孟鲁司特对支气管哮喘患者体内炎症水平的影响

目的：研究孟鲁司特对支气管哮喘患者外周血嗜酸性粒细胞（EOS）、NF-kB、TNF-α、IL-10的影响。方法：检测40例急性发作期哮喘患者（哮喘组）孟鲁司特治疗前后外周血EOS、NF-kB活性、TNF-α、IL-10的水平变化,并与40例健康体检人员（对照组）作比较。结果：哮喘患者（治疗前）外周血EOS、NF-kB、TNF-α水平都明显高于对照组（P〈0.05）,IL-10水平明显低于对照组（P〈0.05）。哮喘患者治疗后,外周血EOS、NF-kB、TNF-α水平明显下降（P〈0.05）,IL-10水平明显升高（P〈0.05）。结论：孟鲁司特对哮喘患者外周血EOS、NF-kB、TNF-α、IL-10的水平有一定程度的调节作用,从而降低支气管哮喘患者体内炎症水平,促进病情缓解与好转。     

乳铁蛋白对极早产儿感染性疾病预防作用的研究

目的 探讨乳铁蛋白对于极早产儿感染性疾病的预防作用。方法 收集本院NICU收治的胎龄28～31+6周极早产儿,按照不同的喂养方式,在常规治疗的基础上,部分予以添加乳铁蛋白,部分喂糖水,统计出生后28天内患儿晚发型败血症、新生儿坏死性小肠结肠炎及新生儿肺炎的发生率。结果 添加乳铁蛋白的极早产儿晚发型败血症和新生儿肺炎的发生率均低于对照组（P<0.05）,其中母乳/混合喂养的新生儿添加乳铁蛋白后晚发型败血症和新生儿肺炎的发生率与对照组相比,差异无统计学意义（P>0.05）,配方乳喂养新生儿添加乳铁蛋白后其晚发型败血症和新生儿肺炎的发生率低于对照组（P<0.05）;母乳/混合喂养极早产儿晚发型败血症及新生儿肺炎的发生率均低于配方乳喂养新生儿（P<0.05）;各组极早产儿坏死性小肠结肠炎的发生率相比较,差异均无统计学意义（P>0.05）。结论 添加乳铁蛋白可以显著降低配方乳喂养的极早产儿晚发型败血症和新生儿肺炎的发生率,但对于母乳喂养的极早产儿无显著影响;添加乳铁蛋白不能降低极早产儿坏死性小肠结肠炎的发生率。     

不同奶方喂养对早产儿胃排空及黄疸的影响

目的探讨母乳及配方奶对早产儿消化道生长发育及黄疸的影响.方法将33例早产儿随机分成母乳及配方奶喂养组,采用B型实时超声显像法测定其生后第5、7、10d胃排空变化,并同时检测血清总胆红素水平.结果两组早产儿随日龄增长,50%胃排空时间逐渐缩短.母乳喂养儿第5、第7d 50%胃排空时间短于奶方喂养儿,差异有显著意义(P均<0.05).生后第5、7、10d两组早产儿血清总胆红素水平差异无显著性意义(P均>0.05).结论母乳喂养儿较奶方喂养儿胃排空功能成熟快.     

caspase-3、caspase-9在哮喘大鼠模型嗜酸性粒细胞中的表达及糖皮质激素的影响

支气管哮喘是以嗜酸性粒细胞（EOS）浸润为主，多种细胞参与的慢性气道变应性炎症。患者哮喘发作时，其外周血及气道内嗜酸性粒细胞均明显增多，当EOS被激活后，可诱发哮喘时一系列的炎症级联反应。哮喘病人可能存在EOS凋亡受抑或EOS凋亡缺陷。天冬氨酸特异性半胱氨酸蛋白酶家族（caspases）是细胞凋亡的分子机制中重要的效应因子。     

