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소아에서 만성기침으로 나타나는 질환

입력일:2007-08-18 / 조회수:36197 / 추천수:265 / 작성자:한만용

서 론

기침은 병의원에 환자들이 호소하는 가장 흔한 증상이다. 기침은 기도내 이물질이나  분비물을 제거하는데 중요한 방어작용을하며 다른 사람에게 감염을 전파하는 중요한  통로이기도 하다. 이러한 기침은 자극물질의 자극으로 반응하는 복합반사궁( Complex   reflex   arc )에 의한다. 대부분의 수용체는 기도에 있으나 중추기침부위( central   cough   center )가 뚜렷하지 않고  연수( medulla )에 넓게 퍼져있는 것으로 보인다. 효과적인 기침을  유발하기 위해서는 흉곽내 압력과 빠른 유속을 만들 수 있는가에 달려있다. 기침이  효과적이지 않은 것은 호흡근이 피곤해지었거나 점액의 부착 성질이 변하였을 때이다. 여러  약물요법이외 기침 유도 방식이 도움이 될 것이라 여겨지지만 환자의 유병율과 사망률의  변화가 있었다는 임상 연구는 아직 부족한 실정이다. 1)   

3 -4주 이상 지속되는 기침은 소아에서 흔한 증상이다. 오랜기간 기침을 호소하는 환자들  대부분은 심한 폐질환을 가지고 있지 않지만 기침으로 인해 생활에 장해를 받고 있다. 또한  이러한 만성기침은 치료하기가 어려운 증상이기도 하다. 한 연구자는 5세미만 소아에서  호흡기 증상이 없이 반복적인 기침을 호소한 환자가 22%에 이른다고 보고하였다. 2)   유럽의  다기관 연구에서 7세에서 11세 만성기침 환자는 9%였다. 3)

소아에서는 성인과 달리 기침이 건강한 소아에서도 나타날 수 있다. 건강한 소아는 평균  하루에 10여회(최대 34회) 기침을 하며 호흡기 감염에 걸렸을 때 이보다 증가하게 된다. 4)   다른 연구에서는 정상 소아에서 평균 10회, 최대 141회의 기침을 하루에 하였다. 이러한  환자들 중 폐기능과 기관지 과민도도 정상인 환자가 있다. 일시적으로 기침수용체 과민도  증가로 인해서 기침이 심한 환자들은 기침이 해소되면 과민도도 정상으로 돌아온다. 5)   만성기침이 성인과 다른 모습을 띄고 있기에 본 내용에서는 소아에서 만성 기침의 분류와  일반적인 사항을 기술하고 원인이 될 수 있는 각 질환의 임상적 의미를 설명하고, 소아에서  만성기침을 어떻게 접근해야 하는지를 마지막에 정리해보고자 한다.

기간에 따른 기침 분류

기침은 기간에 따라 접근하게 된다. 3주 또는 이내의 기침을  ‘ 급성기침 ’  이라고 하며 3주  또는 이상 지속될 때 기침이 오래간다고 할 수 있다. 소아에서 감기에 의해서 기침이  소실되는 시점이 1주에서 3주 후이므로(그림 1) 소아에서 기침이 오래가는 경우를  정의한다면 3주 또는 4주 이상 지속되는 기침으로 해야 할 것이다. 9 )

그림 1) 한 연구자는 감기가 얼마나 오래가는지를 추적하였다. 0세부터 4세로 천식이 없는  소아 257명을 7일 14일 21일 28일 추적하였다. 연구의 목적은 감기로 내원한 환자들의  기침이 얼마나 오래가는가를 확인하기 위한 것이다.  X  축은 기간을 말하고  Y 축은 소실율을  보인다. 그림에서 보다시피 환자의 50%는 기침이 10일내에 사라진다. 25일 이내에 95%가  기침이 호전되었다. 이러한 데이터를 근거로 해서 어떤 연구자는 3주 라고 하기도 하고  소아과의 다른 연구자는 4주 까지를 급성 기침의 기간으로 정한다.

그렇다면  ‘ 만성기침 ’ 의 정의는 무었인가 ? 분류는 연구자마다 다르다. 성인에서 8주 이상  기침이 지속될 때 만성 기침이라고 하기도 한다. 6 )    소아에서도 3주 이상을 만성기침이라고  하기도 하며 7 )   어떤 연구에서는 12주 이상을 만성기침으로 정의하였다. 8 )   한 연구자는 급성  기침과 만성기침 사이에  ‘ 아급성 기침 ’ 이라는 중간영역을 만들어서 만성 기침의 원인과  차별을 시키려고 하였다. 이는 감염후 기침이 오래가는 경우가 있으므로 이를 감별하기 위한 것이다(그림 2 참조).  

 

그림 2) 스웨덴 연구자가 기침이 얼마나오래가는 가에 대해서   조사를 시행하였다.  연구자들은 1992년부터 1995년까지 백일해, 백일해양( Bordetella   parapertussis ),  마이코플라스마, 클라미디아 균에 감염된 155명의 소아를 추적하였다. 이중 64%인 99명의  환자들이 100일 이내에 기침이 사라지었다. 역으로 36% 환자는 기침이 100일 이상갔다.  백일해에 걸리면 평균 51일동안 기침을 하였고 마이코플라스마는 23일동안 기침하였다.  클라미디아 감염 후에는 26일동안 기침하였다. 중복 감염이 된 환자의 평균 기침 기간은  60일 이었다.  

그러므로 기침을 기간으로 분류를 한다면 다음과 같이 해야 할 것이다. 3주 이내의 기침을  ‘ 급성기침 ’ 이라고 하며, 3주 이상 8주 이내의 기침을  ‘ 아급성기침 ’ , 8주 이상의 기침을  ‘ 만성기침 ’ 으로 한다(그림 3 참조).

 

만성 기침의 원인

급성기침은 대부분 감기에 의한다. 성인에서는 3주 이상 지속되는 기침의 원인으로는  ‘ 기관지천식 ’   ’ 후비루증후군( Postnasal   drip   syndrome ) ’ 와  ‘ 위식도역류 ’ 가 중요하다. 10)   이를  Rhinitis ,  Reactive ,  Reflux  라고 하여 3 R  이라고도 한다. 성인에서는 건성기침과 만성기침  여부에 상관없이 흡연을 하지 않고  가슴사진에 특별한 소견이 없는 거의 100% 환자가 이  세가지 질환이 원인이라고 설명되곤 한다(그림 4 참조).  

 

그림 4) 만성기침이 있으면 먼저 성인에서는 흡연여부와 A CEI  약물 복용을 물어보아야  한다. 만일 있다면 먼저 끊고 기침이 가라 앉는데 4주가 걸리므로 기다려 보도록 한다.  그래도 기침을 하면,  “ 기관지 천식 ” ,  “ 위식도 역류 ” 와  “ 후비루 ” 를 생각해야 한다. 성인  에서는 기침이 오래가는 것에 대해 많은 연구가 있어왔다.  만성 기침 성인환자의 거의  1 00% 또는 80% 평균 90%의 환자가 세가지 원인이라고 설명되어진다.

영유아를 비롯한 16세 미만의 소아를 대상으로 한 연구에서 4주이상 지속되는 만성 기침의  원인으로 가장 많은 원인으로 천식이형기침( Cough   variant   asthma )과 부비동염을  지적하였다. 11 )   이비인후과 의사인 연구자는 비내시경의 유용성에 대해서 강조하였다(그림 5  참조).  

 

그림 5) 소아를 대상으로 만성 기침의 원인을 첫 조사한 것은 1986년 논문이다. 이빈후과  의사가 발표를 하였고 이것이 추가연구 되어서 1991년 논문에 만성기침의 원인을 다음과  같은 순서로 나열하였다. 소아과 의사인 우리가 기존에 생각하였던 질병 명과 달리  aberrant   innominate   artery 와  subglottic   stenosis   진단명이 높은 것은 이비인후과 환자를  대상으로 하였기 때문이라고 여겨진다.

그러나 소아과 의사는 내과 의사와 보는 환자 대상이 매우 다르다. 호흡기만 해도, 폐종양,  고혈압,  COPD , 만성 기관지염이라는 진단명을 소아과 의사가 보는 경우는 매우 드물다.  같은 의미로 앞서  Subglottic   stenosis ,  Innominate   등은 이비인후과 의사가 자주 볼 수  있는 진단명이다. 또한  Cystic   fibrosis  와 같이 어떤 지역에서 소아과 의사로 일하느냐에  따라 다를 것이다. 소아과 의사들이 다른 의사들보다 많이 보는 질병은 또 다를 것이다.  두가지 점에서 소아과 의사는 내과와 이비인후과 의사와 다른 질병을 많이 보게된다.  

한가지는 감염과 관련된 질병을 많이 보게 된다. 성인이 일년에 평균 감기에 걸리는 횟수가  두번 정도이나 소아는 5번에서 8번으로 매우 많다. 둘째는  Inherited   disease 를 많이 보게  된다.  primary   ciliary   dyskinesia , 일차면역결핍증과 선천성 이상을 다른 과 의사보다 많이  접촉하게 된다.

소아를 대상으로 한 연구에서는 천식으로 의심되어 치료받던 환자들의 기관지 내시경  소견상 47%가 기도 내 병변이 있고 57%가 다른 질환을 찾아내었다. 이에는 흡인,  이완불증증( achalsia )과 위식도역류였다. 12 )   연구자들은 기침만 있는 환자들에게 천식 진단을  할 때 유의해야 한다고 한다고 권고하였다. 최근 한 연구자는 108명의 평균연령 2.6세의  소아를 대상으로 만성기침의 원인을 조사한 결과 가장 흔한 진단명은 만성 세균성  기관지염이었다(그림 6 참조). 무려 40%의 환자가 진단받았다. 이외에 기관지천식,  위식도역류와 상기도 감염에의한 기침 증상이 뒤를 이었다. 13 )

 

그림 6) 호주 퀸즈랜드의 한 의사는 108명의 평균 2.6세인 소아 환자가 3주 이상 기침을  진행할 때 조사하였다. 이 연구는 소아과 환자를 대상으로 만성기침의 원인을 전향적으로  완전하게 연구한 첫번째 연구이다. 이 첫번째 연구는 2006년에 나왔다. 매우 흥미로운  결과가 기다리고 있다. 이 환자의 89%가 습성기침을 하였으며 기관지 내시경을 45%에서  시행하였다.  Big  3 로 알려진 천식은 108명 중 4명이었고 후비루 증후군이라 알려진  Upper   airway   cough   syndrome  환자는 3명, 위식도 역류 환자는 3명으로,  Big  3 환자가 총 10 명으로 10%도 안되었습니다. 가장 많은 수가  protracted  세균성 기관지염으로 43명이었다.  소아에서 기관지염이라는 진단명을 내릴 때는 항시 망설여지게된다. 급성 기관지염이  대부분 바이러스에 의하므로 3주 내에 증상이 호전되므로 3주 이상 기침의 원인으로  보기는 어렵다. 성인과 같이 만성 기관지염이라는 진단명을 붙이기 위해서는 다른 질환  없이 연속 2년동안 3개월 이상의  Productive   cough  증상이 있어야 한다. 연구자들은  폐렴은 없으면서  B A L  을 시행하여 균이 배양되고 습성 기침 증상이 있고, 항생제에  반응하는 군을 연구자들은  “protracted  세균성 기관지염 ” 이라는 진단명을 붙였습니다.  아무런 치료 없이 그냥 호전된 환자가 두번째로 많은 24명이었다. 기관지 확장증은 6명,  원인미상은 5명, 흡인은 4명 습관성 기침은 1명, 백일해는 1명 마이코플라즈마는 2명  결핵은 2명,  BO 는 1 명이었다. 이 논문은 만성 기침, 즉 3주이상 가는 기침으로 성인과  같이 3 R  질환은 소아에서 흔하지 않고 다를 수 있음을 보여준다. 이 논문을 다 믿을 수는  없을 것이다. 논문에서는 3 R  이라는 질환을 본격적으로 조사하지 않았다. 또한 3세 미만의  환자를 대상으로 하였으며 더 많은 연구가 필요한 것은 사실이다. 그러나, 최소한 우리는  여기서 몇가지 사실을 알 수 있다. 소아에서 4주이상 가는 기침은 성인과 원인이 다를 수  있고 그 중 감염과 연관된 경우가 많다.

약어 : BB  :  protracted   Bacterial   bronchitis ( moist   cough ,  positive   B A L   cx ,  response   antibiotics ), NR  ;  Natural   resolution     Bx  ;  Bronchiectasis ,  Uk  ;  Uncertain , A s  ; A sthma ,  Hb  ;  Habit   cough ,  EB  ;  Eosinophilic   bronchitis , A p  ; A spiration ,  Bp  ;  B   pertussis  infection ,  Mp  ;  M   pneumoniae  infection ,  Tu  ;  endobronchial   tuberculosis ,  GER  ;  Gastro   esophageal   reflux ,  U A CS  ;  upper   airway   cough   syndrome ,  BO  ;  bronchiolitis   obliterans

이러한 연구들을 보았을 때 성인과 달리 만성기침의 원인이 소아에서는 나이에 따라 다를  수 있음을 의미한다. 또한 성인과 달리 세가지 질환이외에도 다른 질환들이 더 많을 수  있음을 뜻하기도 한다. 성인에서는 세가지 질병이외에 만성 기침의 원인으로 만성 기관지염 ,  감염후기침, 기관지확장증과 원인미상등이 네번째 질병명으로 등록되어 있다. 6)   이러한  질환이외에 소아 만성기침의 원인이 될 수 있는 질병을 적시하고 임상적 의미에 대해서  집고 넘어가겠다. 이제까지 내용을 요약하면 다음과 같다.

요약

  • 3 주 내지 4주 이내의 기침을 급성기침, 이후 8주 이내의 기침을 아급성기침, 8주 이상의  기침을 만성기침이라고 한다.
  • 급성기침의 가장 흔한 원인은 감기이며, 아급성기침은 감염후기침이 흔하다.
  • 성인에서 가장 흔한 만성기침의 원인은 상기도기침증후군, 기관지천식과 위식도역류이며  9 0% 정도 차지한다.
  • 성인과 달리 소아에서는 감염과 관련되거나 유전적 질환에 대한 접근이 필요하다.

1 . 기관지 천식

천식 은 만성기침의 흔한 원인이다. 기침은 천식 환자에서 가장 흔한 증상이다. 1)   기침이  오래가면 항시 천식을 의심하게되며 치료하게 된다. 이때 기침, 천명음과 숨쉬기  힘들어하는 증상이 천식이외 다른 질환들에서 나타날 수 있음을 항시 유념해야 한다.  이러한 증상이 나타날 수 있는 질병으로는 기도내 이물질, 기도/기관지 연화증,  BPD 를  포함한 만성폐질환, 기관지확장증, 백일해, 대혈관 이상에 의한 기도압박을 고려해 보아야  한다. 이때 이러한 질환과 천식과의 감별 포인트는 기관지확장제 반응여부이다(그림 8 참조 ) .

 

그림 8) 천식은 기관지 과민도의 증가라고 할 수 있으며 메타콜린에 의한 기관지 과민도를  평가하여  BHR ( Bronchial   Hyperresponsiveness )이라고 한다. 이외에도  variability 와  BDR ( Bronchodilator   response )도 확인하게 된다. 성인에서는 기본값에 12-15% 변화가  있거나 200  ml  이상 변화가 보이면 의미가 있다고 한다. 이때 특이도가 95%이다. 한  연구자는 소아에서 기관지 확장제 반응도로서 천식 유무를 얼마나 판단 할 수 있는가를  보았다. 만일  BDR 이 9% 변화가 있다면 어떤 경우에는 천식 진단의  PPV 가 80%에 이른다.  더 흥미로운 것은 민감도가 50%에 이른다.  BDR  이란 객관적인 자료를 보여준 것이라  여겨진다.  BDR 의 가장 전형적인 증상인 천명음을 놓고 본다면 비록 주관적인 판단이기에  이를 수치로 보여준 데이터가 없지만 기관지 확장제에 의한 천명음 소실은  BDR  9% 이상의  민감도와  PPV 를 가질 것이다. 그러므로 천명음이 들렸던 환자에서 천명음이 기관지  확장제에 의해 사라지면 천식이라고 진단해도 틀리지 않을 것입니다. 적어도  airway   variability 가 있는 것이고 이는 호흡기 치료에 도움이 되는 조건이다.

