血清维生素D水平与儿童哮喘急性发作严重程度的相关性研究

目的 探讨血清维生素D水平与儿童哮喘急性发作严重程度之间的关系.方法 选取2013年3月至2014年3月因哮喘急性发作就诊的患儿49例.依据儿童哮喘急性发作严重程度分级标准,将患儿分为轻度发作组、中度发作组和重度发作组.对比三组患儿人口学资料、血清25-羟维生素D及总IgE水平,并分析血清25-羟维生素D与总IgE水平的相关性.结果 共筛选入组哮喘急性发作患儿49例,轻度发作组20例、中度发作组15例和重度发作组14例.三组患儿的性别比例、年龄、身高和体重差异均无统计学(P＞0.05).从血清25-羟维生素D水平来看,三组之间差异有统计学意义(P ＜0.001),中度(15.30±4.97) nmol/L和重度(13.87±3.33) nmol/L发作组患儿血清25-羟维生素D水平明显低于轻度发作组(35.77±13.64) nmol/L,差异具有统计学意义(P＜0.001);重度发作组患儿血清25-羟维生素D水平虽略低于中度发作组,差异无统计学意义(P＞0.05).从血清总IgE水平来看,虽然三组之间差异无统计学意义(P＞0.05),但随着发作程度的加重,总IgE水平有逐渐增高的趋势.哮喘急性发作患儿血清25-羟维生素D与总IgE之间呈负相关,差异具有统计学意义(P＜0.05).结论 本研究提示低水平维生素D可能与儿童哮喘发作程度的加重及总IgE水平增高有关.足量维生素D可能通过下调总IgE而降低急性发作的程度,维生素D补充治疗可能成为预防或治疗儿童哮喘等过敏性疾病的一种有效途径.     

脑源性神经营养因子与儿童哮喘严重程度的关系

目的探讨血清脑源性神经营养因子(BDNF)水平与哮喘患儿病情严重程度的关系。方法选取60例哮喘急性发作期儿童(轻度组18例、中度组25例、重度组17例)及60例健康体检儿童作为研究对象,采用酶联免疫吸附法(ELISA)检测血清BDNF,分析BDNF水平与哮喘严重程度的关系。结果哮喘急性发作组及症状缓解组的BDNF水平均高于对照组,以急性发作组最高(P0.05);治疗后处于缓解期时,BDNF水平较发作期明显降低(P0.05)。发作期哮喘患儿病情严重程度不同,其血清BDNF水平不同:轻度组最低、重度组最高,差异有统计学意义(P0.05)。结论 BDNF可能在儿童哮喘的发病机制中发挥一定的作用,并且与病情严重程度相关。     

Review of intensive care unit admissions for asthma.

A review of ICU admissions for asthma to the Childrens Hospital of Los Angeles was conducted for the period January 1969 through July 1977. The admission rate remained relatively constant during this period. Patients requiring ICU admission tended to be young, intractable severe asthmatics whose asthma started at a very young age. There were three patients who had no previous history of asthma. The incidence of pneumonitis/atelectasis was somewhat greater than has been reported for patients hospitalized for status asthmaticus. A significant number of children received neither intravenous corticosteriods, sympathomimetics nor oxygen therapy while hospitalized prior to transfer to the ICU. Those children receiving mechanical ventilation or intravenous isoproterenol tended to be somewhat younger and had a higher incidence of pneumonitis/atelectasis and more abnormal blood gas determinations than their counterparts who were not similarly treated. Mechanical ventilation was administered to 15 patients and 19 patients received intravenous isoproterenol. Intravenous isoproterenol resulted in prompt improvement in most patients; except for one patient who experienced cardiac arrhythmia (reversed when the dosage was decreased), this medication was well-tolerated.     