维生素D水平与成人哮喘及非哮喘的相关性研究

目的 评估哮喘及非哮喘者的血清维生素D水平及其与肺功能、嗜酸性粒细胞计数的相关性。方法 选取我院2015年9月1日~2016年1月20日收治的85例哮喘患者以及73例健康体检者作为研究对象。根据皮肤过敏试验结果将哮喘患者分为过敏哮喘组56例和非过敏性哮喘组29例,对比两亚组间维生素D水平的差异性;采外周血测量嗜酸性粒细胞计数,用肺功能仪测量肺功能,包括肺活量（FVC）、第1秒最大呼气量（FEV1）、第1秒最大呼气率（FEV1/FVC）,分析过敏哮喘组和非过敏性哮喘组维生素D水平与肺功能、嗜酸性粒细胞计数的相关性。结果 哮喘患者的维生素D水平为（14.36±0.57）ng/ml,低于健康体检组的（22.13±0.84）ng/ml,统计学意义显著（P＜0.01）。过敏哮喘组和非过敏哮喘组的维生素D水平比较,差异无统计学意义（P＞0.05）。低水平维生素D患哮喘的风险增加1.2倍（优势比:1.194,95%可信区间:1.194~1.286,P＜0.01）。维生素D水平与肺功能和嗜酸性粒细胞计数水平无显著相关性。结论 哮喘患者的维生素D水平低于正常人群,维生素D的缺乏与哮喘的发生密切相关;维生素D水平与肺功能、嗜酸性粒细胞计数没有相关性。     

人奶、牛奶和新生儿配方奶中表皮生长因子含量

目的:比较不同来源新生儿用奶中表皮生长因子(EGF)含量以及母乳EGF含量与新生儿成熟度的相关性。方法:应用放射免疫分析法测定了57份人初乳、4种新鲜牛奶和8种基于牛奶的新生儿配方奶的EGF含量。结果:早产儿乳中EGF含量最高,其次是足月儿乳,母乳EGF含量与新生儿胎龄和出生体重呈负相关;新鲜牛奶的EGF水平(16.6±3.8) nmol/L与足月儿乳相当;非水解蛋白质配方奶中EGF含量较低,水解蛋白质配方奶的EGF浓度在可测范围之下。结论:早产儿乳中EGF的高含量可能代表着一种与早产儿加速生长发育相适应的代偿机制。配方奶中的EGF不足甚至缺乏,不宜应用于消化系统发育不完善或胃肠道受损的新生儿。     

地塞米松或茶碱对血小板活化因子诱导的嗜酸性粒细胞活化的影响

目的:血小板活化因子(PAF)可诱导嗜酸性粒细胞(EOS)脱颗粒产生低密度嗜酸性粒细胞(HE),本研究旨在探讨地塞米松、茶碱对上述过程产生的影响。方法:分离正常人外周血EOS,观察不同密度EOS的组织学差别,测定地塞米松、茶碱对PAF诱导的EOS脱颗粒和正常密度EOS(NE)向低密度EOS(HE)转化的影响。结果:低密度嗜酸性粒细胞颗粒缩小;10^-5mmol/L地塞米松或10mg/L茶碱可使17.87%±2.16%或14.08%±2.42%的正常密度嗜酸性粒细胞转化为低密度嗜酸性粒细胞,与血小板活化因子组比较差异显著(P<0.05,P<0.01);同样浓度的地塞米松和茶碱分别使PAF诱导的嗜酸性粒细胞过氧化物酶的释放量下降至(101.17±10.32)mg/L、(110.85±4.16)mg/L及(100.53±9.65)mg/L、(106.94±10.11)mg/L(P<0.05,P<0.01)。结论:EOS脱颗粒是HE产生的原因之一;地塞米松、小剂量茶碱可以抑制PAF对EOS的活化,这可能是它们抗炎作用的机制之一。     