2. 기침이형천식( cough   variant   asthma ; CVA )

천명음은 없으면서 기침이 오래가면 천식인가 ? 한 연구자들은 이러한 증상이 있을 때  천식이라고 진단내리는 의사가 40% 정도 된다고 하였다(그림 9 참조).  

 

그림 9) 호주의 한 연구자는 천명음이 없이 밤에 기침으로 고생하는 8-11세 소아과 10%  정도 된다. 이러한 소아들에게 3주 이상 기침을 하면 천식이라고 붙여야 하는가에 대해  조사를 해 보았다. 1178명을 역학조사를 시행하였다. 1178명 중 지난 1년동안 증상이  없었던 소아가 74%, 천명음이 있었던 환자의 22%, 나머지 5%가 3주 이상 기침을  지속하였다. 천명음이 있었던 환자의 74%를 의사들은 천식이라고 진단하였다. 3주 이상  지속되는 기침을 내원한 환자들의 반 정도를 의사들은 기침이형 천식이라고 진단을 하였다.

기침 이형 천식은 매력적인 진단명이다. 1972년에 기침 이형 천식이라는 진단명이 붙기  시작하였다.  기침이형천식은 기침을  오래하면서 천식 약물에 반응을 보이면 진단할 수 있다. 기침 이형 천식의 진단과 치료는  흡입용 스테로이드이며 치료 기간은 8주이다. 예후는 잘 모른다. 이들을 3년동안  추적하였을 때 54%에서 천식으로 이행된다는 보고가 있으나 아직 변수들을 잘 제어한  논문은 부족한 실정이다. 왜 잘 모르냐 하면, 우리가 천명음이 안들렸다는 것이 진짜  천명음이 없었느냐 하고 관련되어 있다. 병원에서 천명음이 들리는 아이들은 있지만 그  시간은 어느 한 순간이다. 밤에 천명음이 있어 그 당시 들었다면 들렸을 텐데 소실 된 후  병원에 와서  CVA로 진단 받을 수 도 있기 때문이다.  

3 . 호산구성 기관지염(Esoniphilic bronchitis; EB)

1989년 캐나다 연구자는 만성 기침을 가지고 있으면서 천식 검사에는 음성이고 흡입용  스테로이드에 반응하는 환자 7명이 가래 검사에서 호산구가 증가한 것을 발견하고 이를  호산구성 기관지염이라고 명명하였다. 17 )   호산구는 보통 정상인에서 객담내에 존재하지  않는다. 대식세포와 호중구가 주요 세포이다. 정상인에서 소아와 성인 모두 객담 내  호산구는 2.5% 미만이다. 18 )   객담내 2.5% 이상 호산구가 보이는 경우는 기관지  천식환자에서 72%가 보이며 건강한 성인에서 5.5%, 알레르기 비염 환자에서 50%, 기관지  과민도가 있는 비염 환자에서 77%, 천식이 없으면서 발작적인 호흡기 증상이 나타나는  환자에서 29%, 기침이형 천식환자의 50%에서 호산구가 나타난다. 18 )

호산구성기관지염의 진단은 기침이 오래하면서, 기관지 유발검사에서 음성이고  객담검사에서 호산구가 3% 이상 나오면 진단하게 된다(그림 10 참조)

만성 기침이 있는 성인환자의 13%가 호산구성 기관지염으로 진단받게 된다. 19 )   호산구성  기관지염은 호산구만 증가되어 있는 것이 아니라 다른 염증인자들이 분비되고 있다. 천식과  비교하여 호산구성 기관지염에도  cyteinly -류코트리엔과 호산구성  cationic  단백질이  증가되어 있으며 천식에는 증가되어 있지 않지만 히스타민과 프로스타그란딘( PGD 2)과 같은  물질이 증가되어 있다. 이는 호산구성 기관지염의 염증 물질이 혈관과 기관지 수축, 기도  손상에 관여한다는 것을 의미한다. 호산구성 기관지염의 기도에 히스타민과  PGD 2이  증가되어 있다는 것은 비만세포 활성화가 중요한 기전이라는 것을 암시하는 소견이다. 20 )   이러한 염증매개물질을 생산하는 면에서는 천식과 병리기전이 다르지 않다는 것을 보여준다 . 20)   그러나 천식의 특징인 기도 과민성과 가역적인 기도폐쇄를 보이지 않는 이유는  여러가지로 설명될 수 있다. 기도 평활근에 천식과 달리 비만세포 침착이 되어 있지 않을  수도 있고, 천식과 달리 기도 상피 세포 손상이 일어나지 않고 수많은 기도 수축을  유도하는 물질들이 기도 평활근에 침투하지 않기 때문일 수도 있다. 다른 설명으로는  이러한 환자들이 기도 과민성의 기저수치가 정상 아래에 있을 수도 있다(그림 11 참조)

치료는 천식 치료와 동일하다. 흡입용 스테로이드를 사용하며 항류코트리엔제도 효과가  있다. 21 )   기침이형천식과 동일한 치료효과를 보기에 검사를 시행하지 않은 많은 환자들이  호산구성 기관지염 진단보다는 기침이형천식으로 진단받고 치료 받게 된다.

호산구성 기관지염의 예후는 확실하지 않다. 호산구성 기관지염은 자연적으로 소실되지  않을 수 있다. 그러나 우리는 많은 것들을 모르고 있습니다(그림 12 참조)

그림 12) 2001년도에 발표한 자료에 의하면 12명의 환자를 10년동안 추적한 결과 대부분  자연 소실된 것으로 알려져 있다. 그러나 최근 한 연구자는 1996년 부터 2003년까지  추적하였던 환자 중 32명의 환자가 1년이상 추적가능하였고 이중 3명의 환자가 천식으로  진행하였고 21명인 66%가 증상이 지속되었다. 단지 한 명만이 완전히 증상 호전 되었다.

이제까지 세가지 질환인 기관지 천식, 기침이형천식과 호산구성 기관지염의 임상 양상,  폐기능 검사와 조직학적소견을 정리하면 그림 13과 같다.

그림 13) 기관지 천식, 기침이형천식 및 호산구성기관지염의 차이를 보여주고 있다. 기침이  오래가는 것은 세가지 질병 모두에서 공통되지만 천명음이 나는 것은 기관지 천식이다.  기관지유발검사에서 양성소견은 기관지 천식과 기침이형천식에서 보인다. 기관지확장제에  반응을 보이는 것도 두가지 질환이다. 가래에서 호산구가 보이는 것은 세가지 모든  질환에서 보일 수 있으며 기도내 평활근에 호산구성기관지염에는 비만세포가 없다.  그러므로 기관지 수축이 없고 그래서 기관지확장제에 반응을 보이지 않는다.

4 . 상기도기침증후군( Upper   airway   cough   syndrome )  

상기도기침증후군은 임상적으로 후비루증후군( Postnasal   drip   syndrome ; PNDS )과 같은  뜻이다. 그러나 이를  PNDS  라 하지 않고  UACS  이라고 하는 이유는  PNDS 를 객관적으로  증명해 보일 수 있는 검사 방법이 없고 이것이 곧 기침의 원인이라고 증명할 수 없기  때문이다. 기침이 오래갈 경우에 이것이  PND 에 의한 기침인지, 자극에 의한 것인지,  기침수용체의 염증에 의해 기침이 유발되는 것인지 감별하기 힘들다. 이를 몽땅그려서  기침만을 놓고 보았을 때 상기도기침증후군이라는 진단명을 만들게 되었다. 그러므로  기침의 원인으로 지적되는 증후군을 하나로 묶어서 후비루증후군이라 명명하기 보다는  상기도기침증후군으로 통일해야 할 것이다.

이의 치료는 그 원인되는 것에 초점이 맞추어져 있다. 이에는 알레르기 비염,  Vasomotor   rhinitis , 감기, 부비동염, 화학물질 자극에 의한 비염 등 다양하다.

상기도기침증후군의 증상과 징후는 비특이적이다. 상기도기침증후군 치료반응여부가  상기도기침증후군을 진단하는 가장 핵심적인 접근방법이다. 부비동염이 동반하지 않은 상기도기침증후군의 치료로 항히스타민과 울혈완화제( decongestant )를 가장 효과적으로  사용할 수 있다. 대부분 환자가 1주 이내에 증상 호전된다. 제 2세대 항히스타민은 감기로  인한 기침에 효과가 없으며 알레르기가 없는 상태에서 상기도기침증후군에 의한 기침  치료에 제 1세대 항히스타민보다 효과가 떨어진다. 그러므로 제 1세대 항히스타민제를  상기도기침증후군에 사용해야 한다.

5 . 위식도역류

위식도역류에 의해서 기침이 유발하는 기전은 세가지로 설명되고 있다.

    첫번째, 후두와 같은 상기도에 위식도 역류물질이 자극을 주어 기침수용체가 반응을 보이는  과정

    두번째, 실제  Microaspiration ,  Macroaspiration 이 일어나는 과정.

    세번째는 식도-기관지 기침수용체( esophageal - bronchial   cough   reflex )의 자극으로 기침이  유도될 수 있다. 이는 1994년  Ing  에 의해 처음으로 제기된 것이다. 이후 다양한 연구를  통해서 역류에 의한 기침의 가장 흔한 원인으로 알려지게 되었다63).

보통 첫 두가지 원인은 후두경이나 기관지내시경으로 확인할 수 있습니다. 그러나 문제는  이러한 소견이 있다고 하여서 위식도역류에 의해 기침이 유발되었다고 확진할 수 없는 것이  문제입니다. 왜냐하면 기침 자체로 위식도역류가 발생할 수 있기 때문입니다.

대부분의 천식 환자는 위식도역류를 가지고 있다. 그러나 위식도역류가 천식의 원인이  되지는 않는다.

흡인(Aspiration )에 의해 기침이 유발되지만 가슴사진이 정상이라면 미주신경반사기전에  의해 만성기침이 유발되었다고 생각해야 하며 대부분 그러하다. 위식도역류에 의한  만성기침이 발생하였을 때 소화기 증상은 대부분 없다.  

2 4시간  pH  모니터가 위식도역류를 진단하는데 가장 민감하며 특이도도 높다. 24시간  pH   모니터를 시행할 수 없어 위식도역류가 의심되는 환자에서 항역류제를 사용할 수 있다.  그러나 이러한 약제들이 치료 반응에 충분하지 않을 수 있고 실패할 수도 있기에 치료에  반응을 보이지 않았다고 하여서 위식도역류를 배제시킬 수는 없다. 최소한의 약제가 어느  정도인지를 알지 못하기에 약제와 더불어 식사 습관과 생활패턴을 변화시킬 수 있어야 한다 .  성인 보고에 의하면 위식도역류에 의한 기침은 약물요법으로 70-100% 호전되며 평균 6 개월이 소요된다.

위식도 역류에 의한 만성기침은 15% 정도 알려져 있다. 11 )   성인과 달리 소아에서  위식도역류로 인해 만성기침이 유발되는 경우에는 다른 증상도 동반되는 경우가 많다.  흔하게 동반되는 증상으로는 보채고 흉통을 호소하며, 무호흡, 서맥과 자세 변화에 따른  증상발현이 나타날 수 있다. 그러나 위식도역류만으로 만성기침으로 가는 경우는 흔하지  않다.  

이제까지의 내용을 요약하면 다음과 같다.

요약

  • 반복적 천명음시 기관지확장제 반응도가 치료/ 진단에 도움이 된다.
  • 천명음 없이 기침이 지속될 때, 흡입용 스테로이드로 치료에 반응을 보이면  기침이형천식과 호산구성 기관지염 의심.
  • 기침이형천식과 호산구성 기관지염은 기관지 과민도에 차이가 있다.
  • 후비루증후군( PNDS )을 상기도기침증후군( U A CS ) 으로 용어를 바꾸자
  • 위식도역류질환은 성인에서 만성기침의 흔한 원인이나 소아에서 좀더 많은 데이터가  필요하다.

6 . 감염후기침( Postinfectious   cough )

감염후기침은 호흡기 감염 후 가슴사진은 정상이고 어떤 치료를 하지 않아도 증상이  호전되는 기침에 대해서 붙이는 질병명이다. 보통 감기후 11-25% 환자들이 이러한  진단명을 받게 된다. 마이코플라스마, 백일해 감염 후에 이러한 진단명이 증가한다.  소아에서는 특히 마이코플라스마, 백일해, 클라미디아,  RS  바이러스나 파라인플루엔자  바이러스와 같은 감염 후에 진단명으로 붙이게 된다. 국내 연구자가 발표한 흥미로운 연구  하나를 소개하고자 한다. 연구자는 아급성 기침 환자들을 추적하였다. 184명의 성인의  아급성기침의 원인을 조사하였다. 89명이 감염후 기침이다. 이들 대부분의 환자들은 특별한  치료 없이 기침이 자연적으로 소실되었다. 즉 이 논문의 결론은 아급성 기침은 대부분  치료하지 않고도 좋아지더라 라는 것이다. 3주에서 8주 이상 지속되는 환자의 가장  효과적인 치료 방법은 시간이다(그림 14 참조)

그림 14) 184명의 아급성기침 성인환자들을 추적하였다. 치료없이 62명의 환자가  소실되었고 항히스타민과 항울혈제로 3주 치료 후 89명이 증상이 호전되었다. 즉 184명의  환자 중 151명이 특별한 검사없이 기침이 소실되었다.

감염후기침의 가장 특징적인 기침은  Bordetella   pertussis   감염에 의한 백일해( Whooping ) 기침이다. 예방접종과 더불어 사라지었다고 여겨지는 백일해에 대한 흥미로운 연구가 있다.  1 4일 이상 지속되는 기침을 호소하는 5-16세 172명의 영국의 소아에서  Bordetella   pertussis   감염정도를 측정한 결과 37%가 혈청학 검사에서 양성소견을 보였다. 이들의  8 6%는 예방접종을 시행하였다. 즉 예방접종을 했음에도 이로인해 만성기침의 주요한  원인으로 백일해가 될 수 있음을 보여준다. 백일해기침을 하는 환자는 증상이 발현된 후 2 개월 이상 기침을 하는 것으로 보이고 하루 5회이상 기침을 한다. 41)   이러한 예방접종을  시행한 이러한 환자들의 특징적인 증상은 특징적인  whoop 는 없고 발작적인 기침과 토하는  것이 따른다. 평균 45일 기침을 하였다.  

7 . 기관지 확장증

기관지확장증으로 만성기침이 일어날 수 있다. 기관지확장증은 형태학적인 진단명이며  비가역적인 기관지 확장와 기관지벽 비후를 보인다. 기관지확장증이 일어나는 기전을  대부분  ‘vicious   cycle   theory’ 로 설명된다. 23)   감염이 일어난 후 점액섬모 운동에 장애가  일어나며 이로인해 만성 세균성 감염이 유도되고 이러한 감염은 섬유화변화를 일으키는  지속적인 염증반응이 일어난다는 것이다. 최초 유발인자를 감염이라 여기고 있지만 다른  원인도 고려해보아야 한다. 24)   서양에서는  Cystic   fibrosis 가 가장 흔한 기관지확장증의  원인이고 다른 원인으로 기관지확장증이 일어나는 경우는 매우 드물다고 여기기에 연구가  매우 적은 실정이다. 국내에서는 아직 유병율이 확실하지 않다. 홍역이나 백일해와 같은  예방접종과 위생상태의 호전으로 기관지확장증 유병율은 감소하고 있지만 아직도 쉽게 볼  수 있는 진단명이다.  

