BACKGROUND & AIMS: :We report a patient who developed bronchiolitis obliterans organizing pneumonia (BOOP) after syngeneic BMT for ALL. The patient complained of persistent low-grade fever and non-productive cough after engraftment. Chest CT scan showed patchy infiltration bilaterally in the lower lung fields. Antibiotics were ineffective. Cultures, serological studies and polymerase chain reaction detected no infectious pathogens. We finally made a diagnosis of BOOP by thoracoscopical lung biopsy. The lung lesion disappeared in a month with corticosteroid therapy. While BOOP following allogeneic BMT has been reported, this is the first report after syngeneic transplantation.

背景与目标： ：我们报告了在所有患者的同种BMT后发生闭塞性细支气管炎的患者，并组织了肺炎（BOOP）。该患者抱怨移植后持续低烧和非生产性咳嗽。胸部CT扫描显示下肺野两侧有片状浸润。抗生素无效。文化，血清学研究和聚合酶链反应未发现传染性病原体。我们终于通过胸腔镜肺活检诊断出BOOP。皮质类固醇激素治疗一个月后，肺部病变消失了。虽然已经报道了异基因BMT后的BOOP，但这是同基因移植后的首次报道。

BACKGROUND & AIMS: OBJECTIVES:To measure the duration of illness in ambulatory children diagnosed with bronchiolitis and to examine clinical predictors of duration of illness. DESIGN:Validation inception cohort study. Duration of follow up was 28 days. SETTING:A primary-level ambulatory department of a public sector children's hospital in Cape Town, South Africa. PATIENTS:One hundred eighty-one children aged 2 to 23 months who went to the hospital as their first contact for that episode of illness, and had a clinical diagnosis of bronchiolitis were enrolled consecutively on weekday mornings if their guardian stated that they were contactable by telephone. MAIN OUTCOME MEASURE:Resolution of symptoms, as judged by the guardian, measured by twice-weekly telephone interviews. RESULTS:Median duration of illness (calculated as the reported duration of symptoms before initial hospital visit plus the time from first consultation to recovery) was 12 days (95% confidence interval, 11-14 days). After 21 days, 18% were still ill and after 28 days, 9% were still ill. Sixty-two patients (34.2%) had unscheduled consultations within 28 days, a median of 13 days after the first consultation. There was no association of duration of illness with age, sex, z score for weight for age, or respiratory rate. CONCLUSIONS:Ambulatory children diagnosed with bronchiolitis recover with few complications, but the resolution of symptoms may take several weeks. Providing parents with this information could help reduce the high rate of unscheduled return visits as observed in this cohort.

背景与目标： 目的：测量被诊断为毛细支气管炎的非卧床患儿的病程，并检查其病程的临床预测指标。
设计：验证起始队列研究。随访时间为28天。
地点：南非开普敦一家公共儿童医院的初级门诊部。
患者：一百一十八名年龄在2至23个月的儿童是该疾病的初次接触者，其病情经临床诊断为毛细支气管炎。如果监护人表示可以通过以下方式与他们联系，则他们在工作日的早晨连续入组：电话。
主要观察指标：监护人判断为症状缓解，方法是每周两次电话访谈。
结果：中位病程（以首次就诊前报道的症状持续时间加上从第一次咨询到康复的时间）为12天（95％置信区间为11-14天）。 21天后，仍有18％的病人生病，而28天后，仍有9％的病人生病。 62例患者（34.2％）在28天内进行了计划外的咨询，中位数为第一次咨询后的13天。疾病的持续时间与年龄，性别，年龄权重的z得分或呼吸频率没有关联。
结论：被诊断为毛细支气管炎的迁徙儿童可以恢复，并发症很少，但症状的缓解可能需要几周的时间。向父母提供此信息可以帮助减少在此队列中观察到的计划外回访的高比率。

BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: :While the development of pulmonary disease due to Mycobacterium avium complex (MAC) infection is most commonly associated with underlying predisposing factors, this organism occasionally causes symptomatic disease in otherwise normal individuals. Patients with MAC pulmonary disease most often present with cavitating granulomas, but a spectrum of pathologic changes has been described. The authors present a case of MAC pulmonary disease in an immunocompetent, middle-aged man with no identified predisposing factors. The diagnostic biopsy disclosed the unusual finding of noncaseating granulomas with predominant involvement of bronchioles, corresponding to the patient's obstructive and restrictive pulmonary dysfunction.

