儿童过敏性疾病特应性进程研究进展

儿童过敏性疾病患病率日益增高,不容忽视.儿童过敏性疾病存在特应性进程的假说早在1985年即得到证实,具体是指婴儿或儿童早期出现的某种过敏反应症状常预示未来其他过敏性疾病的发生,众多纵向流行病学研究支持这一假说,其中以来自欧洲和北美的研究居多,亦有研究对此假说提出质疑.儿童过敏进程受诸多因素影响,如早年喘息、性别、父母过敏史等.该文就相关研究展开综述,以对高危患儿的识别和及时干预提供线索.     

婴儿小气道疾病γ干扰素水平与预后和特应性表达

婴儿小气道疾病是由于小气道功能异常引起的喘息性疾病 ,主要包括毛细支气管炎和喘息性支气管炎 ,是儿科常见的呼吸道疾病。本研究通过长期随访 ,探讨γ干扰素水平与疾病预后和特异性表达的关系 ,以利于早期干预治疗。对象1990～ 1993年期间 ,在儿科医院门诊和病房诊治的毛细支气管炎或喘息性支气管炎婴儿 ,年龄 <1岁 ,有明显喘息、双肺弥漫性哮鸣音和胸片肺气肿表现 ,共 5 2例 ,均为第 1次发病 ,未用糖皮质激素治疗 ;正常婴儿 12例及正常成人 16例作为正常对照 ,均无反复呼吸道和其他系统感染病史 ,无过敏性疾病及家族史。方法1.随访及预后…     

喂养干预对特应性高风险婴儿湿疹、食物过敏影响的跟踪研究

目的对具有特应性遗传背景的高风险婴儿随机进行不同方式的喂养干预,观察湿疹和食物过敏的发生情况,探讨喂养干预对婴儿湿疹和食物过敏发生的影响。方法从特应性夫妇中筛选出46例脐血IgE〉0．35kU／L的婴儿,随机分为干预组和非干预组。干预组23例,母乳喂养〉4个月,4个月龄内不添加任何固体辅食,随后低抗原性配方奶粉喂养,6个月内不添加鱼类、虾类食物,12个月内不添加蛋类、花生和坚果类食物;非干预组23例,母乳喂养〈4个月,或普通配方奶粉混合喂养或人工喂养,4个月添加蛋类辅食,其他辅食添加内容和顺序无任何建议或暗示,随访至18个月。临床观察婴儿湿疹的发生情况,食物点刺试验或Fx5E或sIgE检测食物过敏的发生情况。结果6个月时,喂养干预组婴儿湿疹累计发生率4．3％（1／23）,非干预组婴儿湿疹累计发生率26．1％（6／23）;12个月时．喂养干预组婴儿湿疹累计发生率8．7％（2／23）,非干预组婴儿湿疹累计发生率34．8％（8／23）;18个月时,喂养干预组时婴儿湿疹累计发生率17．4％（4／23）,非干预组婴儿湿疹累计发生率39．1％（9／23）,两组湿疹的发生率在各个阶段差异均有统计学意义。干预组食物过敏发生率为13．0％（3／23）;非干预组食物过敏发生率为34．8％（9／23）,差异有统计学意义,过敏食物以鸡蛋最为常见。结论母乳喂养、低抗原性配方奶、延迟添加辅食、高风险食物回避等综合喂养干预方式可以降低高风险婴儿特应性湿疹和食物过敏的发生率,是对具有特应性遗传背景的婴儿有效的初级干预措施。     

脐血细胞因子与特应性疾病发生风险的前瞻性研究

目的探讨特应质夫妇所生婴儿发生特应性疾病的风险。方法应用ELISA法检测30名特应质及26名非特应质父母婴儿脐血IL_4、IL_10、IFN_γ、IgE、IL_4/IFN_γ水平,并对这些新生儿进行随访,观察过敏症状的发生情况。结果特应质组IL_4、IL_10均高于非特应质组,两组差异显著(t=4.48、5.99,P均<0.05);IL_12、IFN_γ含量两组间无明显差异(t=-0.77、1.70,P均>0.05);特应质组IL_4/IFN_γ比值高于非特应质组(t=2.80,P<0.05),两组间差异显著。以≥0.35kU/L为脐血IgE升高的界值,特应质组阳性率明显高于非特应质组(χ2=5.73,P<0.05)。在6～9个月的随访中,特应质组发生过敏性疾病的人数明显高于非特应质组(分别为75%、38.5%;χ2=7.36,P<0.05)。结论特应质夫妇的婴儿出生时就有潜在的过敏倾向;父母特应质病史与脐血IgE升高有一定相关性,脐血中IgE水平高的婴儿发生过敏性疾病的机率明显增高;脐血细胞因子检测对预测特应性疾病发生有一定的临床意义。     