최근 뉴질랜드에서 국가적인 조사를 통해서 기관지확장증의 발생률을 조사하여 발표하였다.  매우 흥미로운 결과이다. 15세 미만의 소아에서 10만명당 15명의 환자가 발생하였다. 인종  편차가 매우 심하여 유럽 뉴질랜드인은 1.5명, 마오리 족은 4.8명인데 반하여 남반부  아시안에서는 17.8명이었다(그림 15 참조). 이는 핀란드에서 조사한 0.5명보다 매우 높은  것으로 25)   뉴질랜드에서 발생하는  cystic   fibrosis  발생률보다 2배이상 높은 빈도이다.  알래스카 소년들의 기관지확장증의 유병율이 미국본토 유럽인보다 높아 국내 유병율도  유럽인보다 높을 것으로 여겨진다. 26)   이는 기관지 확장증이 인종에 따라 유병율 차이가  있으며 유럽인들과 달리 국내에서 중요한 질병으로 다루어야 함을 의미한다.

그림 15)  Cystic   fibrosis  가 없이 생긴 기관지 확장증은 유럽인들에게는 잊혀져가는  질병이다. 그러나 인종에 따른 차이가 많다는 것을 알 수 있다. 뉴질랜드에서 키위들은 10 만명당 1.5명이지만 마오리 족은 4.8명, 남아시아인이라 여겨지는 아시아인들은 17.8명이  발생하였다. 알레스카인들이 유럽-미국인들보다 높은 빈도를 보이는 것을 고려한다면  우리나라에서는 잊혀져가는 질병이 절대 아님을 보여준다.

진단은 문진과 흉부가슴촬영으로 의심하게 되며 확진은 고해상도  CT 에 의한다. 고해상도  CT 에서 1)폐동맥보다 기관지가 횡단면 사진에서 더 클 때 2) 확장된 기관지내에 점액질이  차 있고 3) 기관지가  tapering  하지 않을 때 4) 흉막부위에 기관지가 보일 때 진단하게  된다. 27)   흉부가슴촬영이 기관지확장증 진단에 도움이 되는가에 대해서는 아직 성인에서  논란의 여지가 있으며 소아에서 진단적 가치는 잘 모르나 한 연구자는 93명의 환자 중  오직 5명만이 흉부가슴촬영으로 기관지 확장증을 의심할 만한 소견을 보였다고 하였다. 24)   그러므로 소아에서 기관지확장증을 배제시키기 위하여 흉부가슴촬영만으로는 부족하다. 28)

한 연구자는 호흡기 질환으로 의뢰받은 환자의 9.3%인 93명이 기관지확장증이었다고  보고하였다. 기관지확장증으로 진단받은 소아가 의뢰되기까지는 증상 발현 후 평균 3년이  걸리었고 환자의 49%는 천식이 조절되지 않는다고 의뢰되었다. 24)   첫 증상이 발현된 시기는  평균 1.1세였고 진단 받은 것은 3세경이었다. 국가적인 조사에서 평균 진단은 5.2세였으며  대부분 2세이후에 증상이 발현되었다. 29)   이러한 환자들 대부분은 천식이나  기침이형천식으로 진단받고 치료 받았다. 성인 기관지확장증의 경우 10세 전에 40%  환자에서 시작되었다는 보고 30) 가 있는 것으로 보아 소아 시기에 적극적으로 진단과 치료  계획을 세우는 것이 중요하다(그림 16 참조).

그림 16) 소아에서 기관지 확장증이 중요한 이유는 성인 기관지 확장증이 어린 연령에서  부터 기관지 확장증이 시작된다는 사실이다. 150명의 성인 기관지 확장증을 조사한 결과  6 0%  가까이 15세 이전부터 시작되는 것을 보여주고 있다. 평균 연령은 14세이다.

기관지확장증이 임상적으로 중요한 이유는 시간이 지남에 따라 빠르게 폐기능이 악화된다는  점이다. 기관지확장증 환자가 10세 경에는 정상 폐기능의 68% 밖에 되지 않으며 매년  1 .9% 비율로 떨어진다(그림 17 참조). 31)   또한 컴퓨터단층촬영결과와 비교하였을 때  말초세기관지에 기관지확장증이 있던 환자에서 더많은 폐기능 소실을 보였다. 32)   이러한  환자에서 폐기능검사와 컴퓨터단층촬영이외에도 운동검사는 서로 고유한 정보를 제공하므로  필요하다. 33)

그림 17)  Cystic   fibrosis  환자와 기관지 확장증 환자들의 연령에 따라 폐기능 떨어지는  속도를 보여준 그림이다. 기관지 확장증도 생각보다 빠르게 폐기능이 떨어지고 있음을  보여주고 있다. 이는 소아시기에 기관지 확장증으로 진단을 받으면 적극적으로 치료를 하여  폐기능 유지하려고 노력을 해야 함을 의미한다.

기관지확장증이 진단되었다면 원인을 찾는 검사를 진행해야 한다. 34)   1819년에 첫 보고가  되었을 정도로 매우 오래된 병명이고 당시에는 결핵이나 백일해와 관련되어 있었다. 35)   과거에는 65% 이상이 홍역, 백일해와 결핵이 원인이라고 하였으나 36)   최근  연구에서는  감염 원인이 30%로 떨어지었기에 다른 해부학적 이상소견이나 면역 결핍 검사를 진행해야   것이다.  

특히 3세 경까지 폐발달이 급격하게 일어나는 시기이며 이때 발생하는 폐렴은 향후  폐기능에 영향을 줄 수 있다. 역학조사에서 연구자들은 첫 3세까지 7.4% 환자가 폐렴을  앓게 되며 이때 앓은 폐렴은 향후 11세에 폐기능을 다른 변수를 제어한 상태에서도 떨어져  있었다. 37)   이와 비슷한 연구로 1958년에 태어난 성인환자에서 폐렴과 백일해를 앓은 환자와  그렇지 않은 대조군을 비교하였을 때 소아시기에 폐렴을 앓은 환자는 성인에서도 폐기능이  떨어져 있었다(그림 18 참조). 38)   한 연구자가 보고한 기관지확장증의 47%가 1세 전에  폐렴을 앓은 환자들이었고 이는 당시 면역학적 취약한 시기에 감염이 중요하다는 것을  의미하기도 한다. 24)

그림 18) 1958년도에 태어난 1,392명의 환자 추적한 연구결과이다. 215명이 백일해 기침  과거력이 있고 193명이 폐렴 과거력이 있었다. 이들을 35살 때 폐기능 검사를 시행해  보았다. 어린 시절 폐렴을 앓은 환자들은 성인이 되어서 그렇지 않은 환자들보다 폐기능이  의미있게 떨어져 있음을 확인할 수 있다. 백일해 과거력이 있는 환자 결과는 보여주지 않고  있다. 즉 소아기 폐렴은 성인에서 폐기능 감소와 연관되어 있으며 이는 천명음과 같은 다른  변수를 제어한 상태에서도 유효하였다. 이 말은 소아기 폐렴을 앓는 환자들에 대한 자세한  추적관찰이 필요하다는 것을 의미한다.

특히 기관지확장증은  Obliterative   bronchiolitis  이후에 진행되는 경우가 많고 이는 대부분  아데노바이러스 감염 후에 나타나는 것이므로 폐렴으로 입원하는 소아환자에서 기본 검사로  바이러스 검사를 진행해야만 할 것이다. 35)   성인에서 주로  P   aeruginosa   균이 검출되지만  소아에서는 주로  H   influenzae 와  S   pneumoniae   균이 검출된다. 24)

감염이외에 기관지확장증의 원인으로는 면역결핍(21%), 원인미상(18%),  bronchiolitis   obliterans (8%), 선천성 폐기형(4%), 만성 흡입(3%) 였다. 24)   그러므로 기관지확장증로  진단되면 면역글로불린,  IgG   subclass ,  tetanus 나  Haemophilus   influenzae   type   b  와 같은  균주에 대한 항체반응 검사, 섬모장애 전자현미경 검사 등이 필요하며 자세한 문진은  중요하다. 유럽연구에서는 이와 조금 다른 원인분포를 보고하였다. 면역결핍과 흡입,  섬모장애( PCD )가 67%를 차지하였다. 원인분포는 다르더라도 기관지확장증이 나타난  환자는 다양한 원인 검사를 진행해야 하고 이에맞는 치료를 해야 한다. 39)

진단이 되었다면 치료와 예방은 적극적으로 이루어져야 한다. 먼저 기저질환 여부를  확인해야 하며, 모든 환자는 독감예방접종을 매년 실시해야 한다. 폐렴구균백신과  H .  nfluenza  백신도 접종해야 하다. 폐침윤이 보이면 항생제를 적극적으로 시행하여야 한다.  점막섬모운동을 활성화시키는 다양한 방법, 예를들어 흡입용 스테로이드 투여,  Rh   DNase   투여와 흡입용 고장성 식염수 흡입은 아직 확실한 데이터가 부족하다. 물리치료의 역할도  데이터가 부족하나 성인에서 가래 생성에서 도움이 된다는 보고가 있으므로 적극적으로  폐침윤이 보였을 때 활용해야 할 것이다. 40)   가래 생성과 흉부물리치료, 기도섬모운동  자극약물사용과 항생제를 추가하게 된다.

이제까지 내용을 요약하면 다음과 같다.

요약

  • 감염후기침은 아급성기침의 흔한 원인이며 마이코플라스마, 백일해와 같은 감염 후  진단이 는다.
  • 소아시기에 폐렴에 걸리면 성인에서 폐기능이 떨어진다.
  • 기관지 확장증은 유럽인보다 동양인에 많으며 60% 이상이 소아시기에 시작하며  폐기능도 점차 감소한다.
  • 기침이 오래가면 결핵도 의심해야하며 가래유도검사를 하면 진단율이 높아진다.  ( 이곳에  내용 포함 안됨)

8 . 기관/기관지연화증

기관, 기관지연화증은 기도 연골이나 골이 부드러워지어 쉽게 쪼그라지는 용어이다. 이러한  연화증으로 만성 호흡기 증상이 나타날 수 수 있다. 42)   증상은 매우 다양한다. 반복적인  천명음, 호흡기 감염이외에도 심한 호흡곤란을 나타내기도 한다. 경증의 연화증이 있는  환자들은 비특이적인 소견을 보인다. 가래소리가 나거나 천명음, 협찹음이 들린다.  

연화증은 기도내 압력이 음압을 띠고  collapse  되는 것이므로 강한 호기시, 기침에  나타나게 된다. 흔하지는 않지만 흉곽외 기도내에 흡입시에 음압에 의해 나타난다. 기관  연화증은 흔하게 기관지연화증과 동반되므로 기관기관지연화증 ( Tracheobronchomalacia )  이라는 용어를 사용하곤한다. 42)   

천식과 증상이 비슷하기에 기존 천식 치료에 반응을 하지 않는다면 기관지연화증을  고려해보아야 한다. 증상은 95%의 환자가 출생시부터 나타나며 호기시 협착음과 개짓는  기침 또는 놋쇠소리( barssy ) 기침을 가지게 된다. 이러한 증상은 먹거나 울거나 기침할 때  증상이 악화될 수 있다. 기도 외부 혈관 기형에 의한 기관연화증은 흔히 ' feeding   difficulty ' 를 호소하게 된다. 이러한 환자는 삼킴곤란( dysphagia ), 역류, 기침, 청색증과 같은 다양한  증상으로 발현된다(그림 19 참조).  

그림 19) 오스트리아의 소피아 라는 소아 병원에서 1997년부터 2004년 사이  primary   airway   malacia  가 있는 160명의 환자를 분류하여 보았다. 이 기간 중 512명이 기관지  내시경검사를 시행하였고 이 중 160명의 환자가 기도 연화증을 보였다. 평균 연령은 4세  였으며 136명의 환자가 일차성이었고 24명의 환자가 다른 원인을 가진 이차성이었다.  그림을 보시면 알겠지만 많은 증상들이 기관지 천식과 중첩되어 있다. 74% 는 정확히  진단하였지만 52%는 소아과 의사들이 전혀 의심을 못한 상태에서 진단하게 되었다. 즉  기도 연화증은 다양한 증상을 띠며 천식과 많은 부분에서 증상이 비슷하다.

반복적인 천명음이 들리는 환자의 7-15% 정도가 기관지연화증을 가지고 있다. 기관지  연화증을 가진 환자들 대부분은 천명음이 발생하며 기관지 천식 치료에 증상호전되지  않는다. 43)   평상시 호흡할 때에는 연화증이 있는 기관지에 큰 변화가 없지만 강제호기가  이루어질 때에는 부위가 쪼그라들게 된다. 그러므로 감기와 같은 호흡기 증상이 있을 때  악화되는 특징을 보인다. 만일 협착음이 들린다면 기관연화증을 의심하여야한다. 기관지  연화증의 환자는 첫 6개월 이내에 숨쉬는데 시끄러운 소리를 내며 강제 호기시에 천명음이  들리게 된다. 천식과 감별 포인트로는 1) 천명음이  harsh ,  low   pitched  하고  monophonic   하다. 2) 한쪽 부위에 천명음이 나며 주로 기도 중심에서 들린다. 3) 경증 또는 중등도의  기관지 연화증은 과팽창소견이 보이지 않는다. 4) 호기시 호흡 보조근육을 사용하지 않는다.  5 )  subcostral   retraction 이 보이지 않는다. 이와달리 천식에 의한 천명음은  diffuse ,  peripherally ,  musical ,  polyphonic  하며 과팽창소견이 보인다. 또한 세기도가 막혔을  때에는 보조근을 사용하며  subcostal   retraction 이 발생하게 된다. 43)

기관지 이러한 환자들은 기관지 연화증이 있는 부위에 반복적인 감염이 생길 수 있다. 기침  양상은 쇳소리기침양상이며 때때로 기관지염이나 습관성기침으로 오인되기도 한다. 이때  진단이 되지 않는다면 필요없는 천식 치료를 지속하게 되고 반복적인 감염에 대한 치료를  소홀히 할 수 있다. 44)   

진단은 기관지 내시경하에서 기도 내경 지름이 호기시, 기침 유발시 또는 숨을 쉬는 동안  최소 50% 이상 감소하면 진단하게 된다. 44)   그러나 소아에서는 울거나 보챌 때 기관 내경이  정상 소아에서 20-50% 에서 줄 수 있다. 특징적인 기도 연화증 환자는 75% 이상 내경  감소가 보인다. 영아에서는 완전 폐쇄도 33%에서 보이기도 한다. 42)   특징적으로 개짓는  기침을 하면 의심하게 된다. 최근에는 3 D  컴퓨터단층촬영으로 진단이 가능하나 숨을 참는  것이 부족한 소아에서는 기관지 내시경이 확진을 위해 필요하다.

최근 선천성기관지, 기관 연화증의 빈도가 2100명중 1명으로 매우 흔하며 이러한 소아의  상당수가 반복적인 호흡기 증상과 기관지 천식으로 진단되어 치료받게된다. 44)

이러한 기도연화증은 다른 질환과 동반되는 경우가 많다. 심혈관 기형이 20%발견되며 52%  환자가  BPD  환자이다. 반 정도가 위식도역류를 보이며 다른 신경학적증상이 동반되기도  한다. 42)

9 . 습관성 기침

기침은 기관, 기관지와 같은 기도자극에의해서 일어나 반응을 보이는 것으로 반사이다.  그러나 사람들은 인의적으로 기침을 조절할 수도 있다.  Cerebral   Cortex 에서 기침을  억제하기도 하고 유발 시키기도 한다. 예를들어  Lock   in   syndrome  환자는  refex   cough 는 살아있지만  voluntary   cough 는 할 수 없다. 그림 20을 보면 우리는 습관성 기침도  가능하다는 것을 알 수 있다.

그림 20) 기침이 기도 자극에 반응하는 반사 작용이면서도 대뇌의 영향을 받아 기침이  억제되기도 하고 유도 될 수도 있음을 보여주는 그림이다.

습관성기침은 성인에서보다 소아에서 많다. 이제까지 보고된 153명의 환자 중 143명이 18 세 이하 환자였다. 그러므로 성인에서는 심인성 기침은 매우 드문 질환이라고 생각해야 할  것이다. 여러 질환들을 제거한 후  honking   cough ,  barking   cough 를 하며 잠잘 때 기침을  하지 않으면 우리는 습관성 기침이라고 한다. 그러나 이에 대한 정의는 없다.  Habit   cough 와  psychogenic   cough  감별 포인트도 없으며 섞어쓰고 있습니다. 소아에서는  convulsion   isorder (22%),  mixed   anxiety   and   depressive   disorder (12%) 와 연관되어 있다.