Serum total and free carnitine levels in children with asthma

Background  Serum carnitine is decreased in recurrent pulmonary infections. We aimed to evaluate serum carnitine levels in asthmatic children. Methods  Study group consisted of children with stable asthma and those with acute asthma attacks, while control group included healthy children. Attack severity was determined by the pulmonary score system. Total and free carnitine levels were studied in one blood sample from the control group and stable asthmatics and in two samples from children with acute asthma exacerbation during and after the attack. Results  All the 40 patients in the study group had moderate asthma including 30 with acute attack (13 mild and 17 moderate) and 10 with stable asthma. Carnitine levels were significantly lower in acute attack asthmatics than in the stable asthmatics and controls, while there was no significant difference between the latter two groups. Carnitine levels were not different between asthmatics with mild and moderate attack, and were similar during and after an acute attack. Conclusions  Serum carnitine levels decrease in children with moderate asthma during exacerbation of asthma and shortly thereafter. Further studies are needed to evaluate the effect of carnitine treatment on serum carnitine level.     

Intraindividual changes in theophylline clearance during constant aminophylline infusion in children with acute asthma

Intraindividual changes in theophylline clearance were examined in 13 children with acute exacerbation of asthma receiving a 72-hour constant intravenous infusion of aminophylline. The mean (+/- SD) first, second, and third clearances measured at 24, 48, and 72 hours after the infusion increased from 58.1 +/- 13.8 to 69.7 +/- 28.0 to 84.1 +/- 36.3 ml/hr/kg, respectively (P less than 0.02 from the first and P less than 0.05 from the second). Our results suggest that substantial intraindividual changes in theophylline clearance can occur over a rather short time during intravenously administered aminophylline therapy for acute asthma in children. We recommend that plasma theophylline concentrations be monitored frequently and that aminophylline infusion rate be adjusted on the basis of the measured theophylline concentration data during an acute episode of asthma in the pediatric patient.     

Effectiveness of magnesium sulfate as initial treatment of acute severe asthma in children, conducted in a tertiary-level university hospital: A randomized, controlled trial

Introduction. Magnesium sulfate is a calcium antagonist that inhibits bronchial smooth muscle contraction promoting bronchodilation. It is used for the management of acute severe asthma in children; however most of the studies have been performed in adults. Objective. To evaluate the effectiveness of intravenous magnesium sulfate for the treatment of pediatric patients with acute severe asthma exacerbations. Population and Methods. A clinical, randomized, controlled trial was conducted between March 2006 and March 2011 at Hospital Universitario Austral. Children with acute severe asthma admitted to the emergency department were randomized into two groups. Group A (control group): standard protocol for the initial treatment of acute asthma exacerbation. Group B: treatment protocol with magnesium sulphate for acute severe asthma exacerbation. The primary outcome was the requirement of invasive or non invasive mechanical ventilation support. Results. One hundred and forty three patients randomized into 2 groups were analyzed. The treatment group included 76 patients receiving magnesium sulfate within the first hour of the initiation of rescue treatment at the hospital, and the control group included 67 patients not treated with magnesium sulphate. Among the patients in the control group, 33% (n= 22) required mechanical ventilation support, compared to only 5% (n= 4) of the patients in the treatment group (p = 0.001). Conclusions. Intravenous infusion of magnesium sulfate during the first hour of hospitalization in patients with acute severe asthma significantly reduced the percentage of children who required mechanical ventilation support.     

Acute childhood asthma in Finland:A retrospective review of hospital admissions from 1976 to 1995

The prevalence of childhood asthma has increased markedly in many Western societies during recent decades. We wanted to study whether the incidence and severity of childhood asthma in Finland had changed during the time-period 1976–95. Hospital admission rates from 1976 to 1995 were obtained from the National Hospital Discharge Register and the individual intensive care unit (ICU) registers of the five university hospitals in Finland. The number and length of treatment periods for childhood asthma in all Finnish hospitals and at the ICUs of the five university hospitals were analyzed. The number of children receiving special reimbursement for asthma medication costs was obtained from the central register of the Social Insurance Institution. The data showed that during the time-period investigated, hospital admissions as a result of asthma had increased by 2.8-fold, but the mean length of hospital stay had more than halved (from 7.3 to 2.6 days). The increase in hospital admissions showed greatest significance in the 0–4-year age-group among both sexes (p < 0.001). In contrast, a significant reduction in hospital admissions was found among the 10–14-year age-group (p < 0.001). No discernible change in admission to ICUs was seen. During the same time-period, the number of children receiving special reimbursement for asthma medication costs increased 7.5-fold. Hence, a major increase has occured in the number of children diagnosed with asthma that has not been paralleled by a proportionate increase in the number of hospital admissions. While the prevalence of mild and moderate asthma has increased, the occurrence of severe asthma has remained essentially unchanged.     

