| Part one Analysis of clinical characteristics of infants with recurrent wheezingObjective:To explore the characteristics of blood routine and immune function in children with recurrent wheezing and their differences with non-wheezing children and healthy children of the same age.Methods:Collect clinical data(age,gender,past history)and blood routine,lymphocyte subsets,humoral immunity,and allergen test results of 378 children with recurrent wheezing who were admitted to the Children's Hospital of Soochow University from January 2011 to September 2019.A retrospective analysis was performed and compared with the results of 92 non-asthmatic pneumonia children and 83 healthy children undergoing outpatient physical examination during the same period.Results:1.The CD3+ratio of infants and young children in the recurrent wheezing group was significantly reduced,which was significantly lower than that of the non-wheezing pneumonia group and the healthy control group,and the difference was statistically significant(P<0.05),while the CD3-CD19+ratio was significantly increased,which was significantly higher than the other two groups(P<0.05).CD19+CD23+in infants with recurrent wheezing was significantly higher than that in non-wheezing pneumonia group,the difference was statistically significant(P<0.05).2.The recurrent wheezing group had lower IgG value than the healthy control group,and the IgM value was higher than the normal control group.The differences were statistically significant(P<0.05).There was no significant difference in IgA value between the three groups of children(P>0.05).3.The platelet value of children in the recurrent wheezing group was significantly higher than that in the healthy control group,and the difference was statistically significant(P<0.05).4.Two pairs of three age groups in recurrent wheezing group were compared.The CD3+CD4+ and CD4+/CD8+ratios in the<6month group were higher than those in the 12-36month group,and the CD3+CD8+values were lower than in the 12-36month group(P<0.05);The CD3+and CD3+CD8+values in the 6-12month group were lower than those in the 12-36month group,and the CD4+/CD8+ratios were higher than those in the 12-36month group(P<0.05).5.In the recurrent wheezing group,the IgA,IgG,and IgM value in the ?6month group were lower than in the 6-12month and 12-36month groups(P<0.05).6.In the recurrent wheezing group,the positive rate of allergens in infants and young children was 33%,the positive rate of inhaled allergens was 6.7%,and the positive rate of ingested allergens was 75.7%.Both positives accounted for 17.6%.The allergen positive rate was significantly higher than the inhaled allergen positive rate,and the difference was statistically significant(?2=72.536,P<0.001).7.The top three positive rates of ingestion allergens are milk 58.9%(33/56),protein 41.1%(23/56),and beef 17.9%(10/56).The positive rate of inhaled allergens from high to low was 80%(4/5)of dust mite combination,20%(1/5)of mold fungus,and 20%(1/5)of dog epithelium.8.A total of 183 cases in 378 infants and adolescents with recurrent wheezing had atopic constitution,accounting for 48.4%.There were 29 atopic infants in the non-wheezing group,accounting for 31.5%.The percentage of atopic infants in the repeated wheezing group was significantly higher than that in the non-wheezing group,and the difference was statistically significant(?2=8.526,P=0.004).There was no significant difference in the composition ratio of allergens of atopic infants in different age groups(P>0.05).Conclusion:(1)Infants with recurrent wheezing have a lymphocyte subgroup and humoral immune disorder.(2)The count of platelet parameters increased in infants with recurrent wheezing.(3)The positive rate of inhaled allergens in infants and young children with recurrnet wheezing is high.(4)The proportion of atopic children with recurrent wheezing is significantly higher than that of the non-wheezing group,and atopy is a risk factor for wheezing.Part two Analysis of bronchoscopy and alveolar lavage fluid in children with recurrent wheezingObjective:To explore the role and value of bronchoscopy and alveolar lavage in the diagnosis and treatment of infants and young children with recurrent wheezing diseases.Methods:The clinical data(age,gender)and alveolar lavage fluid samples of 441 recurrent wheezing and 106 non-wheezing children who had bronchoscopy and alveolar lavage examination in the Children's Hospital of Soochow University from January 2011 to September 2019 were collected.Direct immunofluorescence assay was used to detect respiratory syncytial virus(RSV),adenovirus(ADV),Influenza virus types A and B,Inf-A and B),parainfluenza virus types 1,2 and 3(PIV1 to 3).Real-time PCR was used to detect human bocavirus(HBoV),mycoplasma pneumonia(MP),chlamydia pneumonia(CP).RT-PCR was used to detect human rhinovirus(HRV)and human meta-pneumoniae virus(hMPV).A modified Wright-Gimsa staining method was used to detect cell Morphology.BALF was detected by bacterial culture.Results:There were 441 children with recurrent wheezing who were hospitalized for bronchoscopy and alveolar lavage examination during the period of 1-36 months,including 336 males and 105 females.The most common cause of bronchoscopy is endometrial inflammation,accounting for 97.9%(432/441 cases),followed by tracheal softening,accounting for 16.5%(73/441 cases),tracheobronchial abnormal opening and location accounting for 5.4%(24/441 cases)and throat softening accounting for 4.7%(21/441 cases).Comparing the microscopic etiology of children in different age groups,bronchial endometrial inflammation,tracheobronchial softening,and laryngeal softening were different between the three groups.Bronchial endometrial inflammation had the highest detection ratio in the 12-36month group,tracheobronchial softening and laryngeal softening were the highest in the ?6month group,and the differences were statistically significant(P<0.001).The rest showed no significant difference between different age groups under the microscope(P>0.05),Mycoplasma pneumoniae was most commonly detected in BALF,accounting for 39.0%(172/441 cases),followed by bacteria,accounting for 19.5%(86/441 cases),mainly Streptococcus pneumoniae and Haemophilus influenza,58 cases of virus,accounts for 13.1%,mainly human boca virus.There were no significant differences in the detection rates of bacteria,virus and MP among children with recurrent wheezing in different age groups(P>0.05).The total pathogen detection rate of children in the three age groups was 58.7%(44/75 cases),72.1%(114/158 cases),and 76%(158/208 cases).The total pathogen detection rate was the highest in 12-36month group,and the difference was statistically significant(?2=8.148,P=0.017).The proportion of BALF neutrophils and eosinophils in the recurrent wheezing group were significantly higher than that in the non-wheezing group,while the proportion of phagocytic cells was lower than that in the non-wheezing group,and the differences were statistically significant(P<0.05).Conclusion:(1)The most important manifestations of bronchoscopy in infants with recurrent wheezing is bronchial endometrial inflammation.The tracheobronchial softening and laryngeal softening were the most in the small age group.(2)MP is the most common pathogen of recurrent wheezing diseases in infants and young children.(3)The proportion of neutrophils and eosinophils in alveolar lavage fluid of infants with recurrent wheezing increased. |
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