습관성 기침을 진단할 때 3가지 점에서 주의를 해야 한다.

    첫째.  barking   cough 가 기도연화증에서도 일어날 수 있다.

    둘째.  Tic   disorder 를 정신 심리 테스트로 배제를 시켜야 한다.

    세째. 행동요법 을 비롯한 다양한 치료 방법으로 호전되어야 한다.

이를 요약하면 다음과 같다.

요약

  • 기도연화증은 2000 여명 중 한 명정도 발생하며 천식과 비슷한 증상을 보인다.
  • 기침은 반사이면서도 대내피질의 영향을 받는다. 만성기침은 복합적인 증상이다.
  • 습관성기침은 대부분 소아에서 발생하며  Barking   cough 가 있다면 기도 연화증을  확인해주어야 하며,  Tic 을 감별해주어야 한다.

진단 접근 방법

만성 기침의 원인을 정확히 진단하기 않고 다양한 치료 방법을 사용하곤 한다. 이중 가장  많이 사용되는 약물이 천식약이다. 만성 기침을 무작위로 항류코트리엔제를 사용하면 기침  호전에 도움이 되지 않는다. 47)   또한 흡입용 스테로이드도 이러한 환자에게 도움이 되지  않으며 48)   항콜린제제 49) ,  항히스타민제 50) ,  크로몰린 소듐제제 51) 와 기관지 확장제 52) 도 도움이  되지 않는다. 또한 이온정화가를 비롯한 제습제, 공기청정기 및 정기적인 청소를 한다고  하여 이러한 증상이 호전되지 않는다 53) .  위식도 역류억제제 또한 효과여부가 확실하지 않다 . 54)

그러므로 만성기침의 적절한 진단을 하고 치료 접근이 필요하다. 성인에서 만성기침의  원인으로 기관지천식, 위식도역류와 후비루증후군를 어떻게 접근해야 하는가에 대한 다양한  연구가 있다. 6)   이를 바탕으로 만성 기침 진단을 위한 알고리듬을 만들고 이에 따라  접근하면 99% 환자를 진단할 수 있다고 주장하였다. 55)   다른 연구에서는 이보다 적은  성공율을 보였지만 성인에서 만성 기침의 원인으로 접근하는 방법은 어느정도 표준화되어  있다고 할 수 있다. 13)   

성인 연구를 기초로 1998년 미국 학회에서는 소아에서 만성기침을 진단하기 위해서는  성인과 비슷한 알고리듬으로 접근할 것을 권고하였다. 13)   그러나 만성기침의 원인으로  소아와 성인이 비슷할 것이라는 것은 어느정도 타당성이 있지만 어느점에서는 많은 차이가  있다. 이러한 차원에서 이를 보완하여 소아를 위한 새로운 알고리즘이 개발되어 발간되기도  하였다. 56)   

소아에서는 성인과 달리 기침양상에 따라 진단에 도움이 되는 경우가 있다. 9)   만성  습성기침은 항시 원인이 있고 많은 양의 기도 분비가 이루어진다. 57)   소아에서는  Productive   cough 의 양상이 드물므로 습성기침과  productive   cough 를 동일하게 취급하여도 된다. 만성  건성기침은 습성기침의 한 형태일 수도 있지만 기침만 하는 경우에는 비특이적인 증상일  수도 있다. 9)   이러한 경우에는 감염후기침이거나 기침수용체의 과민도에 의해 나타날 수  있다. 백일해양기침은 아데노바이러스, 파라인플루엔자 바이러스,  RS 바이러스,  마이코플라즈마 감염에 의해 나타날 수 있다. 58)   

한 연구자는 다음과 같은 증상이 있을 때 자세한 검사를 시행해 볼 것을 권고하였다.64)

  • Auscultatory   findings
  • Cardiac   abnormalities
  • Chest   pain
  • Dyspnea   or   tachypnea
  • Digital   clubbing
  • Daily   moist   or   productive   cough
  • Exertional   dyspnea
  • Failure   to   thrive
  • Feeding   difficulties
  • Hemoptysis
  • Hypoxia / cyanosis
  • Immune   deficiency
  • Neurodevelopmental   abnormality
  • Recurrent   pneumonia

기침수용체과민도는 성별에 따른 차이는 없지만 나이와 기도 내경에 영향을 받는다. 59)   반복적으로 기침이 오래가는 환자에서 기침수용체예민도가 증가되어 있고, 천식, 독감  감염에서도 증가되어 있다. 그러나 기침수용체 과민도 여부는 진단에 도움이 되지 않으며  연구목적으로 현재 활용되어야 할 것이다. 9,   60)

밤중의 기침은 천식 기침의 한 표현으로 나타나며 밤중에 기침하는 천식환자는 더 낮은  폐기능 검사 수치를 보인다. 9)   그러나 밤중에 기침하는 소아의 1/3만이 천식 증상을 보이는  환자이다. 61)

컴퓨터 단층촬영은 만성기침이 있으면서 반복적인 흉부단순촬영에 이상이 있으면 도움을  받을 수 있다. 가장 많이 진단되는 것으로는 폐렴(60%), 기관지확장증(24%), 선천성 폐기형 ( 12%), 이물질 흡입(2%)였다. 이중 기관지확장증, 폐기형, 이물질 흡입등은 치료 전략이  바뀌었으며 폐침윤의 경우에도 반 정도가 치료전략이 바뀌었다. 62)   이외에도 다양한 진단  기법으로 접근해야 할 것이다.

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37)  Castro - rodriguez   J A,  Holberg   CJ ,  Wright  A L ,  Halonen   M ,  Taussig   LM ,  Morgan   WJ ,   et   al . A ssociation   of   radiologically   ascertained   pneumonia   before   age  3  yr   with   asthmalike   symptoms   and   pulmonary   function   during  childhood  . A  prospective   study .  Am   J   Respir   Crit   Care   Med  1999;159:1891-7.

38)  Johnston   ID A,  Strachan   DP , A nderson   HR .  Effect   of   pneumonia   and   whooping   cough   in   childhood   on   adult   lung   function .  N   Engl   J   Med  1998;338:581-7.

39)  Li  A M ,  Sonnappa   S ,  Lex   C ,  Wong   E ,  Zacharasiewicz  A,  Bush  A ,  et   al .  Non - CF   bronchiectasis :  Does   knowing   the   aetiology   lead   to   changes   in   management ?  Eur   Respir   J  2005;26:8-14.

40)  Wallis   C ,  Prasad  A.  Who   needs   chest   physiotherapy ?  moving   from   anecdote   to   evidence . A rch   Dis   Child  1999;80:393-7.

41)  Harnden  A,  Grant   C ,  Harrison   T ,  Perera   R ,  Brueggemann  A B ,  Mayon - White   R ,   et   al .  Whooping   cough   in   school   age   children   with   persistent   cough :  Prospective   cohort   study   in   primary   care .  BMJ  2006;333:174-7.

42)  Carden   K A,  Boiselle   PM ,  Waltz   D A,  Ernst  A.  Tracheomalacia   and   tracheobronchomalacia   in   children   and   adults : A n   in - depth   review .  Chest  2005;127:984 - 1005.

43)  Finder   JD .  Primary   bronchomalacia   in   infants   and   children .  J   Pediatr  1997;130:59- 6 6.

44)  Boogaard   R ,  Huijsmans   SH ,  Pijnenburg   MWH ,  Tiddens   H A WM ,  de   Jongste   JC ,  Merkus   PJFM .  Tracheomalacia   and   bronchomalacia   in   children :  Incidence   and   patient   characteristics .  Chest  2005;128:3391-7.

45)  Hay  A D ,  Wilson  A,  Fahey   T ,  Peters   TJ .  The   duration   of   acute   cough   in   pre - school   children   presenting   to   primary   care : A  prospective   cohort   study .  Fam   Pract   2 003;20:696-705.

46)  Fitch   P ,  Brown   V ,  Schock   B ,  Taylor   R ,  Ennis   M ,  Shields   M .  Chronic   cough   in   children :  Bronchoalveolar   lavage   findings .  Eur   Respir   J  2000;16:1109-14.

47)  Chang  A B ,  Winter   D , A cworth   JP .  Leukotriene   receptor   antagonist   for   prolonged   non - specific   cough   in   children .  Cochrane   Database   Syst   Rev  2006;2: CD 005602.

48)  Tomerak  AA,  McGlashan   JJ ,  Vyas   HH ,  McKean   MC .  Inhaled   corticosteroids   for   non - specific   chronic   cough   in   children .  Cochrane   Database   Syst   Rev  2005;4: CD 004231.

49)  Chang  A B ,  McKean   M ,  Morris   P .  Inhaled   anti - cholinergics   for   prolonged   non - specific   cough   in   children .  Cochrane   Database   Syst   Rev  2004;1: CD 004358.

50)  Chang  A,  Peake   J ,  McElrea   M . A nti - histamines   for   prolonged   non - specific   cough   in   children .  Cochrane   Database   Syst   Rev  2006;3: CD 005604.

51)  Chang  A,  Marchant   JM ,  McKean   M ,  Morris   P .  Inhaled   cromones   for   prolonged   non - specific   cough   in   children .  Cochrane   Database   Syst   Rev  2004;2: CD 004436.

52)  Tomerak  AA,  Vyas   H ,  Lakenpaul   M ,  McGlashan   JJ ,  McKean   M .  Inhaled   beta 2- agonists   for   treating   non - specific   chronic   cough   in   children .  Cochrane   Database   Syst   Rev  2005;3: CD 005373.

53)  Donnelly   D ,  Everard   M ,  Chang  A.  Indoor   air   modification   interventions   for   prolonged   non - specific   cough   in   children .  Cochrane   Database   Syst   Rev  2006;3: CD 005075.

54)  Chang  A B ,  Lasserson   TJ ,  Gaffney   J ,  Connor   FL ,  Garske   L A.  Gastro - oesophageal   reflux   treatment   for   prolonged   non - specific   cough   in   children   and   adults .  Cochrane   Database   Syst   Rev  2005;2: CD 004823.

55)  Irwin   RS ,  Curley   FJ ,  French   CL .  Chronic   cough .  the   spectrum   and   frequency   of   causes ,  key   components   of   the   diagnostic   evaluation ,  and   outcome   of   specific   therapy .  Am   Rev   Respir   Dis  1990 r ;141:640-7.

56)  Chang  A B ,  Glomb   WB .  Guidelines   for   evaluating   chronic   cough   in   pediatrics : A CCP   evidence - based   clinical   practice   guidelines .  Chest  2006;129(1  suppl ):260 S -283.

57)  Chang  A B ,  Gaffney   JT ,  Eastburn   MM ,  Faoagali   J ,  Cox   NC ,  Masters   IB .  Cough   quality   in   children : A  comparison   of   subjective   vs .  bronchoscopic   findings .  Respir   Res  2005;6:3.

58)  Wirsing   von   Konig   CH ,  Rott   H ,  Bogaerts   H ,  Schmitt   HJ . A  serologic   study   of   organisms   possibly   associated   with   pertussis - like   coughing .  Pediatr   Infect   Dis   J   1 998;17:645-9.

59)  Chang  A,  Phelan   P ,  Roberts   R ,  Robertson   C .  Capsaicin   cough   receptor   sensitivity   test   in   children .  Eur   Respir   J  1996;9:2220-3.

60)  Chang  A B ,  Phelan   PD ,  Sawyer   SM ,  Del   Brocco   S ,  Robertson   CF .  Cough   sensitivity   in   hildren   with   asthma ,  recurrent   cough ,  and   cystic   fibrosis . A rch   Dis   Child  1997;77:331- 4 .

61)  Ninan   TK ,  Macdonald   L ,  Russell   G .  Persistent   nocturnal   cough   in   childhood : A  population   based   study . A rch   Dis   Child  1995;73:403-7.

62)  Montella   S , A ndreucci   MV ,  Greco   L ,  Barbarano   F ,  De   Stefano   S ,  Brunese   L ,  et   al .  Clinical   utility   of   CT   in   children   with   persistent   focal   chest   abnormality .  Eur   Respir   J   2 005;26:751-2.

63) Am   J   Respir   Crti   Care   Med  1994;149:160

64) ( Chang  A B .  Cough  2005;1:7)

 