健康婴儿与过敏性疾病婴儿肠道双歧杆菌构建差异初探

目的 通过比较健康婴儿与过敏性疾病婴儿肠道双歧杆菌的构建规律,探讨婴儿肠道双歧杆菌与过敏性疾病的关系。方法 收集48例婴儿生后第0（胎便）、2、7、15天,1、6、12月时共7个时间点的粪便样品,其中22例在1岁以前患过过敏性疾病的婴儿组成过敏组,26例健康婴儿作为健康组,使用实时荧光定量PCR技术对婴儿粪便中双歧杆菌属及8种双歧杆菌菌种进行定性及定量分析。结果 两组婴儿在0~1月期间肠道双歧杆菌构建过程不同,健康组第2天表现出双歧杆菌下降的"重建"特征,而过敏组不存在此特征。过敏组第1月时双歧杆菌属的检出量低于健康组（P < 0.05）;第15天时B.breve的检出率低于健康组（P < 0.05）,且B.infantis定植延迟。结论 婴儿出生后0~1月的肠道双歧杆菌及其构建规律可能与过敏性疾病的发生有关,该时期可能是婴儿出生后过敏性疾病的防治关键期。     

上海地区720例特应质儿童食物过敏临床分析

目的 探讨上海地区特应质儿童中食物过敏的发病情况和临床特点,以及食物过敏与其他过敏性疾病的关系.方法 采用国际上经典的食物过敏诊断方法 进行研究,对2007年7月-2008年7月因过敏症状在上海儿童医学中心过敏/免疫专科就诊的720例2个月～17岁特应质儿童,进行病史收集、皮肤点刺试验、排除性饮食试验和开放式食物激发试验.结果 最后确诊食物过敏59例(发生率8.19%).初次发生食物过敏的平均年龄为(0.40±0.33)岁.引起过敏的主要食物为鸡蛋(5.83%)、牛奶(2.78%),虾(1.67%)、鱼(1.25%);3岁以下儿童对鸡蛋过敏多见,≥3岁对虾过敏多见(P<0.01);94.92%的儿童对一种或二种食物过敏.食物过敏100%可引起皮肤症状,25%的特应质儿童因食物过敏引起湿疹;消化道症状发生率为3.39%;呼吸道症状发生率为1.69%;过敏性休克发生率为1.69%.≥3岁仍食物过敏的儿童吸入性过敏原阳性、患哮喘和过敏性鼻炎/结膜炎的人数均显著多于3岁以下的食物过敏儿童(P<0.01).结论 上海地区的特应质儿童中,食物过敏的发生率高,发生年龄小.对有皮肤过敏症状的儿童,应首先考虑食物过敏可能.早期诊断并阻断食物过敏,可预防其他严重过敏性疾病的发生.     

孕妇无症状感染与婴儿关系的研究

本文对465名孕妇及其部分婴儿进行了病毒学和临床研究,结果证实孕妇和婴儿巨细胞病毒(CMV),风疹病毒(RuV),弓形机(Tox)感染率分別为3.58%和3.0%、3.6%和2.8%、0。母婴配对分析显示宫内CMV、RuV感染率分别为66.7%、100%。6名先天性CMV感染儿中患先天性心脏病者1例,另5例目前长发育正常。7名先天性RuV感染儿中死胎1例、早产2例,随访发现均有不同程度的心身障碍。本文首次证实长沙市东区孕妇存在着宫内无症状病毒感染,主要病原是RuV、CMV,这是优生优育中值得重视的问题。     

儿童过敏性疾病的早期预防

过敏性疾病的共同特征是机体对常见的吸入性过敏原或食物性过敏原产生以特异性IgE介导的或者细胞介导的免疫反应,临床上出现过敏反应(hyperresponsiveness).儿童时期主要的过敏性疾病包括支气管哮喘、过敏性鼻炎、过敏性结膜炎、特应性皮炎以及食物过敏.由于靶器官不同,过敏性疾病的临床表现各有特征.支气管哮喘以气道黏膜慢性炎症和气道高反应性为特征,表现为反复发作性咳嗽、气喘,常夜间或凌晨发作.过敏性鼻炎是以鼻腔黏膜嗜酸细胞浸润为特征的慢性炎症,表现为季节性或常年性鼻塞、喷嚏、流涕.过敏性结膜炎是睑结膜和球结膜的过敏性炎症,表现眼痒、球结膜和睑结膜充血、流泪.特应性皮炎又称异位性皮炎、湿疹,是皮肤的慢性特应性炎症,表现为皮肤多形性皮损、渗出、瘙痒、增生.食物过敏是免疫介导的对食物的不良反应,可以表现为胃肠道症状、皮肤症状或者呼吸道症状,重者可以发生过敏性休克.     

