LUCIND：描绘儿童神经系统疾病中的呼吸系统合并症

文献信息

中文摘要

背景： 患有神经功能障碍的儿童和青少年由于气道清除功能受损、胸廓限制、吞咽困难和气道微生物定植，发生呼吸系统合并症和继发性肺部疾病的风险很高。尽管这些并发症具有临床相关性，但该人群中关于结构性肺改变及其临床相关因素的系统性影像学数据仍然匮乏。
方法： LUCIND（神经系统疾病中的肺部合并症）是一项前瞻性、横断面影像学研究，纳入150名无原发性肺部疾病的神经功能障碍儿童和青少年。参与者按风险分为三个亚组（每组n=50）：1）伴气管造口的神经功能障碍，2）伴吞咽困难的神经功能障碍，3）不伴吞咽困难的神经功能障碍。主要目标是使用超低剂量光子计数计算机断层扫描检测慢性结构性肺异常，如支气管扩张、支气管壁增厚和实变。该技术可在接近传统X线摄影的辐射水平下获得可靠的形态学数据。由于采集时间极短，成像无需镇静即可完成，从而确保在这一脆弱人群中具有较高的患者安全性和可行性。次要目标包括将影像学发现与临床特征相关联，如吞咽功能、呼吸道感染负担、气道微生物定植，以及包括气道清除和抗生素使用在内的治疗措施。影像学将辅以标准化临床数据、言语治疗评估和详细的照护者问卷。
结论： LUCIND将提供一个独特的数据集，以加深我们对神经功能障碍儿童慢性肺病的理解。结果可能为未来的风险分层、早期干预策略和优化临床路径提供信息，并有可能改善生活质量和长期呼吸系统结局。

英文摘要

BACKGROUND: Children and adolescents with neurodisability are at high risk of respiratory comorbidity and secondary pulmonary disease due to impaired airway clearance, thoracic restriction, dysphagia and microbial airway colonisation. Despite the clinical relevance of these complications, systematic imaging data on structural lung changes and their clinical correlates in this population remain scarce.
METHODS: LUCIND (Lung Comorbidity in Neurological Diseases) is a prospective, cross-sectional imaging study enrolling 150 children and adolescents with neurodisability without primary pulmonary disease. Participants are stratified into three risk-based subgroups (n=50 each): 1) neurodisability with tracheostomy, 2) neurodisability with dysphagia, and 3) neurodisability without dysphagia. The primary objective is to detect chronic structural lung abnormalities such as bronchiectasis, bronchial wall thickening and consolidations using ultralow-dose photon-counting computed tomography. This technique yields robust morphological data at radiation levels approaching those of conventional radiography. Due to ultra-short acquisition times, imaging is performed without sedation, ensuring high patient safety and feasibility in this vulnerable population. Secondary aims include the correlation of radiological findings with clinical features, such as swallowing function, respiratory infection burden, microbial airway colonisation, and therapeutic measures including airway clearance and antibiotic use. Imaging will be complemented by standardised clinical data, logopaedic assessment, and detailed caregiver questionnaires.
CONCLUSION: LUCIND will provide a unique dataset to refine our understanding of chronic lung disease in children with neurodisability. Results may inform future risk stratification, early intervention strategies, and optimised clinical pathways, potentially improving both quality of life and long-term respiratory outcomes.