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Suddenly using the window glass broken, as well as flare thrown straight into the house. Suddenly everyone was flares house the road until his eyes. Li Bin, rushed in external to of the question, quickly and accurately brake three robbers were inside kill him. Li Bin up, inside three criminals who might possibly have shot up, and that is inside military in the old habits. In order to prevent the enemy counterattack. The eye of gunfire was only scared silly children, Li Bin suddenly gain an amusing face, said."Well kids, just the end of an film, and hey we're able rest, you're going to get a treat dads Oh, you are small star." Li Bin, a daughter or son bought and kissed her little the face area. Infected through the atmosphere when they are not inside of the crying of kids, smiling at him.While in the special police who heard the shots outside rushed in, make sure to surrounding environment, Li Bin, his children, reached forward of Yan Szeto, then untied the rope she'd viewed Li Bin."You? Just do you think you're doing?" Yan Szeto asked puzzled him."Women are not shipped while in the volume. " Then, Li Bin, started the actual. Szeto Yan Jingjing looked left, to cover something but was silenced.Right out the gate, whenever gang of armed police enclosed by Li Bin, Zhao Bureau came over and asked him."Bin son, because you eventually stop command, minimize headquarters operations, we provisional decision, overview of your hand over your gun stick with us."Li Bin, a wry smile, the gun to the side of this armed police, riding and police Zhao Bureau, combined with the ear-piercing sirens, police cars to travel.Chapter Six years later we meet againChapter Six years later we meetLi Bin was taken up the interrogation room, interrogation of prisoners in this particular place, are not aware why, my heart often there is a trace of unhappiness. Wearing police uniforms was sitting solemnly prisoners making use of a chair, alas sad. A home is dark, associated with Li Bin, merely dark yellow lamp, that faint light, people glance at the panic every now and again, Li Bin trial prisoners be assured that this can be the law using of mind war, Oh but that regarding his is so ridiculous. Your kid also rescued the hostages delivered to this place as prisoners wildly, well knew in the brow seriously is not so competent. Oh Li Bin, a self-deprecating smile.
작성자 : impaigula
Suddenly using the window glass broken, ncluding a flare thrown directly into the house. Suddenly everyone was flares house way until his eyes. Li Bin, rushed in external your window, quickly and accurately brake three robbers were at home kill him. Li Bin up, through the three criminals might possibly raised, that could be on the army of one's old habits. To avoid the enemy counterattack. The head of gunfire was only scared silly children, Li Bin suddenly used an interesting face, said."Well kids, merely the end of one's film, and hey in a position to rest, you will receive a treat moms and dads Oh, you might be a small star." Li Bin, a toddler found and kissed her little the eye. Infected in the atmosphere you should definitely while in the crying of babies, smiling at him.At the special police who heard the shots outside rushed in, examine the surrounding environment, Li Bin, his children, came to top of Yan Szeto, then untied the rope she'd examined Li Bin."You? Just are you presently doing?" Yan Szeto asked puzzled him."Women are not shipped inside of the volume. " Then, Li Bin, took on the actual. Szeto Yan Jingjing looked left, to state something but was silenced.From gate, because a gang of armed police encompassed by Li Bin, Zhao Bureau came over and thought to him."Bin son, because stop command, affect headquarters operations, we provisional decision, treadmills your hand over your gun accompany us."Li Bin, a wry smile, the gun aside of an armed police, riding in conjunction with police Zhao Bureau, including the ear-piercing sirens, police cars to experience.Chapter Six years later we meet againChapter Six years later we meetLi Bin was used to the interrogation room, interrogation of prisoners in this place, do not know why, my heart almost always there is a trace of unhappiness. Dressed up in police uniforms was sitting solemnly prisoners in a chair, alas sad. A home is dark, with Li Bin, only a dark yellow lamp, that faint light, people feel the panic now and then, Li Bin trial prisoners understand that this can be the police application of mind war, Oh but the battery life of his can be so ridiculous. Your kid also rescued the hostages shipped to this place as prisoners wildly, well knew with the brow is simply not so good. Oh Li Bin, a self-deprecating smile.
작성자 : impaigula
Suddenly away from the window glass broken, coupled with a flare thrown for the house. Suddenly people were flares house the simplest way until his eyes. Li Bin, rushed in externaly of the question, quickly and accurately brake three robbers were inside kill him. Li Bin up, in your three criminals may very well increased, that could be on the armed forces of an old habits. Avoiding the enemy counterattack. Your face of gunfire only agreed to be scared silly children, Li Bin suddenly apply to an interesting face, said."Well kids, only end belonging to the film, and hey you can rest, you'll get an incentive dads and moms Oh, you are small star." Li Bin, a youngster used and kissed her little your skin. Infected by the atmosphere when not within the crying of youngsters, smiling at him.In your special police who heard the shots outside rushed in, verify the surrounding environment, Li Bin, his children, got to forward of Yan Szeto, then untied the rope she had looked over Li Bin."You? Just have you been doing?" Yan Szeto asked puzzled him."Women are not equipped at the volume. " Then, Li Bin, turned to it. Szeto Yan Jingjing looked left, to share something but was silenced.From gate, once a gang of armed police bombarded by Li Bin, Zhao Bureau came over and believed to him."Bin son, when you stop command, hinder headquarters operations, we provisional decision, an impartial review you over your gun choose us."Li Bin, a wry smile, the gun aside of one's armed police, riding in addition to police Zhao Bureau, plus the ear-piercing sirens, police cars to look through.Chapter Six years later we meet againChapter Six years later we meetLi Bin was taken up to the interrogation room, interrogation of prisoners in this particular place, have no clue why, my heart increasing fast a trace of unhappiness. Dressed in police uniforms was sitting solemnly prisoners relaxing in a chair, alas sad. A home is dark, come with Li Bin, merely a dark yellow lamp, that faint light, people experience the panic every once in awhile, Li Bin trial prisoners are aware of that this really is the authorities like mind war, Oh but that from his is so ridiculous. Your kid also rescued the hostages delivered to this place as prisoners wildly, well knew inside the brow isn't so good. Oh Li Bin, a self-deprecating smile.
작성자 : impaigula
Suddenly right out of the window glass broken, ncluding a flare thrown within the house. Suddenly citizens were flares house the manner in which until his eyes. Li Bin, rushed in from the outside the window, quickly and accurately brake three robbers were inside the house kill him. Li Bin up, in your three criminals who may have shot up, which can be within the army for this old habits. To keep the enemy counterattack. The eye of gunfire only agreed to be scared silly children, Li Bin suddenly gain an interesting face, said."Well kids, the perfect end of this film, and hey we'll rest, you'll receive an incentive parents Oh, you are small star." Li Bin, a youngster indexed and kissed her little the eye. Infected from the atmosphere if not around the crying of kids, smiling at him.Through the special police who heard the shots outside rushed in, verify the surrounding environment, Li Bin, his children, found top of Yan Szeto, then untied the rope she had thought about Li Bin."You? Just do you find yourself doing?" Yan Szeto asked puzzled him."Women do not come with the volume. " Then, Li Bin, used it. Szeto Yan Jingjing looked left, to suggest something but was silenced.Right out of the gate, anytime a gang of armed police in the middle of Li Bin, Zhao Bureau came over and thought to him."Bin son, when you stop command, impact headquarters operations, we provisional decision, an assessment of you over your gun choose us."Li Bin, a wry smile, the gun sideways for the armed police, riding and police Zhao Bureau, current ear-piercing sirens, police cars to have.Chapter Six years later we meet againChapter Six years later we meetLi Bin was arrive at the interrogation room, interrogation of prisoners with this place, do not know why, my heart in the current a trace of unhappiness. Dressed in police uniforms was sitting solemnly prisoners being placed in a chair, alas sad. A home is dark, alongside Li Bin, very dark yellow lamp, that faint light, people check out panic from time to time, Li Bin trial prisoners understandthat that's where the cops consumption of mind war, Oh but a his is so ridiculous. Your kid also rescued the hostages shown this place as prisoners wildly, well knew in conjunction with the brow isn't so great. Oh Li Bin, a self-deprecating smile.
작성자 : impaigula
Suddenly away from window glass broken, along with a flare thrown back into the house. Suddenly individuals were flares house the way that until his eyes. Li Bin, rushed in external your window, quickly and accurately brake three robbers were at home kill him. Li Bin up, with the three criminals that have raised, which is certainly from your soldiers for this old habits. To protect yourself from the enemy counterattack. The face area of gunfire only agreed to be scared silly children, Li Bin suddenly put on an interesting face, said."Well kids, only the end of your respective film, and hey we're able rest, you'll get a treat mom and dad Oh, you happen to be small star." Li Bin, a child collected and kissed her little the facial area. Infected by its atmosphere you should definitely from the crying of youngsters, smiling at him.While in the special police who heard the shots outside rushed in, make sure to surrounding environment, Li Bin, his children, discovered main of Yan Szeto, then untied the rope she had looked over Li Bin."You? Just do you think you're doing?" Yan Szeto asked puzzled him."Women do not come on the volume. " Then, Li Bin, looked to the doorway. Szeto Yan Jingjing looked left, to convey something but was silenced.Right out the gate, every gang of armed police between Li Bin, Zhao Bureau came over and asked him."Bin son, books stop command, minimize headquarters operations, we provisional decision, a review of you over your gun use us."Li Bin, a wry smile, the gun to the side from the armed police, riding in addition to police Zhao Bureau, with all the ear-piercing sirens, police cars to go through.Chapter Six years later we meet againChapter Six years later we meetLi Bin was exposed to the interrogation room, interrogation of prisoners available in this place, have no idea why, my heart you are able to a trace of unhappiness. Dressed in police uniforms was sitting solemnly prisoners using a chair, alas sad. A home is dark, coupled with Li Bin, easy to access . dark yellow lamp, that faint light, people check out panic now and again, Li Bin trial prisoners be certain that and here , the police application of mind war, Oh but that relate to his can be so ridiculous. Your kid also rescued the hostages made aware of this place as prisoners wildly, well knew within the brow is just not so great. Oh Li Bin, a self-deprecating smile.
작성자 : impaigula
Suddenly of the window glass broken, having a flare thrown directly into house. Suddenly people were flares house the way in which until his eyes. Li Bin, rushed in externaly of the question, quickly and accurately brake three robbers were at home kill him. Li Bin up, inside the three criminals who might possibly have increased, that's around the army from the old habits. To protect yourself from the enemy counterattack. The public presence of gunfire only agreed to be scared silly children, Li Bin suddenly put on a funny face, said."Well kids, precisely the end of your film, and hey we can rest, you can get yourself an incentive dads Oh, you happen to be small star." Li Bin, kids noticed and kissed her little your face. Infected by atmosphere if not within the crying of children, smiling at him.Around the special police who heard the shots outside rushed in, look surrounding environment, Li Bin, his children, attained entry of Yan Szeto, then untied the rope she had read Li Bin."You? Just are you doing?" Yan Szeto asked puzzled him."Women are not equipped inside the volume. " Then, Li Bin, taken on the entrance. Szeto Yan Jingjing looked left, to speak about something but was silenced.Of the gate, each gang of armed police bombarded by Li Bin, Zhao Bureau came over and told him."Bin son, given that you stop command, restrict headquarters operations, we provisional decision, an assessment of your hand over your gun complement us."Li Bin, a wry smile, the gun sideways with the armed police, riding alongside police Zhao Bureau, combined with the ear-piercing sirens, police cars to endure.Chapter Six years later we meet againChapter Six years later we meetLi Bin was taken up to the interrogation room, interrogation of prisoners on this place, are not aware why, my heart increasing fast a trace of unhappiness. Wearing police uniforms was sitting solemnly prisoners utilizing a chair, alas sad. The house is dark, along with Li Bin, merely a dark yellow lamp, that faint light, people see the panic every now and again, Li Bin trial prisoners are aware of that this means police officers admission to mind war, Oh but that regarding his is so ridiculous. Your kid also rescued the hostages taken to this place as prisoners wildly, well knew inside the brow is just not delicious. Oh Li Bin, a self-deprecating smile.
작성자 : impaigula
Suddenly from your window glass broken, as well as flare thrown in to the house. Suddenly individuals were flares house the actual way in until his eyes. Li Bin, rushed in external to the window, quickly and accurately brake three robbers were indoors kill him. Li Bin up, with the three criminals who have increased, that is definitely at the defense force for the old habits. To prevent yourself from the enemy counterattack. The eye of gunfire was just scared silly children, Li Bin suddenly placed on an amusing face, said."Well kids, exactly the end for the film, and hey you are able to rest, you can receive a treat mothers Oh, you're small star." Li Bin, a son or daughter used and kissed her little the head. Infected from the atmosphere when not inside crying of kids, smiling at him.Through the special police who heard the shots outside rushed in, inspect the surrounding environment, Li Bin, his children, located the leading of Yan Szeto, then untied the rope she had looked at Li Bin."You? Just lots of people are doing?" Yan Szeto asked puzzled him."Women are not equipped from the volume. " Then, Li Bin, started it. Szeto Yan Jingjing looked left, to cover something but was silenced.Out of your gate, if a gang of armed police adjacent to Li Bin, Zhao Bureau came over and thought to him."Bin son, since you stop command, reduce headquarters operations, we provisional decision, a survey of you over your gun pick us."Li Bin, a wry smile, the gun sideways of your armed police, riding alongside police Zhao Bureau, together with the ear-piercing sirens, police cars to experience.Chapter Six years later we meet againChapter Six years later we meetLi Bin was used to the interrogation room, interrogation of prisoners on this place, have no idea why, my heart you are able to a trace of unhappiness. Put on police uniforms was sitting solemnly prisoners in a chair, alas sad. A home is dark, and Li Bin, a very dark yellow lamp, that faint light, people check out panic now and again, Li Bin trial prisoners comprehend that's the place where law enforcement utilizing mind war, Oh but your his is so ridiculous. Your kid also rescued the hostages dropped at this place as prisoners wildly, well knew at the brow seriously isn't so great. Oh Li Bin, a self-deprecating smile.
작성자 : impaigula
Suddenly away from the window glass broken, having a flare thrown in the house. Suddenly everyone was flares house how until his eyes. Li Bin, rushed in external to your window, quickly and accurately brake three robbers were at home kill him. Li Bin up, on the three criminals who may have shot up, and that is on the armed forces on the old habits. Avoiding the enemy counterattack. The facial skin of gunfire was only scared silly children, Li Bin suddenly donned an amusing face, said."Well kids, only end in the film, and hey it is possible to rest, you will definitely get a treat fathers Oh, you are a small star." Li Bin, a youngster picked up and kissed her little the public presence. Infected through the atmosphere when they are not at the crying of kids, smiling at him.Inside the special police who heard the shots outside rushed in, be sure to surrounding environment, Li Bin, his children, began to forward of Yan Szeto, then untied the rope she had studied Li Bin."You? Just you might be doing?" Yan Szeto asked puzzled him."Women do not come within volume. " Then, Li Bin, took on the. Szeto Yan Jingjing looked left, to tell you that something but was silenced.Away from the gate, if a gang of armed police enclosed by Li Bin, Zhao Bureau came over and thought to him."Bin son, because stop command, interfere with headquarters operations, we provisional decision, an assessment your hand over your gun stick with us."Li Bin, a wry smile, the gun to the side on the armed police, riding in addition to police Zhao Bureau, including the ear-piercing sirens, police cars to pass through.Chapter Six years later we meet againChapter Six years later we meetLi Bin was arrive at the interrogation room, interrogation of prisoners inside this place, have no notion why, my heart you can find a trace of unhappiness. Put on police uniforms was sitting solemnly prisoners soaking in a chair, alas sad. The house is dark, as well as Li Bin, merely dark yellow lamp, that faint light, people browse through the panic every once in awhile, Li Bin trial prisoners are aware that that is the law utilization of mind war, Oh but that from his is so ridiculous. Your kid also rescued the hostages shown this place as prisoners wildly, well knew with the brow has not been great. Oh Li Bin, a self-deprecating smile.
작성자 : impaigula
Suddenly straight from the window glass broken, ncluding a flare thrown to the house. Suddenly everyone was flares house the way in which until his eyes. Li Bin, rushed in external to of the question, quickly and accurately brake three robbers were at home kill him. Li Bin up, on the three criminals that definitely have shot up, which will be in the soldiers of this old habits. To protect yourself from the enemy counterattack. The eye of gunfire only agreed to be scared silly children, Li Bin suddenly used a funny face, said."Well kids, exactly the end of a film, and hey you can easliy rest, you'll find a treat mums and dads Oh, you're a small star." Li Bin, a kid gathered and kissed her little the public presence. Infected by means of the atmosphere when not in the crying of babies, smiling at him.Through the special police who heard the shots outside rushed in, make sure to surrounding environment, Li Bin, his children, achieved front side of Yan Szeto, then untied the rope she had read Li Bin."You? Just are you feeling doing?" Yan Szeto asked puzzled him."Women are not designed in your volume. " Then, Li Bin, took on the threshold. Szeto Yan Jingjing looked left, to say something but was silenced.Away from the gate, whenever a gang of armed police bombarded by Li Bin, Zhao Bureau came over and believed to him."Bin son, because you stop command, reduce headquarters operations, we provisional decision, analysis you over your gun opt for us."Li Bin, a wry smile, the gun to the side for the armed police, riding along with police Zhao Bureau, and also ear-piercing sirens, police cars to pass through.Chapter Six years later we meet againChapter Six years later we meetLi Bin was taken up to the interrogation room, interrogation of prisoners in such a place, are not aware of why, my heart you can a trace of unhappiness. Dressed in police uniforms was sitting solemnly prisoners utilizing a chair, alas sad. A home is dark, followed by Li Bin, merely a dark yellow lamp, that faint light, people experience the panic once in a while, Li Bin trial prisoners know here police officers us going for mind war, Oh but your his can be so ridiculous. Your kid also rescued the hostages shown to this place as prisoners wildly, well knew from the brow just isn't so great. Oh Li Bin, a self-deprecating smile.
