| Objective: To study the level of inflammatory factors and the classification of cells in alveolar lavage fluids of pediatric asthma patients and non-asthmatic patients, explore the significance of bronchoalveolar lavage via bronchofiberscope for diagnosis of asthma and study the clinical significance of bronchoalveolar lavage via bronchofiberscope combining endoscopic budesonide perfusion for treatment of pediatric asthma.Method: 83 children(6 ~ 48 months) with acute attack of moderate persistent asthma were selected and randomly divided into the control group(42 cases) and the treatment group(41 cases); at the same time, 40 non-asthmatic children that received fiberoptic bronchoscopy were taken as the non-asthmatic children group.(1) Bronchofiberscope was used to collect bronchoalveolar lavage fluid and enzyme linked immunosorbent assay(ELISA) was used to detect the levels of Ig E, IL-4 and IL-13, so as to analyze the difference among the levels of these three markers;(2) smears with cells collected from the lavage fluid were stained by Wright Giemsa staining; classification and count of cells were also performed; then, statistic analysis regarding differences in cell types of the asthmatic group and the non-asthmatic group was performed;(3) conventional anti-asthma treatment was given to the control group; based on conventional anti-asthma treatment, bronchoalveolar lavage combining endoscopic budesonide perfusion was given to the treatment group; lung function indexes of children in both groups were measured before treatment and 1 week after treatment, respectively; total effective rates were observed and statistical analysis was separately made; complications of the treatment group were observed. Results:(1) Comparisons regarding cells in lavage fluids of the asthmatic group(the treatment group or the control group) and the non-asthmatic group: proportions of eosinophils, neutrophils and lymphocytes in lavage fluid of the asthmatic group were 9.3±2.1%, 10.4±1.8% and 21.6±4.5%, respectively; proportions of these cells in lavage fluid of the non-asthmatic group were 0.9±0.2%, 1.5±0.6% and 10.8±1.2%, respectively; there was significant statistical difference between the two groups(P<0.01).(2) Comparisons the levels of Ig E, IL-4 and IL-13 in lavage fluids of the asthmatic group and the non-asthmatic group: amounts of Ig E, IL-4 and IL-13 in lavage fluid of the asthmatic group were 332.64±28.32 IU/m L, 29.78±2.13 pg/m L and 41.78±4.81pg/m L, respectively; amounts of these markers in lavage fluid of the non-asthmatic group were 65.52±7.21 IU/m L, 7.95±1.21 pg/m L and 10.92±1.45 pg/m L, respectively; there was significant statistical difference between the two groups(P<0.01).(3) Changes of the airway under endoscope after lavage via bronchofiberscope: there were obvious swelling and hyperemia of tracheal mucosa, increased secretions and airway stenosis in the treatment group before lavage; while after lavage, swelling and hyperemia of tracheal mucosa, amount of secretions and airway blockage were reduced.(4) Comparisons regarding lung functions of the treatment group and the control group before treatment: lung function test were performed to both groups before treatment; there was no significant statistical difference between the two groups regarding the six indexes: PTEF, PTVT, %V-PF, Tp/Te, 25/PF and 50/PF(p>0.05); when lung functions of the treatment group before and after treatment were compared, there was significant statistical difference in each of the six indexes(p<0.01); when lung functions of the control group before and after conventional treatment were compared, there was significant statistical difference in each of the six indexes(p<0.05); when lung functions of the treatment group and the control group after treatment were compared, there was significant statistical difference in each of the six indexes between the two groups(p<0.05).(5) Comparison regarding curative effects in the treatment group and the control group: total effective rates in the treatment group and the control group were respectively 90.2%(37/41)and 76.2%(32/42), with significant statistical difference(P<0.01).(6) Statistics on complications occurred after receiving bronchoalveolar lavage via bronchofiberscope: transient hyoxemia, cyanosis and tachycardia or bradycardia occurred in 5 children(12.2%); postoperative pyrexia occurred in 3 children(7.3%); postoperative cough and/or exacerbation of asthma occurred in 2 children(4.9%). Conclusions:(1) Compared to non-asthmatic patients, there are higher eosinophils, neutrophils,lymphocytes,Ig E, IL-4 and IL-13 in bronchoalveolar lavage fluid of pediatric asthma patients;(2) Lung functions of pediatric asthma patients can be significantly improved by bronchoalveolar lavage via bronchofiberscope combining endoscopic budesonide perfusion; And bronchoalveolar lavage via bronchofiberscope combining endoscopic budesonide perfusion is highly effective in treatment of pediatric asthma patients;... |
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