类风湿关节炎患者SIRL-1表达及其调控NETs形成的作用

目的：探讨白细胞信号抑制受体-1(SIRL-1)在类风湿关节炎（RA）患者关节滑膜组织和外周血中性粒细胞、单核细胞、嗜酸性粒细胞中的表达及其对中性粒细胞外捕网（NETs）形成的影响。方法：免疫组织化学染色比较RA患者和骨关节炎（OA）患者滑膜组织中表达SIRL-1的阳性细胞数；流式细胞术分析RA患者和健康志愿者（HC）外周血中性粒细胞、单核细胞和嗜酸性粒细胞表面SIRL-1表达；密度梯度离心法分离RA患者和HC外周血中性粒细胞，分析SIRL-1单克隆抗体（SIRL-1mAb）自发形成NETs的影响。结果：RA滑膜组织中表达SIRL-1的阳性细胞数少于OA滑膜组织（P=0.040 2）；与健康对照组相比，RA患者外周血中性粒细胞和单核细胞表面SIRL-1表达明显降低（P=0.029 8,P=0.006 7），但两组人群嗜酸性粒细胞SIRL-1表达差异无统计学意义（P=0.401 7）;RA患者中性粒细胞比健康对照组更易自发形成NETs(P=0.000 2)；与未使用SIRL-1 mAb组相比，SIRL-1 mAb处理的RA患者形成NETs水平明显降低（P=0.036 8）,SIRL-1 ...     

谷氨酰胺与无乳糖配方奶喂养治疗坏死性小肠结肠炎患儿疗效观察

目的探讨谷氨酰胺与无乳糖配方奶喂养对坏死性小肠结肠炎早产儿免疫功能、胃肠激素的影响。方法选择56儿坏死性小肠结肠炎患儿为研究对象,采用随机数字表法分为观察组与对照组各28例,两组患儿均给予综合对症治疗,在此基础上,观察组给予谷氨酰胺与无乳糖配方奶喂养,对照组给予谷氨酰胺与早产儿配方奶喂养。喂养14d后,比较两组患儿免疫功能、胃肠激素、体质量变化及治疗效果。结果免疫功能:观察组Ig A、Ig G、Ig M、CD4+、CD4+/CD8+均明显高于对照组,CD8+明显低于对照组,差异有统计学意义(t=5.482~6.271,P0.05);胃肠激素:观察组胃动素、胃泌素水平明显高于对照组(t=7.178~8.211,P0.05);体质量:观察组体质量明显高于对照组(t=2.340,P0.05)。结论谷氨酰胺与无乳糖配方奶喂养有助于改善儿坏死性小肠炎患儿免疫功能及胃肠功能,促进患儿健康成长。     

早产儿不同喂养方法时血浆胃动素变化的研究

目的比较早产儿生后早期间断鼻十二指肠喂养和鼻胃管喂养对进奶量、生长情况、喂养相关并发症的影响及血浆胃动素的变化.方法将40例早产儿随机分为鼻十二指肠喂养和鼻胃管喂养组,用同一种配方乳喂养.记录喂养1用的入液量、体格生长指标、大便性状、喂养相关并发症.测定喂养前及喂养1w后血浆胃动素水平.结果喂养后1周鼻十二指肠喂养组较鼻胃管喂养组平均进奶量显著增加(P＜0.001);恢复出生体重时间明显缩短(P＜0.05);高胆红素血症发生率显著减少(P＜0.01).两组喂养1w后身长、头围的变化无明显差异(P＞0.05),但两组血浆胃动素水平均较喂养前显著增加(P＜0.001).结论间断鼻十二指肠喂养是早产儿生后早期较适宜的喂养方法.     

Allergic symptoms up to 4–6 years of age in children given cow milk neonatally A prospective study

