特应性体质对毛细支气管炎患儿血清糖皮质激素受体水平的影响

目的探讨特应性体质(简称特应质)对毛细支气管炎(简称毛支)患儿糖皮质激素受体(GR)表达的影响。方法采用ELISA法测定和比较毛支组(77例,包括34例特应质患儿)和肺炎组(68例)患儿血清中GRα、GRβ水平的变化。38例同期住院的非感染性小儿外科术前患儿,且无特应性及过敏性疾病家族史的患儿作为对照组。结果与对照组比较,毛支组和肺炎组中血清GRα、GRβ水平均明显升高(P0.01);毛支组血清GRα、GRβ水平高于肺炎组(P0.01)。毛支组GRα/GRβ比值较对照组和肺炎组明显升高(P0.01)。毛支组特应质和非特应质患儿血清GRα、GRβ水平与对照组比较均明显升高(P0.01);毛支组非特应质患儿GRβ水平明显高于特应质患儿(P0.01);毛支组特应质患儿GRα/GRβ比值较对照组和毛支组非特应质患儿明显升高(P0.01)。结论毛支患儿血清GRα、GRβ表达水平增强;特应质毛支患儿表现为GRα/GRβ比值增加,提示特应质毛支患儿对糖皮质激素有较高的敏感性。     

The impact of pre- and post-natal smoke exposure on future asthma and bronchial hyper-responsiveness

AIM: To analyse the impact of pre- and post-natal smoke exposure on asthma presence, bronchial hyper-responsiveness, airway function and active smoking in early adulthood. METHODS: We have prospectively studied 101 children hospitalized due to wheezing before the age of 2 years. The cohort was re-investigated at age 17-20 years and tested for airway function and bronchial hyper-responsiveness. Data on maternal smoking during pregnancy were obtained from the Swedish Medical Birth Register. RESULTS: There was a significant, independent correlation between both pre- and post-natal smoke exposure and asthma at age 17-20 years, OR 3.5 (1.1-11.3) and 3.4 (1.2-10.1), respectively. Maternal smoking during pregnancy was an independent risk factor for current bronchial hyper-responsiveness, OR 6.6 (1.2-35.5). Pre-natal smoke exposure seemed to negatively affect small airway function in early adulthood due to structural changes. Post-natal smoke exposure was independently associated with an increased risk of current smoking, OR 7.4 (1.6-35.2). CONCLUSION: In subjects hospitalized due to early wheezing, pre- and post-natal smoke exposure increase the risk of asthma in early adulthood. The connection between pre-natal smoke exposure and asthma appears to be mediated via the development of bronchial hyper-responsiveness. Smoke exposure in infancy is associated with an increased risk of active smoking in early adult age, which is in turn linked to current asthma.     

支气管哮喘患儿心功能变化及其临床意义

目的：探讨支气管哮喘患儿发作期左、右心功能变化及其与哮喘严重程度的关系。方法：用美国Acuson128XP/10型彩色多普勒超声诊断仪对24例危重、极危重哮喘患儿(危重组)及40例非危重哮喘患儿(普通组)进行左、右心功能测定,并与34例正常儿童(对照组)进行比较。结果：非危重组哮喘患儿在发作期以右心舒张功能受损为主,右室收缩功能亦受损,左心收缩及舒张功能正常;危重组哮喘患儿以左心收缩功能受损为主,左室舒张功能受损,右心收缩及舒张功能亦受损。结论：支气管哮喘患儿存在一定程度的心功能受损,并与哮喘严重程度密切相关。     

Lung function and bronchial hyper-reactivity from 11 to 18 years in children with bronchiolitis in infancy

Background

Various trajectories for lung function and bronchial hyper-reactivity (BHR) from early childhood to adulthood are described, including puberty as a period with excessive lung growth. Bronchiolitis in infancy may be associated with increased risk of developing chronic obstructive pulmonary disease, but the development of respiratory patterns during puberty is poorly characterized for these children. We aimed to study the development and trajectories of lung function and BHR from 11 to 18 years of age in children hospitalized for bronchiolitis in infancy.