Non-IgE-mediated asthma in children

Among 586 children with asthma, 484 (82%) were found to have IgE-mediated ("extrinsic") asthma, and seventy-two (12%) non-IgE ("intrinsic") asthma. The remaining 30 patients (6%) were classified as "intermediate", as they had serum IgE within or above serum IgE levels of healthy children but no allergy to common allergens. During a three-year study period, the seventy-two patients with intrinsic asthma as opposed to 84 patients with extrinsic asthma had significantly more hyperinflation of the lungs, more episodes of acute hospital admissions due to asthma and/or pneumonia, more elevated serum IgG and IgM, and more cultures from secretions of lower airways of Haemophilus influenzae and pneumococci. Further, although treated with corticosteroids, eleven of the children with intrinsic asthma showed progressive disease, judged from fixed and/or declining forced vital capacity followed by signs of lung fibrosis on repeated pulmonary X-rays. It is emphasized that children with intrinsic asthma may represent an entity of childhood asthma, in some cases with severe progression of disease within a few years.     

NON-IgE-MEDIATED ASTHMA IN CHILDREN

ABSTRACT. Among 586 children with asthma, 484 (82 %) were found to have IgE-mediated ("extrinsic") asthma, and seventy-two (12 %) non-IgE ("intrinsic") asthma. The remaining 30 patients (6%) were classified as "intermediate", as they had serum IgE within or above serum IgE levels of healthy children but no allergy to common allergens. During a three-year study period, the seventy-two patients with intrinsic asthma as opposed to 84 patients with extrinsic asthma had significantly 1) more hyperinflation of the lungs, 2) more episodes of acute hospital admissions due to asthma and/or pneumonia, 3) more elevated serum IgG and IgM, and 4) more cultures from secretions of lower airways of Haemophilus influenzae and pneumococci. Further, although treated with corticosteroids, eleven of the children with intrinsic asthma showed progressive disease, judged from fixed and/or declining forced vital capacity followed by signs of lung fibrosis on repeated pulmonary X-rays. It is emphasized that children with intrinsic asthma may represent an entity of childhood asthma, in some cases with severe progression of disease within a few years.     

中性粒细胞弹性蛋白酶在学龄前儿童哮喘急性发作诊断中的作用

目的 测定学龄前哮喘儿童外周血中性粒细胞弹性蛋白酶(NE)水平,阐明NE在哮喘急性发作诊断中的作用。方法 收集2008年1月至2010年1月确诊为哮喘的学龄前儿童85例,分为哮喘急性发作组44例(急性组)和非急性发作组41例(非急性组);同期35例健康体检儿童作为对照组。用ELISA法检测各组外周血的NE和白细胞介素-8(IL-8)水平,并进行NE的受试者工作特征曲线(ROC)评价。结果 哮喘组的NE和IL-8水平高于对照组,其中急性发作组高于非急性发作组(Pr=0.48,P27.73μg/L作为判断哮喘急性发作的界值,其灵敏度为65.9%、特异度为95.1%,ROC曲线下面积为0.87(P结论 通过检测学龄前哮喘儿童NE水平,有助于哮喘急性发作的诊断。     

Decreasing morbidity of childhood asthma by regular outpatient follow-up, in Crete