背景与目标： ：虽然禽鸟分枝杆菌复合物（MAC）感染导致的肺部疾病发展与潜在的诱发因素最相关，但该生物偶尔会在其他正常个体中引起症状性疾病。 MAC肺部疾病患者最常出现空洞性肉芽肿，但已描述了一系列病理变化。作者介绍了一例具有免疫功能的中年男子的MAC肺部疾病，但未发现诱发因素。诊断性活检揭示了非干酪性肉芽肿的异常发现，其中主要是细支气管受累，这与患者的阻塞性和限制性肺功能不全相对应。

BACKGROUND & AIMS: :Bronchiolitis is a common cause of wheezing among infants. Respiratory syncytial virus (RSV) is the most common infectious agent to cause bronchiolitis, and RSV infection accounts for more than 125,000 hospitalizations per year in the United States. Beyond supportive measures, the care of infants with bronchiolitis remains controversial. Practitioners continue to treat infants with a variety of pharmacologic agents, despite limited evidence of their efficacy. Investigators continue to search for the safest and most cost-effective methods to treat infants with bronchiolitis, not only to overcome obstructive symptoms during the acute illness, but also to prevent recurrent symptoms of airway obstruction that occur in some children for years after their initial episode of bronchiolitis. Improved understanding of the pathogenesis of RSV infection and of virus-host interactions may one day lead to the development of agents that alter the initial inflammatory response and strategies that help prevent recurrent episodes of wheezing and the development of asthma after acute bronchiolitis.

背景与目标： 毛细支气管炎是婴儿气喘的常见原因。呼吸道合胞病毒（RSV）是引起毛细支气管炎的最常见传染原，在美国，RSV感染每年导致超过125,000例住院治疗。除支持措施外，毛细支气管炎婴儿的护理仍存在争议。尽管有有限的证据表明，从业人员继续用各种药物治疗婴儿。研究人员一直在寻找最安全，最具成本效益的方法来治疗毛细支气管炎的婴儿，不仅可以克服急性疾病期间的阻塞性症状，而且还可以预防某些儿童在初发后的数年中反复出现的气道阻塞症状毛细支气管炎。对RSV感染的发病机理和病毒-宿主相互作用的加深了解可能有一天会导致改变初始炎症反应的药物和有助于预防急性细支气管炎后反复发作的喘息和哮喘发展的策略的开发。

BACKGROUND & AIMS: :Respiratory Syncytial Virus (RSV) is the leading cause of hospitalization for lower respiratory tract infections (LRTI) in young children worldwide. RSV is an important cause of LRTI in infants and a variety of factors, such as gender, age at admission, gestational age, birth weight, and exposure to tobacco smoke and breast feeding may affect the prevalence of RSV-related disease and, possibly, the risk of developing asthma-like symptoms during the school years. AAP in 2006 formulated the new guidelines on diagnosis and management of bronchiolitis, giving recommendations on different conditions requesting clinical decisions also in terms of prevention.