脐血嗜酸性粒细胞阳离子蛋白与早期婴儿特应性皮炎相关性的前瞻性研究

目的探讨脐血嗜酸性粒细胞阳离子蛋白(ECP)、脐血特异性IgE(sIgE)与父母特应质、婴儿特应性皮炎和食物皮肤点刺试验阳性率之间的相关性,为婴儿早期过敏性疾病的发生风险提供前瞻性检测指标。方法选择2009年6月至2010年3月期间分娩的健康新生儿及其母亲,调查父母特应质情况。收集并检测脐血中ECP、鸡蛋和牛奶sIgE的含量。随访婴儿,记录出生后6周、3个月、6个月时的特应性皮炎发生情况,并在婴儿出生后3、6个月时实施食物皮肤点刺试验。结果调查并随访146例婴儿及其母亲。父母为特应质与非特应质的婴儿比较,其脐血ECP含量差异无统计学意义(P>0.05)。新生儿脐血中鸡蛋、牛奶sIgE均为阴性。按脐血中ECP含量是否>10μg/L将婴儿分为2组,婴儿出生后6周、3个月、6个月时,特应性皮炎发病率在ECP增高婴儿中均高于正常者(P<0.01)。脐血ECP含量与婴儿3、6个月时的食物皮肤点刺试验阳性率无相关性(P>0.05)。结论父母特应质对脐血ECP水平无影响。新生儿脐血中鸡蛋、牛奶sIgE均为阴性,故孕末期回避饮食依据不足。脐血ECP增高与婴儿早期特应性皮炎发生有显著相关性,而脐血ECP含量与婴儿3、6个月时的...     

特应性进程的机制及治疗进展

过敏性疾病的发生按照特定时间顺序进行,由婴儿期特应性皮炎和食物过敏进展为儿童及成人期哮喘和过敏性鼻炎的现象称为特应性进程。其发生与生命早期环境、母体过敏、遗传、免疫、皮肤屏障缺陷、微生物菌群等密切相关。饮食、环境干预、特异性免疫治疗及新近出现的靶向辅助型T细胞2（Th2）所介导炎症的生物制剂等,为特应性进程的干预治疗提供了崭新的方向。     

过敏性疾病高危因素的研究进展

近年来,过敏性疾病的发病率呈上升趋势.过敏性疾病轻者仅有局部表现,重者可引起过敏性休克甚至死亡.由于其发病机制至今仍不清楚,故缺乏有效的治疗手段.及早发现引起过敏性疾病的高危因素并对其进行管控有助于降低过敏性疾病的发病率.该文就近年来引起过敏性疾病的流行病学研究、高危因素、机制假说及未来研究趋势等作一综述.     

儿童变态反应性疾病相关因素研究

目的通过分析儿童变态反应性疾病(食物过敏、过敏性鼻炎、过敏性哮喘、过敏性湿疹)的相关因素,明确主要危险因素,以利早期预防及干预治疗。方法对2004年1月～12月诊断为变态反应性疾病的276例患儿进行问卷调查及相关实验室检查;随机选择无变态反应性疾病史的266例其他疾病患儿为对照。结果延长母乳喂养时间组发生变态反应性疾病的危险性较小(P<0.005)。特应性体质、过敏性疾病家族史、RSV感染和细菌感染与变态反应性疾病的发生有关(P<0.005)。婴儿期主要是食物过敏,之后以吸入性过敏原过敏为主。多因素Logistic回归分析表明影响儿童变态反应性疾病的主要危险因素是:自身特应性体质、喂养方式、食物过敏原、吸入过敏原,其OR值分别为11.144、2.414、16.888、40.439。结论早期明确变态反应性疾病高危因素,针对危险因素进行规范化管理及采取相应治疗,将防止呼吸道变态反应性疾病的发生与发展。     

Prevalence of self-perceived allergic diseases and risk factors in Italian adolescents

The aim of the study was to assess the symptoms prevalence of allergic diseases in a population of 11–15 yr old schoolchildren, to evaluate the associations between asthma and other symptoms and identify risk factors for asthma, rhinitis and eczema syndromes. A sample of 481 students was studied using an International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Prevalence of different kind of self-reported symptoms was calculated. Using a logistic regression approach, we tried to identify risk factors for three syndromes – rhinitis, eczema and asthma. The highest and the lowest prevalence rates of self-reported symptoms were recorded for rhinitis (43.6%) and for eczema (8.1%), respectively. The prevalence of asthma was 15.7%. Univariate analysis showed a mutual association between wheeze and rhinitis symptoms. Multivariate logistic regression model for eczema syndrome revealed female gender as a significant risk factor. The polytomic logistic multivariate regression revealed female gender and family history of allergy as significant risk factors for rhinitis syndrome only, and maternal smoking and familial allergy for rhinitis and asthma together. In particular, familial allergy yields a 400% higher chance of developing asthma and rhinitis together. The synergistic effect of familial allergy on rhinitis and asthma syndromes suggests the implementation of preventive measures in children with family history of these diseases.     