AIM: There is evidence that the prevalence and morbidity of childhood asthma are increasing in many countries despite improvement of therapeutic regimens. We aimed to study possible changes in childhood asthma morbidity in Crete, Greece, by evaluating hospital admissions and emergency room visits for childhood asthma before and after 1-year regular follow-up at a special pediatric pulmonary out-patient clinic. METHODS: We followed-up 118 asthmatic children, aged 1-14 years, at a special pediatric pulmonary outpatient clinic. We evaluated the total number of hospital admissions due to asthma as well as asthma exacerbations during the 12 months before and 12 months after the regular follow-up care at the special pediatric pulmonary outpatient clinic. RESULTS: The total annual number of hospital admissions of the 118 children before and after the regular follow-up was 122 and 19, respectively (reduction of 84%). Similarly, the total number of asthma exacerbations was 771 before and 230 after the 1-year follow-up (reduction of 71%). CONCLUSION: These findings show that regular follow-up care of asthmatic children at a specialized pediatric pulmonary outpatient clinic considerably reduces the morbidity of childhood asthma, thus reducing hospital costs for asthma and improving the quality of life for asthmatic children and their families.     

哮喘患儿Clara细胞分泌蛋白的临床意义

目的探讨Clara细胞分泌蛋白(CCSP)检测在儿童哮喘中的临床意义。方法采用酶联免疫吸附法检测50例哮喘急性发作期患儿血清CCSP水平,其中22例患儿经治疗后于缓解期采血复查,另设20例健康儿童作对照。结果哮喘急性发作期、缓解期患儿血清CCSP水平均较健康对照组显著降低(P<0.001,0.01)。中重度发作哮喘患儿,血清CCSP浓度显著低于轻度发作的哮喘患儿(P<0.001)。病程长的哮喘患儿CCSP水平显著低于病程短者(P<0.05)。结论CCSP具有抗感染作用,CCSP的减少可诱导或加重哮喘儿童的呼吸道炎症。检测血清CCSP是反映小呼吸道Clara细胞受损的一种非侵入性方法;CCSP可作为判断哮喘病情、治疗效果及预后的指标之一。     

Relationship of type I procollagen to corticosteroid therapy in children with inflammatory bowel disease

We determined the serum concentration of the C-terminal propeptide of type I procollagen (pColl-I-C) in 60 children and adolescents (ages 4 to 17 years) with inflammatory bowel disease (24 ulcerative colitis, 36 Crohn disease) and in seven children (ages 2 to 15 years) with nongastrointestinal disease (asthma) during varying regimens of corticosteroid therapy. Patients with inflammatory bowel disease were grouped according to disease severity (mild, and moderate to severe). Significantly lower pColl-I-C concentrations and growth velocities were found in each severity group among those subjects receiving daily corticosteroid therapy compared with those receiving alternate-day or no corticosteroid therapy (P less than 0.01). When daily corticosteroid therapy was initiated and then maintained for 7 to 14 days in 11 patients with exacerbation of inflammatory bowel disease clinical improvement resulted, but mean procollagen concentrations decreased significantly (P less than 0.001). In seven children with asthma receiving methylprednisolone intravenously, significant decreases in pColl-I-C concentrations were noted within 24 to 48 hours of therapy (P less than 0.001). These data indicate that serum procollagen values decrease during both short- and long-term daily administration of corticosteroid therapy. Longitudinal assessment of procollagen concentrations may provide rapid assessment of the effects of different corticosteroid regimens on growth.     