In a previously published prospective study, we followed the development of allergic symptoms in term infants with a slightly reduced birthweight (-1 SD to -2 SD). These children received, according to local routine, early feeding with cow milk formula in order to diminish such neonatal problems as hypoglycemia and hyperbilirubinemia. Of 216 infants 207 were observed for allergic symptoms up to 18 months of age. One group (F) received cow milk formula during the first days of life before the mother's breastmilk production started and was then breastfed; the other (B) was not given any formula before normal breastfeeding started. Unexpectedly, we found fewer allergic symptoms, in particular allergic skin problems, in the group fed cow milk, the difference being concentrated to children with a family history of allergic symptoms. At 5 years of age 183 of the 207 children have been reinvestigated. Mild symptoms of allergy (suspected and obvious) were found in 22% (F) and 27% (B) respectively (NS). Moderate and severe symptoms of allergy (obvious) were found in 4.2% (F) and 4.5% (B). In the subgroup with a double family history of allergic symptoms, 28% (7/25, F) and 59% (10/17, B) had symptoms of allergy (p less than 0.05). This difference was even more pronounced when laboratory tests in favour of atopic diagnosis were included, 14% (F) and 53% (B) respectively (p less than 0.05). Thus at 5 years we still find a significantly lower frequency of allergic symptoms in the subgroup fed cow milk formula early with a family history of allergic symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)     

Development of atopic disease after early administration of cow milk formula

We prospectively studied the incidence of atopic disease in healthy term infants with a birth weight between -1 and -2 SD who were fed a cow milk formula during the first few days of life. A total of 216 infants were randomized to receive either early feeding with formula before normal breastfeeding was started (n = 112) or "normal feeding" with breastmilk (n = 104). Symptoms of allergy developed in 18% of the infants before 18 months of age in the formula fed group, as compared to 33% in the breastfed group (P less than 0.05). The difference was confined to the group of infants with a history of allergy in two family members. Thus, 11% of the formula-fed infants developed allergy symptoms, as compared to 61% of the control infants (P less than 0.01). Our study implies that early feeding during the first days of life with a cow milk formula, before the introduction of breastmilk, may reduce the incidence of allergy symptoms before 18 months of age in infants with a family history of allergy.     

Allergy to cow's milk in the first year of life and its prevention

Cow's milk allergy in the first year of life is one of the most common problems faced by pediatricians. Both over and under diagnosis is seen. Cow's milk allergy, which is IgE-mediated should be differentiated from milk intolerance due to lactase deficiency or other causes. Cow's milk allergy may effect the gastrointestinal tract, respiratory tract, skin or blood. Anaphylaxis may occur. Diagnosis is made primarily on clinical grounds but skin tests and/or RAST are of value. Elimination and subsequent challenge confirms the diagnosis but challenge is not always necessary. Challenge should not be performed if there is evidence of anaphylaxis. Avoidance is the mainstay of treatment and breastfeeding is the optimal choice. Since antigenically intact cow's milk protein can pass into the breast milk, the mother should avoid excessive intake of milk products herself while breast feeding. Alternatives to breast milk such as soy formulas or hydrolysed casein or whey formulas may be used. Twenty-five percent of milk-sensitive infants are also allergic to soy protein. Hydrolysed casein formulas are more hypoallergenic but are expensive and less palatable. Hydrolysed whey formula, which is comparable in expense to soy formulas but is less allergenic, may prove of value in the management of the milk-allergic infant as well as for prophylaxis in infants from susceptible parents. Parents of infants born to families with bilateral atopic histories may be able to prevent milk allergy by using dietary manipulations which include decreased prenatal maternal milk intake and while breast feeding as well as careful avoidance of milk products in the infant's diet during the first year of life.     

Development of childhood allergy in infants fed breast, soy, or cow milk

Seventeen hundred and fifty-three infants fed breast, soy, or cow milk from birth to 6 months of age were followed for varying periods to 7 years to observe the development of childhood allergy. There were 45.8 per cent with an immediate family history of allergy, 15.6 per cent with a remote history, and 38.6 per cent with a negative history. Allergy occurred in 218 (12.4 per cent), 132 males, 86 females. The development of allergy was similar in the 3 milk groups. The cow group showed allergy earlier than the breast group. Diet did not affect the incidence of the allergic diseases. In 218 allergic children, gastrointestinal allergy occurred in 13 per cent, atopic dermatitis in 33 per cent, urticaria in 8.0 per cent, allergic rhinitis in 50 per cent, and asthma in 43 per cent. Feeding egg yolk before 3 weeks of age or after 6 months of age did not affect the development of allergy. Allergy to soy milk occurred in 0.5 per cent; to cow milk, in 1.8 per cent. The incidence of allergy by family history showed significant differences: immediate, 15.6 per cent; remote, 12.1 per cent; and negative, 8.8 per cent. In the immediate group, allergy occurred earlier and asthma and allergic rhinitis more often. Feeding breast or soy milk in place of proprietary liquid cow milk from birth to 6 months did not affect the development of childhood allergy.     