背景与目标： ：呼吸道合胞病毒（RSV）是全球幼儿下呼吸道感染（LRTI）住院的主要原因。 RSV是婴儿引起LRTI的重要原因，诸如性别，入院年龄，胎龄，出生体重以及接触烟草烟雾和母乳喂养等多种因素可能会影响RSV相关疾病的流行，并且可能在学年期间出现哮喘样症状的风险。 AAP在2006年制定了关于毛细支气管炎诊断和处理的新指南，针对不同情况提出了建议，要求在预防方面也需要临床决策。

BACKGROUND & AIMS: :STATEMENT OF FINDINGS: Varying concentrations of helium-oxygen (heliox) mixtures were evaluated in mechanically ventilated children with bronchiolitis. We hypothesized that, with an increase in the helium:oxygen ratio, and therefore a decrease in gas density, ventilation and oxygenation would improve in children with bronchiolitis. Ten patients, aged 1-9 months, were mechanically ventilated in synchronized intermittent mandatory ventilation (SIMV) mode with the following gas mixtures delivered at 15-min intervals: 50%/50% nitrogen/oxygen, 50%/50% heliox, 60%/40% heliox, 70%/30% heliox, and return to 50%/50% nitrogen/oxygen. The use of different heliox mixtures compared with 50%/50% nitrogen/oxygen in mechanically ventilated children with bronchiolitis did not result in a significant or noticeable decrease in ventilation or oxygenation.

背景与目标： ：结论：在机械通气性毛细支气管炎患儿中，评估了不同浓度的氦氧（氦氧混合气）混合物。我们假设，随着氦气与氧气比例的增加，从而降低儿童的毛细支气管炎的气体密度，通气量和充氧量，这种状况将得到改善。年龄为1-9个月的10例患者在同步间歇性强制通气（SIMV）模式下进行了机械通气，并以15分钟的间隔输送以下气体混合物：50％/ 50％氮气/氧气，50％/ 50％日光浴，60 ％/ 40％日光灯，70％/ 30％日光灯，并返回50％/ 50％氮气/氧气。在机械通气的细支气管炎患儿中，与50％/ 50％的氮/氧相比，使用不同的氦氧混合气不会导致通气或氧合的显着或显着降低。

BACKGROUND & AIMS: :Airway rejection after lung transplantation is recognized histologically as lymphocytic bronchiolitis (LB). We hypothesized that inhaled steroids could control LB and that changes in exhaled nitric oxide (eNO) would correlate with the development of LB and also have a role in monitoring response to treatment. A cohort of 120 lung transplant (LT) recipients attending for review and biopsy had eNO measurements, FEV1, lavage microbiology, and biopsy histology performed prospectively. Wilcoxon signed-rank test was used to assess the significance of changes in eNO and FEV1. The coefficient of reproducibility of eNO measurement in stable recipients was 2.36 ppb. Fourteen developed graft dysfunction owing to isolated LB and were treated with inhaled budesonide 800 microg twice daily. They showed significant increases in eNO at diagnosis, median (range) 10.9 ppb (4.6 to 48) ppb compared with baseline, 4.33 (1.0 to 10.76), p = 0.008, and a decrease in FEV1. After inhaled treatment, both eNO and FEV1 returned to baseline values. Seven developed acute vascular rejection (with or without LB) and were treated with oral corticosteroids; no changes in eNO occurred at diagnosis or after treatment. Serial eNO measurements provide a useful noninvasive method of identifying airway inflammation in LT recipients. Inhaled budesonide may be a useful addition to systemic immunosuppressants in controlling airway inflammation posttransplant.

背景与目标： 肺移植后：气道排斥在组织学上被认为是淋巴细胞性细支气管炎（LB）。我们假设吸入的类固醇可以控制LB，而呼出的一氧化氮（eNO）的变化将与LB的发生有关，并且在监测对治疗的反应中也具有作用。参加检查和活检的120名肺移植（LT）接受者队列前瞻性地进行了eNO测量，FEV1，灌洗微生物学和活检组织学检查。 Wilcoxon符号秩检验用于评估eNO和FEV1变化的重要性。在稳定的受者中，eNO测量的可重复性系数为2.36 ppb。由于分离出的LB，有十四个移植物功能障碍，每天两次吸入布地奈德800μg吸入治疗。他们显示出诊断时的eNO显着增加，中位数（范围）与基线相比为10.9 ppb（4.6至48）ppb，4.33（1.0至10.76），p = 0.008，FEV1降低。吸入治疗后，eNO和FEV1均恢复到基线值。 7例出现急性血管排斥反应（有或没有LB），并接受口服皮质类固醇激素治疗；诊断或治疗后eNO均无变化。连续的eNO测量为鉴定LT受体的气道炎症提供了一种有用的非侵入性方法。在控制移植后气道炎症中，吸入布地奈德可能是对全身免疫抑制剂的有用补充。