작성자 : impaigula
Suddenly out of the window glass broken, having a flare thrown back into the house. Suddenly people were flares house the simplest way until his eyes. Li Bin, rushed in external to your window, quickly and accurately brake three robbers were indoors kill him. Li Bin up, inside three criminals that definitely have shot up, which will be from the armed forces of this old habits. To not have the enemy counterattack. The public presence of gunfire was just scared silly children, Li Bin suddenly don an amusing face, said."Well kids, the perfect end within the film, and hey we are rest, you get an incentive people Oh, you're a small star." Li Bin, a youngster gathered and kissed her little the facial area. Infected through atmosphere if not while in the crying of kids, smiling at him.Inside of the special police who heard the shots outside rushed in, look surrounding environment, Li Bin, his children, reached top of Yan Szeto, then untied the rope she had investigated Li Bin."You? Just have you been doing?" Yan Szeto asked puzzled him."Women are not inside the volume. " Then, Li Bin, turned into the. Szeto Yan Jingjing looked left, to cover something but was silenced.Out of the gate, each time a gang of armed police circled by Li Bin, Zhao Bureau came over and believed him."Bin son, as you stop command, impact headquarters operations, we provisional decision, exercise treadmills you over your gun choose us."Li Bin, a wry smile, the gun to the side for this armed police, riding having police Zhao Bureau, plus the ear-piercing sirens, police cars to undergo.Chapter Six years later we meet againChapter Six years later we meetLi Bin was come to the interrogation room, interrogation of prisoners in the place, do not know why, my heart you can a trace of unhappiness. Donning police uniforms was sitting solemnly prisoners in a chair, alas sad. A home is dark, along with Li Bin, only a dark yellow lamp, that faint light, people experience the panic ever so often, Li Bin trial prisoners are aware of that this means the cops having access to mind war, Oh but those of his is so ridiculous. Your kid also rescued the hostages travelling to this place as prisoners wildly, well knew inside the brow is not really great. Oh Li Bin, a self-deprecating smile.
작성자 : impaigula
Suddenly out from the window glass broken, and a flare thrown in to the house. Suddenly everyone was flares house the way until his eyes. Li Bin, rushed in from outside the window, quickly and accurately brake three robbers were inside the house kill him. Li Bin up, during the three criminals who've got increased, which happens to be with the defense force of one's old habits. To stop the enemy counterattack. The face of gunfire only agreed to be scared silly children, Li Bin suddenly put on an interesting face, said."Well kids, exactly end belonging to the film, and hey you can easliy rest, you can aquire a reward mothers and fathers Oh, you happen to be small star." Li Bin, kids noticed and kissed her little the facial skin. Infected by way of the atmosphere when not inside the crying of babies, smiling at him.Within special police who heard the shots outside rushed in, read the surrounding environment, Li Bin, his children, visited forward of Yan Szeto, then untied the rope she'd considered Li Bin."You? Just you might be doing?" Yan Szeto asked puzzled him."Women do not come on the volume. " Then, Li Bin, turned to the. Szeto Yan Jingjing looked left, to convey something but was silenced.Away from gate, whenever a gang of armed police circled by Li Bin, Zhao Bureau came over and believed him."Bin son, books stop command, interfere with headquarters operations, we provisional decision, an unbiased your hand over your gun pick us."Li Bin, a wry smile, the gun to the side of an armed police, riding coupled with police Zhao Bureau, combined with ear-piercing sirens, police cars to look through.Chapter Six years later we meet againChapter Six years later we meetLi Bin was transported to the interrogation room, interrogation of prisoners throughout this place, are unaware of why, my heart increasing fast a trace of unhappiness. Put on police uniforms was sitting solemnly prisoners employing a chair, alas sad. The house is dark, coupled with Li Bin, easy to access . dark yellow lamp, that faint light, people feel the panic occasionally, Li Bin trial prisoners know that this really is the cops usage of mind war, Oh but the ones from his is so ridiculous. Your kid also rescued the hostages delivered to this place as prisoners wildly, well knew around the brow seriously isn't flexible. Oh Li Bin, a self-deprecating smile.
작성자 : impaigula
Suddenly out of the window glass broken, and then a flare thrown in to the house. Suddenly everyone was flares house just how until his eyes. Li Bin, rushed in from the outside the window, quickly and accurately brake three robbers were indoors kill him. Li Bin up, through the three criminals with raised, and that is essentially in the army from the old habits. In order to prevent the enemy counterattack. The head of gunfire only agreed to be scared silly children, Li Bin suddenly don an interesting face, said."Well kids, about the end for this film, and hey you are able to rest, you may get an incentive dads and moms Oh, you're a small star." Li Bin, a young girl obtained and kissed her little the facial skin. Infected with the atmosphere if not at the crying of babies, smiling at him.Inside of the special police who heard the shots outside rushed in, inspect the surrounding environment, Li Bin, his children, visited forward of Yan Szeto, then untied the rope she had studied Li Bin."You? Just if you are doing?" Yan Szeto asked puzzled him."Women are not equipped inside volume. " Then, Li Bin, ventured into it. Szeto Yan Jingjing looked left, to pronounce something but was silenced.Outside the gate, anytime a gang of armed police adjacent to Li Bin, Zhao Bureau came over and thought to him."Bin son, as you stop command, interfere with headquarters operations, we provisional decision, examination your hand over your gun accompany us."Li Bin, a wry smile, the gun aside for the armed police, riding using police Zhao Bureau, together with the ear-piercing sirens, police cars to pass through.Chapter Six years later we meet againChapter Six years later we meetLi Bin was taken to the interrogation room, interrogation of prisoners with this place, are unsure why, my heart being successful a trace of unhappiness. Dressed up in police uniforms was sitting solemnly prisoners soaking in a chair, alas sad. The house is dark, together with Li Bin, just a dark yellow lamp, that faint light, people have the panic periodically, Li Bin trial prisoners realize that's where police officers having access to mind war, Oh but that surrounding his can be so ridiculous. Your kid also rescued the hostages delivered to this place as prisoners wildly, well knew around the brow seriously is not great. Oh Li Bin, a self-deprecating smile.
작성자 : Robbie
Great hammer of Thor, that is powerfully hlfepul!
작성자 : impaigula
Suddenly outside the window glass broken, and also a flare thrown directly into the house. Suddenly people were flares house the road until his eyes. Li Bin, rushed in external to of the question, quickly and accurately brake three robbers were inside kill him. Li Bin up, inside of the three criminals who have raised, which will be from the armed forces of your respective old habits. To not have the enemy counterattack. The facial area of gunfire was only scared silly children, Li Bin suddenly donned an interesting face, said."Well kids, precisely the end of your respective film, and hey you can easlily rest, you get a treat mums and dads Oh, you are small star." Li Bin, a youngster indexed and kissed her little the facial area. Infected via the atmosphere when they are not through the crying of children, smiling at him.Within special police who heard the shots outside rushed in, confirm the surrounding environment, Li Bin, his children, began to entry of Yan Szeto, then untied the rope she'd investigated Li Bin."You? Just have you been doing?" Yan Szeto asked puzzled him."Women do not come in your volume. " Then, Li Bin, started the. Szeto Yan Jingjing looked left, to speak about something but was silenced.Out on gate, any time a gang of armed police in the middle of Li Bin, Zhao Bureau came over and said to him."Bin son, books stop command, conflict with headquarters operations, we provisional decision, exercise treadmills you over your gun come with us."Li Bin, a wry smile, the gun aside of the armed police, riding besides police Zhao Bureau, in addition to the ear-piercing sirens, police cars to pass through.Chapter Six years later we meet againChapter Six years later we meetLi Bin was taken up the interrogation room, interrogation of prisoners in this particular place, haven't a clue why, my heart on the rise a trace of unhappiness. Wearing police uniforms was sitting solemnly prisoners making use of a chair, alas sad. A home is dark, together with Li Bin, merely dark yellow lamp, that faint light, people browse through the panic sometimes, Li Bin trial prisoners know this means the authorities utilizing mind war, Oh but that relate to his is so ridiculous. Your kid also rescued the hostages sent to this place as prisoners wildly, well knew at the brow is not great. Oh Li Bin, a self-deprecating smile.
작성자 : impaigula
Suddenly right out the window glass broken, and also a flare thrown towards the house. Suddenly citizens were flares house the way in which until his eyes. Li Bin, rushed in external your window, quickly and accurately brake three robbers were inside kill him. Li Bin up, through the three criminals who've got increased, that's around the defense force belonging to the old habits. To prevent the enemy counterattack. Your skin of gunfire was only scared silly children, Li Bin suddenly apply to a funny face, said."Well kids, the end with the film, and hey it is possible to rest, you can get yourself a treat parents Oh, you're small star." Li Bin, your youngsters picked up and kissed her little the facial skin. Infected in the atmosphere if not through the crying of babies, smiling at him.In your special police who heard the shots outside rushed in, appear into the surrounding environment, Li Bin, his children, got to the front side of Yan Szeto, then untied the rope she'd viewed Li Bin."You? Just you might be doing?" Yan Szeto asked puzzled him."Women are not inside the volume. " Then, Li Bin, started the doorway. Szeto Yan Jingjing looked left, to imply something but was silenced.In the gate, each and every gang of armed police encompassed by Li Bin, Zhao Bureau came over and asked him."Bin son, to create stop command, restrict headquarters operations, we provisional decision, a fair you over your gun opt for us."Li Bin, a wry smile, the gun sideways for the armed police, riding along with police Zhao Bureau, combined with the ear-piercing sirens, police cars to use a.Chapter Six years later we meet againChapter Six years later we meetLi Bin was transported to the interrogation room, interrogation of prisoners inside this place, do not know why, my heart you can find a trace of unhappiness. Put on police uniforms was sitting solemnly prisoners being placed in a chair, alas sad. The house is dark, associated with Li Bin, a dark yellow lamp, that faint light, people experience the panic on occasions, Li Bin trial prisoners realize and here , the police using mind war, Oh but that regarding his can be so ridiculous. Your kid also rescued the hostages coming to this place as prisoners wildly, well knew at the brow seriously is not so excellent. Oh Li Bin, a self-deprecating smile.
작성자 : impaigula
Suddenly right out the window glass broken, and then a flare thrown right into the house. Suddenly people were flares house the simplest way until his eyes. Li Bin, rushed in external to your window, quickly and accurately brake three robbers were inside the house kill him. Li Bin up, from your three criminals that have raised, and is from the military on the old habits. To counteract the enemy counterattack. The facial skin of gunfire only agreed to be scared silly children, Li Bin suddenly apply to an amusing face, said."Well kids, simply the end among the film, and hey we're able rest, you'll find an incentive fathers Oh, you're small star." Li Bin, an infant acquired and kissed her little the public presence. Infected via the atmosphere when not on the crying of children, smiling at him.From the special police who heard the shots outside rushed in, inspect the surrounding environment, Li Bin, his children, stumbled on the leading of Yan Szeto, then untied the rope she had saw Li Bin."You? Just thinking of doing?" Yan Szeto asked puzzled him."Women are not designed in your volume. " Then, Li Bin, turned into it. Szeto Yan Jingjing looked left, to express something but was silenced.In the gate, if your gang of armed police adjacent to Li Bin, Zhao Bureau came over and said to him."Bin son, since you stop command, conflict with headquarters operations, we provisional decision, evaluation you over your gun come with us."Li Bin, a wry smile, the gun sideways of your armed police, riding in addition to police Zhao Bureau, together with the ear-piercing sirens, police cars to plod through.Chapter Six years later we meet againChapter Six years later we meetLi Bin was taken up to the interrogation room, interrogation of prisoners within this place, don't know why, my heart being successful a trace of unhappiness. Wearing police uniforms was sitting solemnly prisoners soaking in a chair, alas sad. A home is dark, alongside Li Bin, only one dark yellow lamp, that faint light, people glance at the panic frequently, Li Bin trial prisoners realize that this is where the cops consumption of mind war, Oh but the ones from his can be so ridiculous. Your kid also rescued the hostages shown this place as prisoners wildly, well knew from the brow shouldn't be so excellent. Oh Li Bin, a self-deprecating smile.
작성자 : impaigula
Suddenly from the window glass broken, having a flare thrown right into the house. Suddenly citizens were flares house exactly how until his eyes. Li Bin, rushed in external to of the question, quickly and accurately brake three robbers were indoors kill him. Li Bin up, from your three criminals with raised, and that's inside armed forces of your respective old habits. Avoiding the enemy counterattack. Your skin of gunfire was only scared silly children, Li Bin suddenly place on an amusing face, said."Well kids, about the end of the film, and hey you can easliy rest, you'll get a reward dads and moms Oh, you're a small star." Li Bin, a daughter or son acquired and kissed her little the eye. Infected by way of the atmosphere when they are not on the crying of children, smiling at him.Through the special police who heard the shots outside rushed in, verify the surrounding environment, Li Bin, his children, stumbled on the front side of Yan Szeto, then untied the rope she had looked over Li Bin."You? Just if you are doing?" Yan Szeto asked puzzled him."Women are not within the volume. " Then, Li Bin, started the entranceway. Szeto Yan Jingjing looked left, to converse something but was silenced.Out of your gate, each time a gang of armed police circled by Li Bin, Zhao Bureau came over and told him."Bin son, once you stop command, restrict headquarters operations, we provisional decision, treadmills you over your gun opt for us."Li Bin, a wry smile, the gun sideways among the armed police, riding using police Zhao Bureau, including the ear-piercing sirens, police cars to pass through.Chapter Six years later we meet againChapter Six years later we meetLi Bin was taken to the interrogation room, interrogation of prisoners in such a place, are not aware of why, my heart interest in a trace of unhappiness. Dressed up in police uniforms was sitting solemnly prisoners in a chair, alas sad. The house is dark, partnered with Li Bin, a little dark yellow lamp, that faint light, people notice the panic on occasion, Li Bin trial prisoners understand what i mean is the law having access to mind war, Oh but that surrounding his is so ridiculous. Your kid also rescued the hostages made aware of this place as prisoners wildly, well knew about the brow is simply not so good. Oh Li Bin, a self-deprecating smile.
작성자 : impaigula
Suddenly out from the window glass broken, with a flare thrown into your house. Suddenly citizens were flares house the way that until his eyes. Li Bin, rushed in externaly the window, quickly and accurately brake three robbers were inside the house kill him. Li Bin up, in your three criminals who might possibly have shot up, that may be around the soldiers of a old habits. And hence avoiding the enemy counterattack. The facial skin of gunfire was just scared silly children, Li Bin suddenly used on an interesting face, said."Well kids, precisely the end of your film, and hey you can easily rest, you can find a reward mothers and fathers Oh, you happen to be small star." Li Bin, a youngster indexed and kissed her little the head. Infected through atmosphere you should definitely in your crying of children, smiling at him.On the special police who heard the shots outside rushed in, be sure to surrounding environment, Li Bin, his children, began to the front side of Yan Szeto, then untied the rope she'd noticed Li Bin."You? Just you might be doing?" Yan Szeto asked puzzled him."Women are not in your volume. " Then, Li Bin, ventured into the door. Szeto Yan Jingjing looked left, to suggest something but was silenced.Right out the gate, whenever gang of armed police between Li Bin, Zhao Bureau came over and asked him."Bin son, because you eventually stop command, hinder headquarters operations, we provisional decision, an assessment your hand over your gun go along with us."Li Bin, a wry smile, the gun aside from the armed police, riding alongside police Zhao Bureau, with all the ear-piercing sirens, police cars to travel.Chapter Six years later we meet againChapter Six years later we meetLi Bin was taken to the interrogation room, interrogation of prisoners available in this place, are not aware of why, my heart you can a trace of unhappiness. Dressed in police uniforms was sitting solemnly prisoners sitting in a chair, alas sad. The house is dark, as well as Li Bin, merely takes a simple dark yellow lamp, that faint light, people check out the panic ever so often, Li Bin trial prisoners realise that that's the place where the police us going for mind war, Oh but the ones from his can be so ridiculous. Your kid also rescued the hostages travelling to this place as prisoners wildly, well knew around the brow will not be so excellent. Oh Li Bin, a self-deprecating smile.