Methods

Infants hospitalized for bronchiolitis at the University Hospitals in Stavanger and Bergen, Norway, during 1997-1998, and an age-matched control group, were included in a longitudinal follow-up study and examined at 11 and 18 years of age with spirometry and methacholine provocation test (MPT). The MPT data were managed as dose-response slope (DRS) in the statistical analyses. Changes in lung function and DRS from 11 to 18 years of age were analyzed by generalized estimating equations, including interaction terms.

Results

z-scores for forced vital capacity (FVC), forced expiratory volume in first second (FEV₁), FEV₁/FVC ratio, and DRS were not different from 11 to 18 years of age in both the post-bronchiolitis and the control group. The trajectories from 11 to 18 years did not differ between the two groups. BHR at age 11 was independently associated with asthma at age 18.

Conclusion

Children hospitalized for bronchiolitis had stable predicted lung function and BHR from 11 to 18 years of age. The lung function trajectories were not different from controls.

     

儿童支气管哮喘的远期转归及影响因素研究进展

儿童支气管哮喘患病率逐年上升,但控制率不足三分之一.病例对照研究及队列研究提示儿童期哮喘可持续至青少年甚至中老年,肺功能受损亦始于生命早期并持续存在.及时确诊并介入规范化个体化药物控制治疗、特异性免疫治疗和随访管理干预,定期监测肺功能受损情况,同时改善不良环境因素,可能有助于改善儿童哮喘的远期转归.     

以胸闷为主诉的不典型支气管哮喘患儿激发试验前后的肺功能特点

目的 了解以胸闷为主诉的不典型支气管哮喘患儿在支气管激发试验前后的肺功能特点。方法 选取2010 年1 月至2013 年12 月在我院肺功能室进行支气管激发试验的不典型哮喘患儿34 例为研究对象(不典型哮喘组),同期选取典型哮喘患儿34 例为对照,检测不典型哮喘组患儿支气管激发试验前后的肺功能,以及典型哮喘组患儿发作期和缓解期肺功能。结果 不典型哮喘组激发前肺功能指标用力肺活量(FVC)、第1 秒最大呼气量(FEV1)、FEV1/FVC、呼气峰流速(PEF)、用力呼气25 %、50 %、75%肺活量时的呼气峰流速(FEF25、FEF50、FEF75)、最大呼气中期流量(MMEF75/25)分别为105%±12%、104%±12%、100%±7%、88% ±13%、90% ±14%、81% ±17%、73% ±25%、80%±17%,明显高于典型哮喘组患儿发作期肺功能各指标(PP>0.05)。不典型哮喘组激发后肺功能各指标与典型哮喘组发作期相比差异无统计学意义(P>0.05),但均低于典型哮喘组缓解期和不典型哮喘组激发前水平。结论 支气管激发试验有助于不典型哮喘患儿的诊断。     

毛细支气管炎患儿红细胞免疫及T细胞亚群变化的研究

目的：探讨毛细支气管炎患儿红细胞免疫和T细胞亚群的变化及意义。方法：对45例毛细支气管炎患儿和30例正常儿童的红细胞免疫功能和T细胞亚群进行检测。检测外周血红细胞免疫复合物花环率（RBC-ICR）、红细胞C3b受体花环率（RBC-C3bRR）;采用流式细胞术检测CD3+、CD4+、CD8+细胞亚群。结果：毛细支气管炎患儿RBC-C3bRR［（13.6±6.2）%］、CD8+细胞百分比［（21.6±4.4）%］ 较对照组的（18.0±7.4）% 和 (25.6±5.2)%减低（P<0.01）;CD3+［（59.9±6.7）%］和CD4+细胞百分比［（53.5±6.2）%］及RBC-ICR［（8.3±3.5）%］均高于对照组的（52.1±8.3）%、（46.8±4.9）% 和（6.1±2.5）%（P<0.01）。毛细支气管炎患儿RBC-ICR和CD4+细胞百分比存在正相关（r=0.63,P<0.05）,RBC-C3bRR和CD4+细胞百分比存在负相关（r=-0.82,P<0.01）。结论：毛细支气管炎患儿存在T淋巴细胞、红细胞免疫功能障碍,可能在毛细支气管炎的发病机制中起到一定作用。     

