Jornal Brasileiro de Pneumologia (Jun 2010)
Celularidade do líquido de LBA em crianças e adolescentes saudáveis e com doenças pulmonares Cell profile of BAL fluid in children and adolescents with and without lung disease
Abstract
Este estudo teve como objetivo rever a literatura existente sobre a celularidade do LBA em crianças e adolescentes saudáveis, bem como sobre sua utilização como método propedêutico e de acompanhamento nas afecções pulmonares neste grupo etário. Para tanto, utilizamos o banco de dados médico Medline com a seleção de artigos publicados entre 1989 e 2009 utilizando os seguintes descritores MeSH com operadores boolianos: bronchoalveolar lavage AND cytology OR cell AND child. Em crianças saudáveis, a celularidade é composta por macrófagos alveolares (> 80%), linfócitos (cerca de 10%), neutrófilos (cerca de 2%) e eosinófilos (The objective of this study was to review the literature on bronchoalveolar lavage fluid cell profiles in healthy children and adolescents, as well as on the use of BAL as a diagnostic and follow-up tool for lung disease patients in this age bracket. To that end, we used the Medline database, compiling studies published between 1989 and 2009 employing the following MeSH descriptors (with Boolean operators) as search terms: bronchoalveolar lavage AND cytology OR cell AND child. In healthy children, the cell profile includes alveolar macrophages (> 80%), lymphocytes (approximately 10%), neutrophils (approximately 2%) and eosinophils (< 1%). The profile varies depending on the disease under study. The number of neutrophils is greater in wheezing children, especially in non-atopic children, as well as in those with pulmonary infectious and inflammatory profiles, including cystic fibrosis and interstitial lung disease. Eosinophil counts are elevated in children/adolescents with asthma and can reach high levels in those with allergic bronchopulmonary aspergillosis or eosinophilic syndromes. In a heterogenous group of diseases, the number of lymphocytes can increase. Evaluation of the BAL fluid cell profile, when used in conjunction with clinical and imaging findings, has proven to be an essential tool in the investigation of various lung diseases. Less invasive than transbronchial and open lung biopsies, BAL has great clinical value. Further studies adopting standard international protocols should be carried out. Such studies should involve various age groups and settings in order to obtain reference values for BAL fluid cell profiles, which are necessary for a more accurate interpretation of findings in children and adolescents with lung diseases.
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