白细胞介素-13基因多态性对哮喘患儿血清白细胞介素-13及总免疫球蛋白E水平的影响

目的　探讨白细胞介素 1 3(IL 1 3)基因多态性对血清IL 1 3及总免疫球蛋白E(IgE)水平的影响 ,以了解IL 1 3基因多态性在儿童哮喘发病机制中可能的作用。 方法　运用限制性内切酶片断长度多态位点法 (RFLPs)检测哮喘患儿及正常对照组儿童IL 1 3Intron3 1 92 3位点C/T基因多态性 ,并运用ELISA法测定其血清IL 1 3及总IgE水平。 结果　哮喘患儿TT、TC基因型频率分布高于正常对照组 (P <0 0 5 ) ,且TT、TC基因型患儿血清IL 1 3、总IgE水平较CC基因型明显升高 (P <0 0 1 )。 结论　IL 1 3基因多态性在儿童哮喘发病机制中可能起重要的作用。     

Overt glucocorticoid excess due to inhaled corticosteroid therapy

Inhaled corticosteroids have become an important therapeutic option in the treatment of childhood asthma. The preparations currently available for pediatric use (beclomethasone dipropionate and triamcinolone acetonide) do not, in general, cause significant hypothalamic-pituitary-adrenal axis suppression and physical signs of glucocorticoid excess have not been described with their use. We report an 8-year-old girl with asthma in whom obesity, hirsutism, and growth retardation developed during treatment with inhaled triamcinolone acetonide alone. Laboratory studies showed suppression of endogenous cortisol production but did not demonstrate suppression of the hypothalamic-pituitary-adrenal axis. Cessation of inhaled triamcinolone acetonide therapy resulted in resolution of obesity and hirsutism, resumption of normal growth, and a return to normal of serum cortisol levels and urinary 17-hydroxycorticosteroid excretion. Careful monitoring of growth velocity and (if clinically indicated) morning serum cortisol levels in asthmatic children using inhaled corticosteroids will detect the rare instance of glucocorticoid excess resulting from systemic absorption of these drugs.     

Treatment and Complications of Childhood Asthma in Japan

Recently the prevalence of asthma and emergency hospital admissions are increasing, but most childhood asthma can be controlled with appropriate therapy. Children can maintain their normal life cycle by outpatient treatment. There are two main complications of childhood asthma. One is the result of pathophysiological features and the other related to therapy. Status asthmaticus is the most serious complication and may be fatal.     

Anthracycline-Associated Cardiotoxicity in Survivors of Childhood Cancer

Anthracycline chemotherapeutic agents are widely used to treat childhood cancers, helping to create an increasing population of childhood cancer survivors. Cardiac complications can occur years after exposure to anthracyclines and are a leading cause of noncancerous morbidity and mortality in this population. The mechanism of its cardiotoxicity is not completely known, although oxidative stress is believed to play a significant role. This pathway and other nonoxidative mechanisms are reviewed. Several risk factors such as age, dose, female gender, and concomitant radiation therapy are known, but the relative risks of many comorbidities such as diabetes and hypertension are not well studied. No standard, evidence-based guidelines for appropriate screening methods to detect cardiotoxicity exist. Periodic imaging with echocardiography or radionuclide angiography is appropriately recommended for long-term survivors but is of limited use during therapy. Biomarkers such as cardiac troponins and brain natriuretic peptides may aid in detecting cardiotoxicity. Studies investigating the use of agents such as angiotensin-converting enzyme (ACE)-inhibitors and beta-blockers to treat anthracycline cardiotoxicity have shown promise, but more data are needed. Structural analogs such as epirubicin were developed to minimize cardiotoxicity but have not sufficiently reduced it. Liposome-encapsulated anthracyclines have shown a considerable decrease of cardiotoxicity in adults without sacrificing efficacy, but the data related to children are sparse. The only agent proven to be cardioprotective is the iron chelator, dexrazoxane. Studies have shown that dexrazoxane is safe and significantly reduces the incidence of cardiotoxicity. Dexrazoxane should be considered for pediatric oncology protocols using anthracyclines that include longitudinal assessment.     

Effect of placebo substitution during long-term betamethasone valerate aerosol treatment in asthmatic children.