肺功能检查及呼出气一氧化氮在儿童支气管哮喘规范化管理中的应用

目的探讨肺功能与呼出气一氧化氮(FeNO)在儿童支气管哮喘规范化治疗过程中的变化及意义。方法选取254例初诊、急性发作期的支气管哮喘患儿作为研究对象,按照有无合并过敏性鼻炎分为合并鼻炎组与未合并鼻炎组,并以62例健康儿童作为对照组。哮喘患儿均给予规范化治疗,于治疗初始以及治疗3、6、9、12个月复查肺功能及FeNO水平;对照组测定一次肺功能和FeNO。结果规范治疗1年中第1秒用力呼气容积(FEV1)、最高呼气流速(PEF)、最大呼气中段流量(MMEF),以及最大呼气25%、50%及75%肺活量的瞬间流速(MEF25、MEF50、MEF75)均逐渐升高,FeNO水平逐渐降低(P0.05)。治疗6个月后PEF、FEV1等大气道功能指标基本恢复;9个月后MMEF、MEF25、MEF50、MEF75等小气道功能指标基本恢复;1年后大小气道功能指标与对照组的差异均无统计学意义(P0.05),而FeNO水平仍高于对照组(P0.05)。治疗初始及3个月时,合并鼻炎组的哮喘患儿FeNO均高于未合并鼻炎组(P0.05)。治疗初始FeNO水平与肺功能各项指标均存在负相关(P0.05)。结论哮喘儿童的规范化治疗过程中,肺功能参数逐渐升高,FeNO水平逐渐下降,大气道功能的恢复早于小气道功能,另外也要注意鼻炎对气道反应性的影响。     

4岁以下哮喘患儿特应性状态及其与临床特征关系

目的：分析4岁以下哮喘患儿特应性分布状态及其与临床特征关系。方法：采集62例经临床诊断的4岁以下哮喘患儿病史资料,包括年龄、性别、初次喘息年龄,已发作喘息次数,病史月数,父母过敏史(主要为经临床诊断的哮喘和过敏性鼻炎),个人过敏史(主要为经临床诊断的湿疹和过敏性鼻炎)。UniCAP100系统荧光酶联免疫法筛查混合食物变应原(fx5E)、混合霉菌(mx2)、混合吸入性变应原(Phadiatop)以及测定血清总IgE水平。归纳该组患儿吸入性变应原和食物变应原致敏的分布状态,Logistic回归方法分析各临床特征对变应原致敏的影响作用。结果：fx5E,mx2,Phadiatop阳性率分别为40.3%,14.5%,14.5%,三类混合变应原筛查总阳性率为46.8%,总吸入性变应原致敏率24.2%。结论：4岁以下临床诊断哮喘的患儿经体外检测显示约四分之一存在吸入变应原致敏;父母哮喘史、患儿食物变应原致敏、初次喘息年龄在2岁以后和高IgE水平提示对吸入性变应原致敏的影响有显著性意义。     

支气管肺炎患儿免疫功能变化的临床分析

目的：通过检测普通和重症支气管肺炎患儿血清补体、免疫球蛋白、淋巴细胞亚群变化,探讨免疫功能检测在支气管肺炎中可能的作用。方法：纳入符合诊断标准的普通和重症支气管肺炎患儿各20例,同时选取健康儿童20例为对照组。采用免疫速率散射比浊法和六色流式细胞仪分析法检测各组儿童血清IgA、IgG、IgM、补体C3、C4及淋巴细胞亚群CD3+、CD4+、CD8+、CD16+CD56+及CD19+指标变化。结果：普通及重症肺炎组IgA水平均较对照组明显降低（P0.05）;重症肺炎组CD4+、CD3+水平均较对照组降低（P0.05）。结论：支气管肺炎患儿存在免疫功能的紊乱,在重症组更为明显,免疫水平的变化与肺炎病情的严重程度相关。支气管肺炎患儿免疫功能检测具有重要的临床意义。     