The development and prediction of atopy in high-risk children: Follow-up at age seven years in a prospective randomized study of combined maternal and infant food allergen avoidance

Background: The natural history of allergic disease and its potential for prevention merit close examination because of the explosive worldwide increase in the prevalence and morbidity of atopic disorders. This study examines the development of atopy at age 7 years in 165 children in a high-risk cohort, previously reported from birth to age 4 years. Methods: In this prospective, randomized, controlled study of food allergen avoidance in infancy, the prophylactic-treated group consisted of infants whose mothers avoided cow's milk, egg, and peanut during the last trimester of pregnancy and lactation and who, themselves, avoided cow's milk until age 1 year (casein hydrolysate supplementation before age 1), egg until age 2 years, and peanut and fish until age 3 years. The control group consisted of maternal/infant pairs who followed standard feeding practices. Results: Despite a significant reduction in food allergy and milk sensitization before age 2 years, none of the following differed between the groups at age 7 years: food allergy, atopic dermatitis, allergic rhinitis, asthma, any atopic disease, lung function, food or aeroallergen sensitization, serum IgE level, or presence of nasal eosinophils or nasal basophilic cells. Children with food allergy by 4 years evidenced higher 7-year (current) prevalences of allergic rhinitis and asthma (p < 0.01). Atopic diseases/parameters at age 7 years were shown, by multivariate analysis (p < 0.05), to be associated with several genetic and environmental risk factors (male gender, maternal nonwhite ethnicity and asthma, and household smoking), as well as predictive atopic markers during infancy (elevated serum IgE level; egg, cow's milk, and peanut sensitization; and nasal eosinophils and nasal basophilic cells). Conclusions: These findings help to: (1) elucidate the natural history of atopic disease in high-risk children; (2) document the progression of allergy from atopic dermatitis, food allergy, and food sensitization to respiratory allergy and aeroallergen sensitization despite food allergy prevention in infancy; (3) identify allergy predictive markers; and (4) expand our appreciation of the interactions of genetic and environmental factors in the development of atopy. (J ALLERGY CLIN IMMUNOL 1995;95:1179-90.)     

Correlation of lymphocyte proliferating cell nuclear antigen expression with dietary cow's milk antigen load in infants with allergy to cow's milk.

BACKGROUND: Controversial results have been reported on the participation and diagnostic value of lymphocyte reactivity in cow's milk (CM) allergy. In this study, we used a specific nuclear marker to evaluate lymphocyte proliferation in IgE-mediated CM allergy in infants, and examine its relation with diets containing different CM antigen loads. METHODS: Infants with IgE-mediated CM allergy, as assessed by open provocation and RAST, were grouped according to their exclusive diet, either CM formulae, breast feeding, or hydrolysed whey formulae. A group of non-atopic infants receiving CM was also examined. Lymphocyte proliferation to beta-lactoglobulin was evaluated by quantitation of the proliferating cell nuclear antigen (PCNA) expression in peripheral blood mononuclear cells, by flow cytometry. Immunophenotypic surface markers were also examined. RESULTS: A marked difference of PCNA expression between CM-fed allergic infants and healthy controls was observed (p<0.001). In this setting, PCNA expression >/=10% was highly specific and sensitive as a marker of CM allergy in CM-fed infants. Moreover, a significant correlation (p<0.001) between antigen load and PCNA was established in CM-allergic infants under different diets, higher values obtained with increasing antigen loads. In addition, within the group fed hydrolyzed formulae, low-molecular-weight products resulted in marginally lower PCNA expression than higher-molecular-weight formulae. No differences in immunophenotype were found, with the exception of a higher CD23 expression in the breast-fed group. CONCLUSIONS: PCNA could be a useful marker in the assessment of lymphocyte proliferation to CM antigens. Low CM antigen diets are related with reduced lymphocyte reactivity, which may partly explain the clinical benefit observed with such diets.     