BACKGROUND & AIMS: OBJECTIVE:To determine whether eosinophil-derived neurotoxin (EDN) is a predictive marker of recurrent wheezing episodes in post-respiratory syncytial virus (RSV) bronchiolitis. METHODS:EDN levels and recurrent wheezing episodes were serially measured in 200 infants hospitalized with RSV bronchiolitis. RESULTS:Serum EDN levels at 3 months correlated significantly with total wheezing episodes at 12 months in the RSV-PLC (n  = 71; r = 0.720, p < 0.0001) and RSV-MONT groups (n = 79; r = 0.531, p < 0.001). Positive predictive value of 3-mo EDN level for total wheezing episodes was 57%; negative predictive value, 76%; sensitivity, 72%; specificity, 62%. CONCLUSION:EDN levels have predictive value for the development of recurrent wheezing post-RSV bronchiolitis.

背景与目标： 目的：确定嗜酸性粒细胞源性神经毒素（EDN）是否是呼吸道合胞病毒（RSV）细支气管炎反复喘息发作的预测指标。
方法：连续测量200例RSV细支气管炎住院婴儿的EDN水平和反复喘息发作。
结果：RSV-PLC（n = 71; r = 0.720，p <0.0001）和RSV-MONT组（n = 79; r = 0.531，p）在3个月时的血清EDN水平与12个月时总的喘息发作显着相关<0.001）。 EDN水平3个月对总的喘息发作的阳性预测值为57％；阴性预测值，占76％；敏感度为72％；特异性为62％。
结论：EDN水平对RSV后细支气管炎复发性喘息的发生具有预测价值。

BACKGROUND & AIMS: :152 patients with thromboangiitis obliterans (Buerger's disease) and pain from critical leg ischaemia were randomly allocated to receive iloprost, a chemically stable prostacyclin analogue, or low-dose aspirin, for 28 days in a double-blind trial. On review, 19 patients did not fulfil the stringent entry criteria. Of the other 133 patients, 98 also had leg ulcers. After 21-28 days, 58 (85%) of 68 iloprost-treated patients showed ulcer healing or relief of ischaemic pain, compared with 11 (17%) of 65 in the aspirin-treated group. 43 (63%) on iloprost treatment had complete relief of pain, compared with 18 (28%) on aspirin. Ulcers healed completely in 18 of 52 (35%) who received iloprost compared with 6 of 46 (13%) who received aspirin. 6 months after the start of treatment, the response rate was 45 of 51 (88%) patients treated with iloprost compared with 12 of 44 (21%) patients treated with aspirin.

背景与目标： 在双盲试验中，将152名患有闭塞性血栓性血管炎（Buerger病）和因严重下肢缺血的疼痛的患者随机分配接受伊洛前列素（伊洛前列素），伊洛前列素是一种化学稳定的前列环素类似物或小剂量阿司匹林。经复查，有19名患者不符合严格的入院标准。在其他133名患者中，有98名还患有腿部溃疡。 21-28天后，接受伊洛前列素治疗的68位患者中有58位（85％）溃疡愈合或减轻了缺血性疼痛，而阿司匹林治疗组的65位中有11位（17％）。伊洛前列素治疗组中有43（63％）名患者完全缓解了疼痛，而阿司匹林治疗组中只有18（28％）名。接受伊洛前列素的52名患者中有18名（35％）的溃疡完全治愈，而接受阿司匹林的46名患者中有6名（13％）的溃疡得到了完全治愈。在开始治疗后的6个月，伊洛前列素治疗的51例患者中有45例（88％）有效率，而阿司匹林治疗的44例患者中有12例（21％）有效率。