Smoking related to plasma leptin concentration in pregnant women and their newborn infants

Leptin, a hormone produced in adipose tissue and placenta, is potentially important in relation to energy metabolism and growth. We investigated the effect of cigarette smoking on maternal plasma leptin concentration during pregnancy, and on plasma leptin concentration and weight among infants up to 13 wk of age. Plasma leptin concentration was measured in women in week 18 (n = 203) and week 35 (n = 164) of pregnancy, while cotinine (nicotine metabolite) was measured in plasma sampled from mothers in week 35 of pregnancy (n = 159). Leptin concentration was also measured in plasma from the umbilical cord (n = 133) and from 4-wk-old (n = 129) and 13-wk-old (n = 130) infants. There was no difference in plasma leptin concentration between smoking and non-smoking mothers at 18 wk and at 35 wk of pregnancy. Plasma cotinine concentration was higher in smoking than in non-smoking mothers, and a negative correlation between plasma cotinine and leptin concentrations was found. The leptin concentrations in umbilical cord plasma were similar, although the birthweights of newborns from smoking mothers were significantly lower than those from non-smoking mothers. The plasma leptin concentrations were similar between the two groups also at 4 wk of age. At 13 wk of age, infants of smoking mothers had significantly higher plasma leptin concentrations than infants of non-smoking mothers. Conclusion: Our results indicate that a lower birthweight of neonates among smoking mothers is not due to altered plasma leptin concentration.     

Nevirapine pharmacokinetics in pregnant women and in their infants after in utero exposure.

The safety, toxicity and pharmacokinetics of nevirapine were studied in HIV-infected pregnant women beginning chronic therapy late in the third trimester and in their infants. Initial dose pharmacokinetic profiles in the pregnant women were similar to those seen in nonpregnant adults. Serum nevirapine concentrations fell below the 100-ng/ml target concentration by Day 7 of life in four infants, suggesting that nevirapine elimination is accelerated in these infants compared with newborns whose mothers receive only a single intrapartum nevirapine dose.     

新生儿与妊娠母亲脂代谢的关系探讨

目的探讨新生儿与妊娠母亲脂代谢的关系。方法同时测定118组配对母亲、脐血、新生儿和42例成人对照组血清胆固醇(CHOL)、甘油三酯(TG)、载脂蛋白A1(ApoAl)、载脂蛋白B(ApoB)含量。结果血清CHOL、TG、ApoA1、ApoB含量高低依次为母亲＞对照组＞新生儿＞脐血。母亲血脂含量不影响新生儿的检测结果。新生儿血清CHOL、TG、ApoB含量随日龄增大而变化,ApoAl含量与日龄变化无关。结论妊娠母亲的高脂血症不能减少新生儿出生时存在的低脂血症。生后及时给新生儿补充脂类物质是必要的,母乳喂养为最佳补充方式。     

Development of atopic sensitization and allergic diseases in early childhood

Atopic diseases and atopic sensitization were studied from birth up to 2 y in a population-based prospective study. Physical examinations were done at 6, 12 and 24 mo, including skin-prick tests and blood samples, for the determination of serum IgE level and circulating IgE antibodies to food and inhalant allergens. In addition, questionnaire surveys were done about clinical symptoms of allergy, infections and the home environment. At 2 y the prevalences of definite and probable atopic diseases were 17% and 13%, respectively. The cumulative incidence of allergy was 25%. Atopic dermatitis was the main manifestation of atopy, with a peak prevalence of 15% at 2 y. The prevalence of positive skin-prick tests was constant at all ages, i.e. 7% at 6, 12 and 24 mo. Positive skin-prick tests against inhaled allergens were more than twice as common at 24 than at 12 mo, while sensitivity to food decreased. In contrast, circulating IgE antibodies to egg became more common with age, reaching 20% at 2 y. Conclusions: The present study indicates that manifestations of allergic diseases and incidence of sensitization to foods and inhalants are equally common in Estonian and Scandinavian children during the first 2 y of life, despite a much lower prevalence among older children and adults in Estonia.