T lymphocytes and blood eosinophils in early infancy in relation to heredity for allergy and type of feeding.

T lymphocytes in 50 one-month-old infants were determined and correlated to heredity for allergy, blood eosinophil counts, and type of feeding. It was found that infants with heredity for atopy had significantly lower relative numbers of T lymphocytes than infants without heredity (p less than 0.05). This difference was particularly obvious in heredity for asthma on the paternal side (p equals 0.001). There was an inverse correlation between T lymphocyte counts and blood eosinophil counts in infants who were cow's milk-fed; i.e., low T lymphocyte counts were associated with high blood eosinophil counts (r = -0.59, p less than 0.01). T lymphocyte counts were not correlated to the type of feeding, whereas blood eosinophils were significantly higher in the cow's milk-fed than in the breast-fed group (p less than 0.01). The results suggest that atopic allergy may be associated with a genetically determined lymphocyte defect.     

The impact of caesarean delivery and type of feeding on cow’s milk allergy in infants and subsequent development of allergic march in childhood

Background: The incidence of IgE‐mediated cow’s milk allergy (CMA) has increased over the last few years. There are several genetic and environmental risk factors that may be related to this allergy and the subsequent allergic march (AM). Methods: A prospective, cohort study was conducted in patients recruited into the study between 1998 and 2002. Information on clinical variables and complementary tests, perinatal and obstetric factors and the type of hydrolysed formula used was recorded. A cross sectional study on the prevalence of allergic diseases in this cohort was performed in 2004. Results: We compared IgE‐mediated CMA patients with non‐IgE‐mediated CMA patients and found that IgE‐mediated CMA is associated with caesarean delivery (OR = 2.14 95% CI: 1.02–4.49), duration of breast feeding (>2 months, OR = 4.14; 95% CI: 2.17–7.89) and the use of supplementary artificial formula whilst breast feeding (OR = 2.86; 95% CI: 1.33–6.13). The factors associated with AM in IgE‐mediated CMA patients were caesarean delivery (OR = 0.42; 95% CI: 0.19–0.92) and the use of more extensively hydrolysed high grade hydrolysates (+EH/HGH) (OR = 0.44; 95% CI: 0.20–0.98), both as protective factors. Conclusions: Caesarean delivery is demonstrated as being a risk factor for IgE‐mediated CMA, but it does not increase the risk of AM in these infants. The use of +EH/HGH appears to protect IgE‐mediated CMA patients from eventually developing AM.     

Whey hydrolysate compared with cow's milk-based formula for weaning at about 6 months of age in high allergy-risk infants: effects on atopic disease and sensitization

Ninety-one high atopy-risk infants were prospectively followed up to 18 months of age with regard to the development of allergic/atopic manifestations and sensitization. They were randomized into one of two feeding groups, i.e., a hydrolyzed, ultrafiltered cow's milk whey formula, Profylac® ( n = 32), or an ordinary cow's milk formula ( n = 39), for 12 months, started after exclusive breast-feeding for 0–9 (median 6.0) months. Lactating mothers avoided milk, egg, and fish, as did the infants up to 12 months of age. Twenty of the 91 infants were breast-fed exclusively for more than 9 months and regarded as a control group. All infants were followed-up by questionnaires, physical examinations, skin prick tests, and determination of serum total IgE and cow's milk-specific IgE. The frequency of allergic/atopic disease was similar in the three groups. However, all three infants who developed cow's milk allergy with skin symptoms belonged to the cow's milk formula group. The skin prick test with whey hydrolysate was negative in all, while with cow's milk it was positive in eight infants. Growth was similar in the three groups. The study comprises too few infants to allow us to make statistically based statements. However, the difficulties encountered and the limited effects obtained by the use of whey hydrolysate at weaning at about 6 months of age made us conclude that we can spare high atopy-risk families this extra burden.