~7.3)vs 2.9(0.5~5.3),U=96,P<0.05].(2)N%was higher in the SPLL group than in the CAL group[52.6%(39.8%~92.8%)vs 11.2%(2%~38.4%),U=0,P<0.05;positive correlation(r=0.9,P<0.05)],and the rate of bacterial infection was higher in the SPLL group than in the CAL group[64.7%(11/17)vs 23.1%(3/13),χ^2=5.1,P<0.05].(3)The rate of viral infection was higher in the CD^+4/CD^+8<1 group than in the CD^+4/CD^+8≥1 group[83.3%(20/24)vs 31.3%(5/16),χ^2=11.1,P<0.05].Conclusion Children with severe pneumonia showing SPLL by CT examination have higher N%and bacterial infection.While CD^+8%dominates and CD^+4/CD^+8 inverses,viral infection rate is higher.Besides pathogen tests,BALF cytometry can provide useful information for differential diagnosis.

关 键 词：支气管镜 肺泡灌洗 流式细胞学 高分辨率计算机断层扫描 重症肺炎 

分 类 号：R725.6[医药卫生—儿科]