BACKGROUND & AIMS: :Infants with the respiratory syncytial virus (RSV) and human rhinovirus respiratory infection (HRV) produce inflammatory interleukins (ILs) in the respiratory epithelium. The aim of this study was to evaluate the levels of interleukin-8 in RSV negative and RSV positive patients. This study search was conducted without a time limit until 2020 through the databases of PubMed, Wiley, Springer, ScienceDirect and Google Scholar search engines, by two researchers independently. The random-effects model was used to compare of interleukin-8 in RSV negative vs. RSV positive patients, using Revman software version 5 meta-analysis software. Totally, 921 patients were evaluated (207 RSV-negative and 714 RSV-positive). The mean concentration of IL8 in RSV positive patients was 15.02 pg/ml (95% CI: 13.68- 16.35%).  According to the meta-analysis results, the standardized mean difference (SMD) of IL8 concentration between RSV-positive and negative patients was 6.31 pg/ml) (95% confidence interval: 2.50- 10.13%). subtotal analysis of the IL8 laboratory assessment method revealed that there was no significant SMD deference in the studies that have used chemiluminescence (P=0.21). while IL8 concentrations were significantly higher in RSV positives in ELISA and Magnetic bead-based assays (P<0.05).  It appears that RSV positive patients may have greater levels of IL8 than RSV negative ones; whereas the synthesis of IL8 tends to be more secreted into the nasopharyngeal space; whereas the evaluation approach can also affect the results.

背景与目标： ：患有呼吸道合胞病毒（RSV）和人鼻病毒性呼吸道感染（HRV）的婴儿在呼吸道上皮中产生炎性白介素（ILs）。这项研究的目的是评估RSV阴性和RSV阳性患者中白细胞介素8的水平。这项研究的搜索是在没有时间限制的情况下进行的，直到2020年，由两名研究人员独立地通过PubMed，Wiley，Springer，ScienceDirect和Google Scholar搜索引擎的数据库进行了搜索。使用Revman软件版本5荟萃分析软件，使用随机效应模型比较RSV阴性和RSV阳性患者的白细胞介素8。总共评估了921例患者（207例RSV阴性和714例RSV阳性）。 RSV阳性患者中IL8的平均浓度为15.02 pg / ml（95％CI：13.68-16.35％）。根据荟萃分析结果，RSV阳性和阴性患者之间IL8浓度的标准平均差（SMD）为6.31 pg / ml（95％置信区间：2.50-10.13％）。 IL8实验室评估方法的小计分析显示，在使用化学发光的研究中，没有明显的SMD依赖（P = 0.21）。在ELISA和基于磁珠的检测中，RSV阳性的IL8浓度显着较高（P <0.05）。看来RSV阳性患者的IL8水平可能高于RSV阴性患者;而IL8的合成往往更多地分泌到鼻咽空间;而评估方法也会影响结果。