Ten children with severe asthma, who had been well controlled on maintenance betamethasone valerate aerosol for an average of 11 months, were given placebo aerosols without their knowledge. The period of placebo substitution was campared with one 28-day period of betamethasone valerate therapy beforehand, and two 28-day periods afterwards. Symptoms were increased during the placebo period, and patients did not return to their previous well-controlled state until the second month after reinstitution of therapy. Changes in the means of twice-daily peak expiratory flow readings (PEFR) followed the same pattern as changes in symptoms. The exacerbation of asthma which occurred during placebo treatment was accompanied by a widening in the diurnal variation between morning and evening PEFR. In comparison with the previous period, morning PEFR fell by a greater amount than evening PEFR. Standardized running tests suggest an increase in exercise-induced bronchoconstriction and in the Exercise Lability Index when the child was receiving only placebo treatment as compared with betamethasone valerate treatment. The trial provided further evidence of the efficacy of betamethasone valerate aerosol in the prophylatic therapy of severe childhood asthma. As 2 of these children were able to discontinue long-term therapy it is unlikely that this drug causes dependency.     

A quality assurance review of outpatient care of children with life-threatening asthma exacerbations

OBJECTIVES: A hospital admission for asthma represents an opportunity to address and improve asthma control. The aims of this study were to compare the ambulatory care of children admitted to the intensive care unit (ICU) following a life-threatening asthma exacerbation with published guidelines of asthma management and to identify areas that could be targeted for change. METHODS: A retrospective review of case notes of children admitted to the ICU with asthma over a 6-month period. Variables recorded were: demographic; asthma history (including prior pattern of asthma, hospital admissions, interval treatment and managing doctor); admission details (consultation of respiratory team and asthma educator); and discharge management. RESULTS: There were 40 admissions of 38 children (24 males) with mean age 5.7 years (range 1.1-14 years). The majority (58%) had previous admissions for asthma (55 admissions in 22 children), with 23% of these to ICU. Sixty three per cent of those with previous admissions had persistent asthma, but only 29% were on inhaled corticosteroid (ICS). Most (60%) were managed by their local medical officer (LMO). Use of ICS was more likely if managed by a paediatrician. A respiratory subspecialist was consulted in 42% and the asthma educator in 70% of ICU admissions. Discharge medication included ICS in 74%, with no interval treatment in 18% of admissions. Follow up was by a respiratory subspecialist in 25% of cases. CONCLUSION: Asthma management before and after admission with life-threatening asthma did not conform to available guidelines. Persistent asthma was under-treated. Paediatricians were more likely to use interval treatment than LMO. We identified areas in which quality of care and outcome could be improved in this vulnerable group of asthmatics.     

血脂与儿童期哮喘的相关性

目的 探讨血脂与哮喘的发生、临床分期、过敏情况及肺功能的关系。方法 选取2016年10月至2017年3月就诊的56例哮喘患儿为哮喘组,46例行健康体检儿童为健康对照组。根据哮喘患儿的临床表现分为急性发作期组（n=24）和慢性持续期组（n=32）。根据皮肤点刺试验和血清IgE测定结果将哮喘患儿分为非过敏性哮喘组（n=16）和过敏性哮喘组（n=38）,2例未测定。检测哮喘组和健康对照组儿童的空腹血脂水平,并对哮喘患儿进行肺功能检测。结果 哮喘组与健康对照组儿童各项血脂水平比较差异均无统计学差异（P > 0.05）;与慢性持续期组及健康对照组相比,急性发作期组患儿血清高密度脂蛋白（HDL）、总胆固醇（TC）水平降低（P < 0.05）;与非过敏性哮喘组相比,过敏性哮喘组患儿血清HDL水平降低（P < 0.05）;在6~13岁年龄组哮喘患儿中,用力肺活量、呼气峰流速、用力呼气50%流量的实测值占预计值的百分比均与HDL有线性回归关系,且均与HDL呈正相关（P < 0.05）;一秒用力呼气容积、最大呼气中期流速与HDL、LDL有线性回归关系,且均与HDL、LDL呈正相关（P < 0.05）。结论 血脂与儿童期哮喘的临床分期、过敏情况及肺功能均有关,提示血脂可能参与了儿童哮喘发病机制的多个环节。