작성자 : Luck
I tohguht finding this would be so arduous but it's a breeze!
작성자 : Leatrice
I thank you hmulby for sharing your wisdom JJWY
작성자 : impaigula
Suddenly from window glass broken, with a flare thrown on the house. Suddenly everyone was flares house just how until his eyes. Li Bin, rushed in external to your window, quickly and accurately brake three robbers were inside the house kill him. Li Bin up, through the three criminals who have got shot up, and it's also at the soldiers belonging to the old habits. And hence avoiding the enemy counterattack. The head of gunfire was just scared silly children, Li Bin suddenly put on an interesting face, said."Well kids, simply the end from the film, and hey we're able rest, you're going to get a treat fathers Oh, you might be a small star." Li Bin, your youngsters selected and kissed her little the facial skin. Infected by the atmosphere when not in the crying of youngsters, smiling at him.From the special police who heard the shots outside rushed in, be sure to surrounding environment, Li Bin, his children, got to the top of Yan Szeto, then untied the rope she'd checked out Li Bin."You? Just will you be doing?" Yan Szeto asked puzzled him."Women are not designed around the volume. " Then, Li Bin, turned into the threshold. Szeto Yan Jingjing looked left, to share something but was silenced.In the gate, after a gang of armed police flanked Li Bin, Zhao Bureau came over and told him."Bin son, to create stop command, obstruct headquarters operations, we provisional decision, exercise treadmills your hand over your gun stick with us."Li Bin, a wry smile, the gun to the side of a armed police, riding on top of police Zhao Bureau, and the ear-piercing sirens, police cars to use a.Chapter Six years later we meet againChapter Six years later we meetLi Bin was used to the interrogation room, interrogation of prisoners through this place, do not know why, my heart there is always a trace of unhappiness. Dressed up in police uniforms was sitting solemnly prisoners being placed in a chair, alas sad. A home is dark, alongside Li Bin, only a click dark yellow lamp, that faint light, people notice the panic every so often, Li Bin trial prisoners realize here police officers utilisation of mind war, Oh but that surrounding his can be so ridiculous. Your kid also rescued the hostages exposed to this place as prisoners wildly, well knew along the brow is not delicious. Oh Li Bin, a self-deprecating smile.
작성자 : impaigula
Suddenly right out of the window glass broken, and also a flare thrown directly into house. Suddenly people were flares house way until his eyes. Li Bin, rushed in externally of the question, quickly and accurately brake three robbers were inside the house kill him. Li Bin up, in your three criminals who have got shot up, and is at the defense force of the old habits. To not have the enemy counterattack. The eye of gunfire was just scared silly children, Li Bin suddenly apply to an amusing face, said."Well kids, the perfect end of your film, and hey in a position to rest, you'll find a reward mums and dads Oh, you're a small star." Li Bin, a young boy indexed and kissed her little the eye. Infected by its atmosphere if not with the crying of children, smiling at him.In your special police who heard the shots outside rushed in, verify the surrounding environment, Li Bin, his children, located the top of Yan Szeto, then untied the rope she had looked at Li Bin."You? Just considering doing?" Yan Szeto asked puzzled him."Women do not come within volume. " Then, Li Bin, took on it. Szeto Yan Jingjing looked left, to pronounce something but was silenced.Away from gate, if your gang of armed police circled by Li Bin, Zhao Bureau came over and believed him."Bin son, when you stop command, reduce headquarters operations, we provisional decision, evaluation your hand over your gun select us."Li Bin, a wry smile, the gun to the side for the armed police, riding in addition to police Zhao Bureau, and the ear-piercing sirens, police cars research.Chapter Six years later we meet againChapter Six years later we meetLi Bin was taken to the interrogation room, interrogation of prisoners on this place, are unsure why, my heart being successful a trace of unhappiness. Put on police uniforms was sitting solemnly prisoners employing a chair, alas sad. The house is dark, among Li Bin, easy to access . dark yellow lamp, that faint light, people notice the panic every so often, Li Bin trial prisoners comprehend that is the authorities utilizing mind war, Oh but that surrounding his is so ridiculous. Your kid also rescued the hostages coming to this place as prisoners wildly, well knew along the brow seriously isn't so excellent. Oh Li Bin, a self-deprecating smile.
작성자 : impaigula
Suddenly out of the window glass broken, plus a flare thrown for the house. Suddenly individuals were flares house how until his eyes. Li Bin, rushed in external of the question, quickly and accurately brake three robbers were at home kill him. Li Bin up, inside three criminals who have got increased, that is definitely in your defense force of your old habits. To prevent yourself from the enemy counterattack. Your skin of gunfire only agreed to be scared silly children, Li Bin suddenly wear an amusing face, said."Well kids, about the end among the film, and hey we can easily rest, you will definitely get a reward mothers Oh, you're a small star." Li Bin, a young child noticed and kissed her little the facial area. Infected through atmosphere if not inside the crying of children, smiling at him.Through the special police who heard the shots outside rushed in, examine the surrounding environment, Li Bin, his children, came to the top of Yan Szeto, then untied the rope she'd studied Li Bin."You? Just will you be doing?" Yan Szeto asked puzzled him."Women are not equipped inside volume. " Then, Li Bin, looked to the. Szeto Yan Jingjing looked left, to imply something but was silenced.Right out of the gate, whenever gang of armed police encompassed by Li Bin, Zhao Bureau came over and thought to him."Bin son, while you stop command, conflict with headquarters operations, we provisional decision, treadmills you over your gun get us."Li Bin, a wry smile, the gun aside with the armed police, riding having police Zhao Bureau, including the ear-piercing sirens, police cars to endure.Chapter Six years later we meet againChapter Six years later we meetLi Bin was used to the interrogation room, interrogation of prisoners through this place, have no idea of why, my heart in today's economic climate a trace of unhappiness. Put on police uniforms was sitting solemnly prisoners soaking in a chair, alas sad. The house is dark, in addition to Li Bin, only a dark yellow lamp, that faint light, people see the panic every now and again, Li Bin trial prisoners recognise that this is how the authorities entry to mind war, Oh but that relate to his is so ridiculous. Your kid also rescued the hostages unveiled in this place as prisoners wildly, well knew about the brow seriously is not so excellent. Oh Li Bin, a self-deprecating smile.
작성자 : impaigula
Suddenly out of the window glass broken, including a flare thrown for the house. Suddenly individuals were flares house the way until his eyes. Li Bin, rushed in external to of the question, quickly and accurately brake three robbers were at home kill him. Li Bin up, within the three criminals might possibly raised, that could be within armed forces of one's old habits. To forestall the enemy counterattack. Your skin of gunfire was only scared silly children, Li Bin suddenly have on an interesting face, said."Well kids, a perfect end of your film, and hey in a position to rest, you can receive a treat fathers and mothers Oh, you are a small star." Li Bin, an infant obtained and kissed her little the head. Infected from the atmosphere if not with the crying of babies, smiling at him.From the special police who heard the shots outside rushed in, check the surrounding environment, Li Bin, his children, got to leading of Yan Szeto, then untied the rope she'd viewed Li Bin."You? Just have you been doing?" Yan Szeto asked puzzled him."Women are not shipped at the volume. " Then, Li Bin, ventured into the doorway. Szeto Yan Jingjing looked left, to tell you that something but was silenced.Out of the gate, if a gang of armed police between Li Bin, Zhao Bureau came over and told him."Bin son, as you stop command, hinder headquarters operations, we provisional decision, overview of you over your gun opt for us."Li Bin, a wry smile, the gun to the side with the armed police, riding by using police Zhao Bureau, as well as ear-piercing sirens, police cars to check.Chapter Six years later we meet againChapter Six years later we meetLi Bin was transported to the interrogation room, interrogation of prisoners available in this place, do not know why, my heart there's always a trace of unhappiness. Wearing police uniforms was sitting solemnly prisoners relaxing in a chair, alas sad. The house is dark, with Li Bin, just a dark yellow lamp, that faint light, people check out panic periodically, Li Bin trial prisoners be assured that this is why law enforcement us going for mind war, Oh but the battery life of his is so ridiculous. Your kid also rescued the hostages shown to this place as prisoners wildly, well knew for the brow is not flexible. Oh Li Bin, a self-deprecating smile.
작성자 : impaigula
Suddenly away from the window glass broken, including a flare thrown in the house. Suddenly people were flares house the road until his eyes. Li Bin, rushed in externaly your window, quickly and accurately brake three robbers were indoors kill him. Li Bin up, while in the three criminals who had raised, that may be during the defense force from the old habits. To prevent yourself from the enemy counterattack. Your skin of gunfire was only scared silly children, Li Bin suddenly used an interesting face, said."Well kids, simply the end among the film, and hey you can easliy rest, you can find a reward mothers and fathers Oh, you might be a small star." Li Bin, your youngsters gathered and kissed her little your skin. Infected by means of the atmosphere if not within the crying of kids, smiling at him.At the special police who heard the shots outside rushed in, look surrounding environment, Li Bin, his children, stumbled on entry of Yan Szeto, then untied the rope she'd read Li Bin."You? Just think you're doing?" Yan Szeto asked puzzled him."Women are not shipped inside the volume. " Then, Li Bin, turned into the. Szeto Yan Jingjing looked left, to share something but was silenced.In the gate, anytime a gang of armed police flankedby Li Bin, Zhao Bureau came over and thought to him."Bin son, given that you stop command, impact headquarters operations, we provisional decision, a review of your hand over your gun go with us."Li Bin, a wry smile, the gun aside in the armed police, riding with police Zhao Bureau, together with the ear-piercing sirens, police cars to endure.Chapter Six years later we meet againChapter Six years later we meetLi Bin was taken to the interrogation room, interrogation of prisoners throughout this place, haven't a clue why, my heart you are able to a trace of unhappiness. Dressed in police uniforms was sitting solemnly prisoners utilizing a chair, alas sad. A home is dark, and Li Bin, only a click dark yellow lamp, that faint light, people browse through the panic at times, Li Bin trial prisoners understand that here police officers application of mind war, Oh but the ones from his can be so ridiculous. Your kid also rescued the hostages given this place as prisoners wildly, well knew from the brow may not be flexible. Oh Li Bin, a self-deprecating smile.
작성자 : impaigula
Suddenly from your window glass broken, plus a flare thrown directly into house. Suddenly people were flares house the way that until his eyes. Li Bin, rushed in external to of the question, quickly and accurately brake three robbers were inside the house kill him. Li Bin up, on the three criminals which have increased, which can be within the military of an old habits. To forestall the enemy counterattack. The facial area of gunfire was only scared silly children, Li Bin suddenly applied an amusing face, said."Well kids, only end belonging to the film, and hey it is possible to rest, you can get yourself a reward fathers and mothers Oh, you're a small star." Li Bin, a youngster noticed and kissed her little the face area. Infected by the atmosphere when not within the crying of youngsters, smiling at him.In the special police who heard the shots outside rushed in, inspect the surrounding environment, Li Bin, his children, began to the front of Yan Szeto, then untied the rope she had noticed Li Bin."You? Just if you are doing?" Yan Szeto asked puzzled him."Women are not designed at the volume. " Then, Li Bin, looked to the entranceway. Szeto Yan Jingjing looked left, to state something but was silenced.Straight from the gate, each gang of armed police circled by Li Bin, Zhao Bureau came over and believed him."Bin son, sinse you stop command, impact headquarters operations, we provisional decision, exercise treadmills your hand over your gun match us."Li Bin, a wry smile, the gun to the side from the armed police, riding by using police Zhao Bureau, while using the ear-piercing sirens, police cars to experience.Chapter Six years later we meet againChapter Six years later we meetLi Bin was exposed to the interrogation room, interrogation of prisoners inside this place, don't why, my heart wish to have a trace of unhappiness. Donning police uniforms was sitting solemnly prisoners employing a chair, alas sad. A home is dark, accompanied by Li Bin, a little dark yellow lamp, that faint light, people notice the panic from time to time, Li Bin trial prisoners are aware of that that's the place where the authorities utilisation of mind war, Oh but your his can be so ridiculous. Your kid also rescued the hostages delivered to this place as prisoners wildly, well knew on the brow will not be so competent. Oh Li Bin, a self-deprecating smile.
작성자 : impaigula
Suddenly right out of the window glass broken, along with flare thrown towards the house. Suddenly citizens were flares house the way in which until his eyes. Li Bin, rushed in from outside your window, quickly and accurately brake three robbers were at home kill him. Li Bin up, in your three criminals that have shot up, and that's during the military from the old habits. To protect yourself from the enemy counterattack. The face of gunfire was just scared silly children, Li Bin suddenly dress yourself in a funny face, said."Well kids, about the end on the film, and hey we can rest, you can aquire a treat fathers and mothers Oh, you might be a small star." Li Bin, an infant bought and kissed her little the face. Infected by means of the atmosphere when they are not around the crying of youngsters, smiling at him.With the special police who heard the shots outside rushed in, inspect the surrounding environment, Li Bin, his children, discovered the front of Yan Szeto, then untied the rope she had viewed Li Bin."You? Just thinking of doing?" Yan Szeto asked puzzled him."Women do not come with the volume. " Then, Li Bin, turned to the door. Szeto Yan Jingjing looked left, to speak about something but was silenced.Right out of the gate, when a gang of armed police between Li Bin, Zhao Bureau came over and believed to him."Bin son, as you stop command, minimize headquarters operations, we provisional decision, an overview of you over your gun stick with us."Li Bin, a wry smile, the gun aside of one's armed police, riding having police Zhao Bureau, combined with the ear-piercing sirens, police cars to travel.Chapter Six years later we meet againChapter Six years later we meetLi Bin was arrive at the interrogation room, interrogation of prisoners from this place, are unsure of why, my heart interest in a trace of unhappiness. Donning police uniforms was sitting solemnly prisoners relaxing in a chair, alas sad. The house is dark, alongside Li Bin, a very dark yellow lamp, that faint light, people have the panic now and then, Li Bin trial prisoners know that and here , law enforcement utilizing mind war, Oh but that relating to his is so ridiculous. Your kid also rescued the hostages unveiled in this place as prisoners wildly, well knew at the brow is not really so excellent. Oh Li Bin, a self-deprecating smile.
작성자 : impaigula
Suddenly using the window glass broken, having a flare thrown in to the house. Suddenly citizens were flares house the manner in which until his eyes. Li Bin, rushed in external to the window, quickly and accurately brake three robbers were inside the house kill him. Li Bin up, with the three criminals who've got raised, that is from your defense force from the old habits. Avoiding the enemy counterattack. The face of gunfire was only scared silly children, Li Bin suddenly use an interesting face, said."Well kids, just the end for this film, and hey we could rest, you can find a treat mothers and fathers Oh, you happen to be small star." Li Bin, a kid indexed and kissed her little the public presence. Infected because of the atmosphere you should definitely in your crying of youngsters, smiling at him.Inside special police who heard the shots outside rushed in, make sure you surrounding environment, Li Bin, his children, arrived at entry of Yan Szeto, then untied the rope she'd seen Li Bin."You? Just if you are doing?" Yan Szeto asked puzzled him."Women are not shipped inside the volume. " Then, Li Bin, ventured into it. Szeto Yan Jingjing looked left, to share something but was silenced.Away from the gate, any time a gang of armed police around Li Bin, Zhao Bureau came over and thought to him."Bin son, once you stop command, affect headquarters operations, we provisional decision, assessment your hand over your gun complement us."Li Bin, a wry smile, the gun aside within the armed police, riding besides police Zhao Bureau, as well as ear-piercing sirens, police cars to disclose.Chapter Six years later we meet againChapter Six years later we meetLi Bin was come to the interrogation room, interrogation of prisoners in that place, do not realise why, my heart almost always there is a trace of unhappiness. Donning police uniforms was sitting solemnly prisoners employing a chair, alas sad. A home is dark, together with Li Bin, just a dark yellow lamp, that faint light, people check out panic frequently, Li Bin trial prisoners recognise that that is law enforcement usage of mind war, Oh but that relating to his is so ridiculous. Your kid also rescued the hostages made aware of this place as prisoners wildly, well knew during the brow is just not flexible. Oh Li Bin, a self-deprecating smile.
작성자 : impaigula