BACKGROUND & AIMS: AIMS AND OBJECTIVES:To measure the benefit of a short-family therapeutic conversation (STC) intervention in an acute paediatric unit. BACKGROUND:Studies of children with bronchiolitis caused by respiratory syncytial virus (RSV) have shown that this virus may have an impact on their respiratory system in the form of a wheezing disorder, asthma and even allergy during their childhood. Studies of the parents of these children indicate that they experience distress, vulnerability and anxiety through the illness period and therefore need support from healthcare professionals. However, little is known about what intervention is of most benefit for these parents. DESIGN:Quasi-experimental. METHOD:Data were collected from a convenience sample from February throughout April 2009 at an acute unit at a children's hospital in Iceland. Parents of infants diagnosed with bronchiolitis caused by RSV were invited to attend. In total, there are 41 participants: 21 in the intervention group (n = 21) and 20 in the control group (n = 20). Parents in both groups answered questionnaires about perceived support and family expressive functioning both before the intervention and on an average of 11 days after the intervention. RESULTS:The main findings showed that mothers in the intervention group perceive significantly higher support after the intervention compared with the control group. The findings also showed a significant difference between the genders (mothers and fathers) in the intervention group. The mothers perceived higher cognitive support than the fathers. CONCLUSIONS:Despite the often chaotic environment in an acute care setting, the research findings give paediatric nurses reason to conclude that a STC intervention benefits mothers of infants with bronchiolitis caused by RSV. RELEVANCE TO CLINICAL PRACTICE:A STC intervention offered by a nurse within an acute paediatric unit can support families in handling the illness experience.

背景与目标： 目的和目的：评估急性小儿科的短期家庭治疗性对话（STC）干预的益处。
背景：由呼吸道合胞病毒（RSV）引起的毛细支气管炎患儿的研究表明，该病毒可能以童年时期的喘息性疾病，哮喘甚至过敏等形式影响其呼吸系统。对这些孩子的父母的研究表明，他们在患病期间会感到困扰，脆弱和焦虑，因此需要医疗保健专业人员的支持。但是，对于哪种干预对这些父母最大的益处知之甚少。
设计：准实验。
方法：数据是从2009年2月至2009年4月在冰岛一家儿童医院的急诊室的便民样本中收集的。邀请被诊断为RSV引起的毛细支气管炎的婴儿的父母参加。总共有41位参与者：干预组21位（n = 21），对照组20位（n = 20）。两组父母均回答了有关干预前和干预后平均11天的感知支持和家庭表达功能的问卷。
结果：主要研究结果表明，干预组的母亲在接受干预后的支持率明显高于对照组。研究结果还表明，干预组的性别（母亲和父亲）之间存在显着差异。母亲比父亲感觉到更高的认知支持。
结论：尽管急性护理环境中经常出现混乱的环境，但研究发现使儿科护士有理由得出结论，STC干预有益于由RSV引起的毛细支气管炎婴儿。
与临床实践的关系：急性儿科内的护士提供的STC干预可以支持家庭处理疾病经历。

BACKGROUND & AIMS: :Bronchiolitis is a distressing, potentially life-threatening respiratory condition that affects young babies. Around 2-3% of all infants younger than 1 year are admitted to hospital with bronchiolitis, usually during the seasonal epidemic. The majority of these infants are infected with respiratory syncytial virus and all have an intense inflammatory response in their airways. Although most infants recover, they have an increased risk of recurrent wheezing. Although bronchiolitis is common, little is known about what causes infants to be susceptible. Diagnostic interventions have little effect on clinical outcome, and apart from supportive measures, there is no specific treatment. Bronchiolitis therefore presents an intriguing clinical conundrum and a major challenge to researchers. High quality clinical studies are needed to clarify assessment of disease severity and criteria for hospital admission, particularly the use of pulse oximetry and chest radiography. Careful mapping of the inflammatory pathways in the pathogenesis of bronchiolitis should lead to development of new therapies to alleviate symptoms.

背景与目标： 毛细支气管炎是一种令人痛苦的，可能威胁生命的呼吸道疾病，会影响年幼的婴儿。通常在季节性流行期间，约有2-3％的1岁以下婴儿入院患有毛细支气管炎。这些婴儿中的大多数感染了呼吸道合胞病毒，并且它们的呼吸道均具有强烈的炎症反应。尽管大多数婴儿都能康复，但他们反复发作喘息的风险增加。尽管毛细支气管炎很常见，但对导致婴儿易感的原因知之甚少。诊断干预措施对临床结果影响不大，除支持性措施外，尚无特异性治疗方法。因此，毛细支气管炎给临床研究人员带来了有趣的难题和重大挑战。需要高质量的临床研究来阐明疾病严重程度和入院标准的评估，尤其是脉搏血氧饱和度和胸部X线摄片的使用。在细支气管炎发病机理中仔细绘制炎症途径的图谱应导致开发新的缓解症状的疗法。

BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: RATIONALE:Bronchiolitis obliterans syndrome (BOS) remains the leading cause of death after lung transplantation. Treatment is difficult, although azithromycin has recently been shown to improve FEV(1). The exact mechanism of action is unclear. HYPOTHESES:(1) Azithromycin reduces airway neutrophilia and interleukin (IL)-8 and (2) airway neutrophilia predicts the improvement in FEV(1). METHODS:Fourteen lung transplant patients with BOS (between BOS 0-p and BOS 3) were treated with azithromycin, in addition to their current immunosuppressive treatment. Before and 3 mo after azithromycin was introduced, bronchoscopy with bronchoalveolar lavage (BAL) was performed for cell differentiation and to measure IL-8 and IL-17 mRNA ratios. RESULTS:The FEV(1) increased from 2.36 (+/- 0.82 L) to 2.67 L (+/- 0.85 L; p = 0.007), whereas the percentage of BAL neutrophilia decreased from 35.1 (+/- 35.7%) to 5.7% (+/- 6.5%; p = 0.0024). There were six responders to azithromycin (with an FEV(1) increase of > 10%) and eight nonresponders. Using categorical univariate linear regression analysis, the main significant differences in characteristics between responders and nonresponders were the initial BAL neutrophilia (p < 0.0001), IL-8 mRNA ratio (p = 0.0009), and the postoperative day at which azithromycin was started (p = 0.036). There was a significant correlation between the initial percentage of BAL neutrophilia and the changes in FEV(1) after 3 mo (r = 0.79, p = 0.0019). CONCLUSION:Azithromycin significantly reduces airway neutrophilia and IL-8 mRNA in patients with BOS. Responders have a significantly higher BAL neutrophilia and IL-8 compared with nonresponders and had commenced treatment earlier after transplantation. BAL neutrophilia can be used as a predictor for the FEV(1) response to azithromycin.

背景与目标： 理由：闭塞性细支气管炎综合征（BOS）仍然是肺移植后死亡的主要原因。尽管最近已证明阿奇霉素可改善FEV（1），但治疗困难。确切的作用机理尚不清楚。
假设：（1）阿奇霉素可减少气道中性粒细胞增多和白介素（IL）-8，（2）气道中性粒细胞减少可预测FEV（1）。
方法：除了目前的免疫抑制治疗外，还用阿奇霉素治疗了14例BOS 0-p和BOS 3之间的BOS肺移植患者。在引入阿奇霉素之前和之后3个月，用支气管肺泡灌洗液（BAL）进行支气管镜检查以区分细胞并测量IL-8和IL-17 mRNA的比例。
结果：FEV（1）从2.36（/-0.82 L）增加到2.67 L（/-0.85 L; p = 0.007），而BAL中性粒细胞的百分比从35.1（/-35.7％）降低到5.7％（/ -6.5％； p = 0.0024）。阿奇霉素有6名反应者（FEV（1）升高> 10％）和8名无反应者。使用分类单变量线性回归分析，反应者和非反应者之间的主要特征差异是初始BAL中性粒细胞增多（p <0.0001），IL-8 mRNA比（p = 0.0009）和阿奇霉素开始的术后天数（p = 0.036）。 BAL中性粒细胞的初始百分比与3个月后FEV（1）的变化之间存在显着相关性（r = 0.79，p = 0.0019）。
结论：阿奇霉素可显着降低BOS患者气道中性粒细胞和IL-8 mRNA的表达。与无反应者相比，有反应者的BAL中性粒细胞和IL-8明显更高，并且在移植后更早开始治疗。 BAL中性粒细胞增多症可用作FEV（1）对阿奇霉素反应的预测因子。