Reduced lung function both before bronchiolitis and at 11 years

Background and Aims: We have previously shown an association between reduced premorbid lung function (V‘maxFRC) and bronchiolitis. We hypothesised that individuals with bronchiolitis will go on to have reduced lung function and increased respiratory symptoms in childhood. Methods: V‘maxFRC was measured at 1 month of age; individuals with bronchiolitis were prospectively identified. Annual symptom questionnaires were completed from 3 to 6 years. At 11 years of age, children underwent an assessment including questionnaire, lung function, airway response to histamine (AR), and skin prick testing. Results: Eighteen individuals with bronchiolitis were ascertained from 253 cohort members. Children with bronchiolitis had increased viral induced wheeze at 3 (OR 5.8, 95% CI 1.4 to 25.2; n = 103) and 5 years (OR 5.3, 95% CI 1.1 to 25.5; n = 101). At 11 years of age, 194 children were assessed including 16 with past bronchiolitis. These 16 individuals had reduced mean z scores for % V‘maxFRC compared with other children (-0.56 and 0.06 respectively) and mean z scores for % FEF_25–75 at 11 years (-0.53 and 0.06 respectively). At 11 years, FEV₁, FVC PEF, AR, atopy, wheeze, and diagnosed asthma were not different between groups. Conclusions: Reduced lung function is present before and after bronchiolitis; the level of reduction is comparable. The mechanism for wheeze and reduced lung function after bronchiolitis appears to be related to premorbid lung function and not bronchiolitis per se.     

Lung function in VSD patients after corrective heart surgery

Static lung volumes, lung elasticity, and airway patency indices were measured in 47 children operated on for ventricular septal defect (VSD). Open-heart surgery was performed at the age of 0.6–12.0 years (midian 4.1 years). In the first group (34 subjects), after primary repair of the VSD, there was an increase in lung recoil pressure at 100% of total lung capacity (TLC) (128% of the predicted value) and a reduction in specific airway conductance (sGaw) (75% of the predicted value). In the second group (13 patients), who had had previous pulmonary artery banding at 0.2–4.0 years (median 0.7 year) there was an increased functional residual capacity/TLC ratio (111% of predicted value), reduced sGaw (69% of predicted value), and reduced maximum expiratory flow at 25% of vital capacity (79% of predicted value). Lung volumes were insignificantly reduced in both groups. The frequency of lung function disturbances was similar in the two groups (71% of patients in the former group and 77% of patients in the latter group). A linear positive correlation between specific airway conductance and the mean pulmonary artery pressure (mPAP) (r=0.793,p<0.006) was observed in children with an mPAP<30 mmHg prior to openheart surgery. A positive correlation between static recoil pressure at full inflation and mPAP (r=0.545,p<0.03) was found in children with an mPAP>30 mmHg. The severity of congenital heart disease prior to surgery and the influence of the timing of the surgical procedures may cause the differences in lung function tests between the groups.     

Reduced lung function both before bronchiolitis and at 11 years.

BACKGROUND AND AIMS: We have previously shown an association between reduced premorbid lung function (V'maxFRC) and bronchiolitis. We hypothesised that individuals with bronchiolitis will go on to have reduced lung function and increased respiratory symptoms in childhood. METHODS: V'maxFRC was measured at 1 month of age; individuals with bronchiolitis were prospectively identified. Annual symptom questionnaires were completed from 3 to 6 years. At 11 years of age, children underwent an assessment including questionnaire, lung function, airway response to histamine (AR), and skin prick testing. RESULTS: Eighteen individuals with bronchiolitis were ascertained from 253 cohort members. Children with bronchiolitis had increased viral induced wheeze at 3 (OR 5.8, 95% CI 1.4 to 25.2; n = 103) and 5 years (OR 5.3, 95% CI 1.1 to 25.5; n = 101). At 11 years of age, 194 children were assessed including 16 with past bronchiolitis. These 16 individuals had reduced mean z scores for % V'maxFRC compared with other children (-0.56 and 0.06 respectively) and mean z scores for % FEF(25-75) at 11 years (-0.53 and 0.06 respectively). At 11 years, FEV(1), FVC PEF, AR, atopy, wheeze, and diagnosed asthma were not different between groups. CONCLUSIONS: Reduced lung function is present before and after bronchiolitis; the level of reduction is comparable. The mechanism for wheeze and reduced lung function after bronchiolitis appears to be related to premorbid lung function and not bronchiolitis per se.