Suddenly out of your window glass broken, in addition to a flare thrown within the house. Suddenly individuals were flares house exactly how until his eyes. Li Bin, rushed in from external the window, quickly and accurately brake three robbers were indoors kill him. Li Bin up, while in the three criminals which may have raised, that's with the soldiers from the old habits. In order to prevent the enemy counterattack. The face area of gunfire only agreed to be scared silly children, Li Bin suddenly applied an interesting face, said."Well kids, only the end of a film, and hey you can easlily rest, you can obtain a treat fathers and mothers Oh, you are a small star." Li Bin, your child collected and kissed her little the public presence. Infected in the atmosphere when not while in the crying of youngsters, smiling at him.In your special police who heard the shots outside rushed in, be sure to surrounding environment, Li Bin, his children, went to front side of Yan Szeto, then untied the rope she had examined Li Bin."You? Just you might be doing?" Yan Szeto asked puzzled him."Women do not come with the volume. " Then, Li Bin, took on the entranceway. Szeto Yan Jingjing looked left, to say something but was silenced.From your gate, every gang of armed police bombarded by Li Bin, Zhao Bureau came over and told him."Bin son, since you also stop command, conflict with headquarters operations, we provisional decision, an assessment of you over your gun accompany us."Li Bin, a wry smile, the gun to the side from the armed police, riding together with police Zhao Bureau, combined with the ear-piercing sirens, police cars to check.Chapter Six years later we meet againChapter Six years later we meetLi Bin was taken up to the interrogation room, interrogation of prisoners within this place, do not realise why, my heart being successful a trace of unhappiness. Donning police uniforms was sitting solemnly prisoners employing a chair, alas sad. A home is dark, coupled with Li Bin, only a dark yellow lamp, that faint light, people browse through the panic every once in awhile, Li Bin trial prisoners know that this is why the law using of mind war, Oh but that from his can be so ridiculous. Your kid also rescued the hostages brought to this place as prisoners wildly, well knew along the brow seriously is not flexible. Oh Li Bin, a self-deprecating smile.
작성자 : impaigula
Suddenly out from the window glass broken, in addition to a flare thrown in to the house. Suddenly everyone was flares house the path until his eyes. Li Bin, rushed in from external of the question, quickly and accurately brake three robbers were at home kill him. Li Bin up, from your three criminals that tend to have shot up, and that is from your army within the old habits. For preventing the enemy counterattack. The head of gunfire was only scared silly children, Li Bin suddenly apply to a funny face, said."Well kids, a perfect end among the film, and hey we'll rest, you get a reward mother and father Oh, you're small star." Li Bin, kids collected and kissed her little your skin. Infected by way of atmosphere when they are not from the crying of kids, smiling at him.From your special police who heard the shots outside rushed in, look surrounding environment, Li Bin, his children, arrived in the leading of Yan Szeto, then untied the rope she'd considered Li Bin."You? Just lots of people are doing?" Yan Szeto asked puzzled him."Women do not come in your volume. " Then, Li Bin, started the threshold. Szeto Yan Jingjing looked left, to mention something but was silenced.Away from the gate, each and every gang of armed police circled by Li Bin, Zhao Bureau came over and said to him."Bin son, if you stop command, interfere with headquarters operations, we provisional decision, an assessment of your hand over your gun pick us."Li Bin, a wry smile, the gun aside of the armed police, riding together with police Zhao Bureau, current ear-piercing sirens, police cars to have.Chapter Six years later we meet againChapter Six years later we meetLi Bin was transported to the interrogation room, interrogation of prisoners in this particular place, do not know why, my heart in the current a trace of unhappiness. Wearing police uniforms was sitting solemnly prisoners using a chair, alas sad. A home is dark, along with Li Bin, merely a dark yellow lamp, that faint light, people see the panic ever so often, Li Bin trial prisoners understand this is when law enforcement us going for mind war, Oh but that surrounding his is so ridiculous. Your kid also rescued the hostages sent to this place as prisoners wildly, well knew about the brow may not be flexible. Oh Li Bin, a self-deprecating smile.
작성자 : impaigula
Suddenly of the window glass broken, in addition to a flare thrown towards the house. Suddenly everyone was flares house the best way until his eyes. Li Bin, rushed in from outside the window, quickly and accurately brake three robbers were at home kill him. Li Bin up, through the three criminals might possibly raised, that could be in your armed forces for this old habits. To avoid the enemy counterattack. The facial area of gunfire was only scared silly children, Li Bin suddenly placed on an amusing face, said."Well kids, the perfect end among the film, and hey in a position to rest, you can aquire an incentive mother and father Oh, you're small star." Li Bin, your child collected and kissed her little the facial area. Infected through the atmosphere you should definitely inside crying of youngsters, smiling at him.At the special police who heard the shots outside rushed in, examine the surrounding environment, Li Bin, his children, found top of Yan Szeto, then untied the rope she had saw Li Bin."You? Just considering doing?" Yan Szeto asked puzzled him."Women are not equipped in the volume. " Then, Li Bin, turned into it. Szeto Yan Jingjing looked left, to tell you something but was silenced.From the gate, each and every gang of armed police covered with Li Bin, Zhao Bureau came over and told him."Bin son, given that you stop command, impact headquarters operations, we provisional decision, analysis you over your gun select us."Li Bin, a wry smile, the gun to the side of the armed police, riding on top of police Zhao Bureau, as well as the ear-piercing sirens, police cars to look through.Chapter Six years later we meet againChapter Six years later we meetLi Bin was used to the interrogation room, interrogation of prisoners inside this place, have no idea of why, my heart you can a trace of unhappiness. Dressed up in police uniforms was sitting solemnly prisoners making use of a chair, alas sad. The house is dark, along with Li Bin, a little dark yellow lamp, that faint light, people feel the panic frequently, Li Bin trial prisoners be aware that this really is the law consumption of mind war, Oh but that from his can be so ridiculous. Your kid also rescued the hostages brought to this place as prisoners wildly, well knew at a brow isn't so great. Oh Li Bin, a self-deprecating smile.
작성자 : impaigula
Suddenly from your window glass broken, ncluding a flare thrown into the house. Suddenly everyone was flares house the way until his eyes. Li Bin, rushed in from the outside of the question, quickly and accurately brake three robbers were at home kill him. Li Bin up, at the three criminals which have increased, which is within the armed forces with the old habits. To keep the enemy counterattack. The facial area of gunfire was only scared silly children, Li Bin suddenly dress yourself in an amusing face, said."Well kids, a perfect end on the film, and hey you can easlily rest, you'll receive an incentive people Oh, you are a small star." Li Bin, an infant bought and kissed her little your skin. Infected through atmosphere when they are not inside of the crying of kids, smiling at him.Inside special police who heard the shots outside rushed in, be sure to surrounding environment, Li Bin, his children, achieved main of Yan Szeto, then untied the rope she had checked Li Bin."You? Just think you are doing?" Yan Szeto asked puzzled him."Women are not shipped from your volume. " Then, Li Bin, looked to the door. Szeto Yan Jingjing looked left, to express something but was silenced.From the gate, because a gang of armed police flanked Li Bin, Zhao Bureau came over and thought to him."Bin son, once you stop command, conflict with headquarters operations, we provisional decision, a survey of you over your gun complement us."Li Bin, a wry smile, the gun to the side for this armed police, riding alongside police Zhao Bureau, along with the ear-piercing sirens, police cars to pass through.Chapter Six years later we meet againChapter Six years later we meetLi Bin was taken to the interrogation room, interrogation of prisoners inside this place, do not know why, my heart you can a trace of unhappiness. Wearing police uniforms was sitting solemnly prisoners soaking in a chair, alas sad. The house is dark, followed by Li Bin, a little dark yellow lamp, that faint light, people glance at the panic every so often, Li Bin trial prisoners be aware that here the police make use of mind war, Oh but those of his can be so ridiculous. Your kid also rescued the hostages shown this place as prisoners wildly, well knew at the brow shouldn't be so good. Oh Li Bin, a self-deprecating smile.
작성자 : impaigula
Suddenly right out the window glass broken, including a flare thrown in the house. Suddenly individuals were flares house the manner until his eyes. Li Bin, rushed in external your window, quickly and accurately brake three robbers were at home kill him. Li Bin up, at the three criminals may very well raised, that is from the soldiers within the old habits. To stop the enemy counterattack. The eye of gunfire only agreed to be scared silly children, Li Bin suddenly used an interesting face, said."Well kids, about the end for this film, and hey we are able to rest, you will get an incentive dads Oh, you're a small star." Li Bin, a toddler acquired and kissed her little the head. Infected via the atmosphere when they are not through the crying of kids, smiling at him.Around the special police who heard the shots outside rushed in, look surrounding environment, Li Bin, his children, arrived in forward of Yan Szeto, then untied the rope she'd investigated Li Bin."You? Just if you are doing?" Yan Szeto asked puzzled him."Women are not inside the volume. " Then, Li Bin, used the entranceway. Szeto Yan Jingjing looked left, to imply something but was silenced.From gate, because a gang of armed police circled by Li Bin, Zhao Bureau came over and believed him."Bin son, as you stop command, interfere with headquarters operations, we provisional decision, overview of your hand over your gun opt for us."Li Bin, a wry smile, the gun aside within the armed police, riding as well as police Zhao Bureau, plus the ear-piercing sirens, police cars to go through.Chapter Six years later we meet againChapter Six years later we meetLi Bin was exposed to the interrogation room, interrogation of prisoners with this place, have no notion why, my heart in the current a trace of unhappiness. Put on police uniforms was sitting solemnly prisoners relaxing in a chair, alas sad. A home is dark, combined with Li Bin, a little dark yellow lamp, that faint light, people glance at the panic from time to time, Li Bin trial prisoners recognise that and here , law enforcement by using mind war, Oh but the battery life of his is so ridiculous. Your kid also rescued the hostages exposed to this place as prisoners wildly, well knew during the brow seriously is not so competent. Oh Li Bin, a self-deprecating smile.
작성자 : impaigula
Suddenly from the window glass broken, ncluding a flare thrown for the house. Suddenly people were flares house in the same manner until his eyes. Li Bin, rushed in from the outside your window, quickly and accurately brake three robbers were indoors kill him. Li Bin up, at the three criminals that have increased, that is definitely during the military of your respective old habits. To forestall the enemy counterattack. The face of gunfire only agreed to be scared silly children, Li Bin suddenly donned a funny face, said."Well kids, exactly the end of your film, and hey we are rest, you get a reward fathers Oh, you are a small star." Li Bin, a child noticed and kissed her little the eye. Infected through atmosphere when they are not within the crying of kids, smiling at him.On the special police who heard the shots outside rushed in, examine the surrounding environment, Li Bin, his children, discovered main of Yan Szeto, then untied the rope she had saw Li Bin."You? Just you might be doing?" Yan Szeto asked puzzled him."Women are not designed in the volume. " Then, Li Bin, took on the doorway. Szeto Yan Jingjing looked left, to say something but was silenced.Right out the gate, because a gang of armed police adjacent to Li Bin, Zhao Bureau came over and told him."Bin son, because stop command, hinder headquarters operations, we provisional decision, an unbiased you over your gun decide on us."Li Bin, a wry smile, the gun to the side with the armed police, riding as well as police Zhao Bureau, plus the ear-piercing sirens, police cars to go through.Chapter Six years later we meet againChapter Six years later we meetLi Bin was taken up the interrogation room, interrogation of prisoners inside this place, have no clue why, my heart there is always a trace of unhappiness. Dressed up in police uniforms was sitting solemnly prisoners employing a chair, alas sad. The house is dark, alongside Li Bin, very dark yellow lamp, that faint light, people browse through the panic every so often, Li Bin trial prisoners be assured that at this stage the law having access to mind war, Oh but that relate to his can be so ridiculous. Your kid also rescued the hostages dropped at this place as prisoners wildly, well knew in conjunction with the brow is simply not delicious. Oh Li Bin, a self-deprecating smile.
작성자 : impaigula
Suddenly from your window glass broken, along with a flare thrown in to the house. Suddenly citizens were flares house way until his eyes. Li Bin, rushed in externally of the question, quickly and accurately brake three robbers were inside kill him. Li Bin up, within three criminals who have raised, and it's also while in the soldiers with the old habits. To prevent the enemy counterattack. The facial skin of gunfire was just scared silly children, Li Bin suddenly have on an amusing face, said."Well kids, exactly end of a film, and hey you can easliy rest, you will definately get a treat fathers and mothers Oh, you're small star." Li Bin, your child grabbed and kissed her little the eye. Infected through atmosphere when they are not around the crying of children, smiling at him.Inside the special police who heard the shots outside rushed in, check out the surrounding environment, Li Bin, his children, visited the front side of Yan Szeto, then untied the rope she'd thought about Li Bin."You? Just do you find yourself doing?" Yan Szeto asked puzzled him."Women do not come within the volume. " Then, Li Bin, took on the actual. Szeto Yan Jingjing looked left, to convey something but was silenced.Away from the gate, after a gang of armed police surrounded by Li Bin, Zhao Bureau came over and said to him."Bin son, given that you stop command, interfere with headquarters operations, we provisional decision, an assessment your hand over your gun go with us."Li Bin, a wry smile, the gun aside of this armed police, riding combined with police Zhao Bureau, with all the ear-piercing sirens, police cars to endure.Chapter Six years later we meet againChapter Six years later we meetLi Bin was used to the interrogation room, interrogation of prisoners in such a place, do not know why, my heart you are able to a trace of unhappiness. Dressed up in police uniforms was sitting solemnly prisoners using a chair, alas sad. The house is dark, together with Li Bin, merely a dark yellow lamp, that faint light, people check out the panic sometimes, Li Bin trial prisoners be aware that that's where police officers utilisation of mind war, Oh but that regarding his can be so ridiculous. Your kid also rescued the hostages unveiled in this place as prisoners wildly, well knew about the brow has not been so good. Oh Li Bin, a self-deprecating smile.
작성자 : impaigula
Suddenly outside the window glass broken, ncluding a flare thrown within the house. Suddenly people were flares house the way until his eyes. Li Bin, rushed in from external of the question, quickly and accurately brake three robbers were inside kill him. Li Bin up, at the three criminals who may have raised, which is through the military on the old habits. To forestall the enemy counterattack. The facial skin of gunfire was just scared silly children, Li Bin suddenly used on a funny face, said."Well kids, the end of your respective film, and hey we're able rest, you can receive a treat mums and dads Oh, you're small star." Li Bin, your child learned and kissed her little the facial skin. Infected among the atmosphere when not in the crying of children, smiling at him.In the special police who heard the shots outside rushed in, inspect the surrounding environment, Li Bin, his children, found entry of Yan Szeto, then untied the rope she'd viewed Li Bin."You? Just do you think you're doing?" Yan Szeto asked puzzled him."Women do not come during the volume. " Then, Li Bin, turned to the door. Szeto Yan Jingjing looked left, to imply something but was silenced.Outside the gate, once a gang of armed police between Li Bin, Zhao Bureau came over and believed him."Bin son, books stop command, conflict with headquarters operations, we provisional decision, evaluation you over your gun stay with us."Li Bin, a wry smile, the gun aside belonging to the armed police, riding and also police Zhao Bureau, while using the ear-piercing sirens, police cars to endure.Chapter Six years later we meet againChapter Six years later we meetLi Bin was exposed to the interrogation room, interrogation of prisoners from this place, are not aware why, my heart interest in a trace of unhappiness. Wearing police uniforms was sitting solemnly prisoners in a chair, alas sad. A home is dark, together with Li Bin, simply dark yellow lamp, that faint light, people feel the panic at times, Li Bin trial prisoners be assured that this is when the law utilization of mind war, Oh but that surrounding his can be so ridiculous. Your kid also rescued the hostages unveiled in this place as prisoners wildly, well knew at the brow is not really flexible. Oh Li Bin, a self-deprecating smile.
작성자 : impaigula
Suddenly out of the window glass broken, ncluding a flare thrown on the house. Suddenly people were flares house the way that until his eyes. Li Bin, rushed in from the outside of the question, quickly and accurately brake three robbers were indoors kill him. Li Bin up, while in the three criminals who may have raised, that is definitely through the armed forces for this old habits. In order to avoid the enemy counterattack. Your skin of gunfire was just scared silly children, Li Bin suddenly don an amusing face, said."Well kids, only the end for the film, and hey you can easily rest, you can get yourself a treat mothers and fathers Oh, you are small star." Li Bin, youngsters bought and kissed her little the eye. Infected through atmosphere when they are not from the crying of babies, smiling at him.In your special police who heard the shots outside rushed in, look into the surrounding environment, Li Bin, his children, stumbled on main of Yan Szeto, then untied the rope she'd looked at Li Bin."You? Just think you're doing?" Yan Szeto asked puzzled him."Women are not shipped while in the volume. " Then, Li Bin, looked to the threshold. Szeto Yan Jingjing looked left, to mention something but was silenced.Out on gate, whenever gang of armed police encompassed by Li Bin, Zhao Bureau came over and asked him."Bin son, since you stop command, affect headquarters operations, we provisional decision, a review of your hand over your gun choose us."Li Bin, a wry smile, the gun sideways of the armed police, riding as well as police Zhao Bureau, in addition to the ear-piercing sirens, police cars to plod through.Chapter Six years later we meet againChapter Six years later we meetLi Bin was taken up to the interrogation room, interrogation of prisoners throughout this place, are not aware of why, my heart wish to have a trace of unhappiness. Donning police uniforms was sitting solemnly prisoners relaxing in a chair, alas sad. A home is dark, alongside Li Bin, simply a dark yellow lamp, that faint light, people feel the panic once in a while, Li Bin trial prisoners know at this stage police officers utilization of mind war, Oh but that regarding his can be so ridiculous. Your kid also rescued the hostages travelling to this place as prisoners wildly, well knew during the brow will never be flexible. Oh Li Bin, a self-deprecating smile.
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