哮喘患儿血内皮素、一氧化氮变化及相互关系

为探讨哮喘患儿血浆内皮素(P-ET)和血清一氧化氮(S-NO)的变化及意义,用放免分析法和分光光度法分别检测哮喘患儿P-ET和S-NO,并与正常儿童进行比较;用直线相关分析法对P-ET和S-NO进行相关分析。结果:急性期儿童及婴幼儿哮喘组P-ET水平均明显高于正常组(P均< 0.01),缓解期均下降,与正常组比较已无差异(P均>0.05);重症哮喘组急性期P-ET水平高于轻症哮喘组(P<0.01),两组与正常组比较差异均有显著性(P均<0.01)。急性期儿童和婴幼儿哮喘组S-NO均高于正常组(P均<0.01),缓解期则下降,与正常组比较均无差异(P均>0.05);重症哮喘组急性期S-NO水平与轻症哮喘组比较差异显著(P<0.01),两组急性期S-NO水平与正常组比较差异均有显著性(P均<0.01)。哮喘急性期P-ET水平与S-NO水平呈显著正相关(r=0.783,P<0.01)。提示哮喘患儿P-ET、S-NO均增高,病情愈重,其值愈高;P-ET与S-NO呈正相关,提示它们均参与哮喘的发病。     

哮喘患儿呼出气一氧化氮的变化

目的观察哮喘患儿呼出气一氧化氮（ＮＯ）的变化。方法采用化学发光法对１２８名７～１２岁正常儿童和７６例６～１４岁哮喘患儿进行呼出气ＮＯ浓度测定，同时测定哮喘儿童一秒钟用力呼气容积（ＦＥＶ１）及其占预计值百分比（ＦＥＶ１％）。对其中２１例哮喘患儿进行治疗后８个月内随访，监测其呼出气ＮＯ浓度，采用组胺激发试验测定其治疗前和治疗６个月后气道反应性。结果哮喘患儿呼出气ＮＯ浓度为３９±２１ｐｐｂ，正常儿童呼出气ＮＯ浓度为２３±１３ｐｐｂ，两组差异有显著意义（Ｐ＜０．００１）；发作期哮喘患儿呼出气ＮＯ浓度略高于缓解期患儿，但差异无显著意义（４２±２４ｐｐｂ，３５±２１ｐｐｂ，Ｐ＞０．０５）；哮喘患儿呼出气ＮＯ浓度与ＦＥＶ１％无明显相关性（ｒ＝０．０９２，Ｐ＞０．０５）。１１例吸入糖皮质激素治疗的哮喘患儿治疗２周后缓解期呼出气ＮＯ浓度较治疗前降低（２７±９ｐｐｂ，４４±１８ｐｐｂ，Ｐ＜０．０５），治疗６个月后气道高反应性（ＡＨＲ）程度表现下降趋势，另１０例未用糖皮质激素治疗的患儿缓解期呼出气ＮＯ浓度和ＡＨＲ程度均无明显改变。结论哮喘患儿呼出气ＮＯ浓度高于正常，吸入糖皮质激素治疗可降低呼出气ＮＯ浓度和ＡＨＲ。     

支气管哮喘与一氧化氮及cGMP关系的初步研究

研究目的小儿哮喘时一氧化氮的作用机制及临床意义。研究方法哮喘患儿３３例，正常健康儿童２０例为对照组。测定一氧化氮（ＮＯ）水平及ｃＧＭＰ水平，并对测定结果进行统计学分析。研究结果所有哮喘患儿血浆ＮＯ及ｃＧＭＰ水平在治疗前均明显高于正常儿童（Ｐ均＜０．００１），其中９例重度哮喘患儿血浆ＮＯ水平较２４例轻中度哮喘患儿更高（Ｐ＜０．００１）；治疗后血浆ＮＯ及ｃＧＭＰ水平均恢复正常。结论哮喘发作时一氧化氮产生过多，发挥其细胞及组织毒性作用，使肺上皮细胞等损伤，从而引起和加重哮喘发病，且血浆ＮＯ水平与哮喘病情密切相关。     

支气管哮喘患儿血清一氧化氮、一氧化氮合酶水平变化临床研究

多年来已认识到哮喘是一种慢性气道变态反应性炎症性疾病。一氧化氮(NO)是几种最有希望成为气道炎症标志物的物质之一。检测呼出气NO需要精密昂贵的仪器设备，作者拟用血清NO、一氧化氮合酶(NOS)检测替代呼出气NO检测，以便于普遍推广，并为临床哮喘病情判断和疗效评价提供一定的参考依据。     

哮喘儿童呼出气一氧化氮水平的测定

目的：　探讨哮喘儿童呼出气一氧化氮(exhalednitricoxide,eNO)水平及其意义。方法：　设定13～15cmH2O呼出气阻力以关闭软腭,用化学发光法测定34例6～14岁哮喘儿童和36名6～13岁非呼吸道疾病儿童单次呼吸的eNO浓度 ,同时测定一秒钟用力呼气容积占预计值百分比 (FEV1%)。结果：哮喘儿童的eNO浓度为 (89.4± 56 .4) ppb ,较非呼吸道疾病儿童eNO浓度 [(15 .8±5.8) ppb]显著增高 (P<0.01) ;哮喘儿童eNO浓度与FEV1%之间无显著相关性(r=0.06 ,P>0.05)。结论：　哮喘儿童eNO浓度高于正常,其变化与FEV1%无关。     

哮喘患儿呼出气一氧化氮及外周血嗜酸粒细胞的变化

目的：检测支气管哮喘（AS）,AS合并过敏性鼻炎（AS/AR）及慢性咳嗽变异性哮喘（CVA）患儿中呼出气一氧化氮（eNO）和外周血嗜酸粒细胞（EOS）的水平及两者的相关性,以探讨eNOS检测在AS儿童中的应用。方法：采用电化学法对5～14岁患有AS（n=12）、AS/AR（n=29）、CVA（n=10）的患儿进行eNO测定,同时测定EOS及一秒钟用力呼气容积占预计值百分比（FEV1％）。30例无特异性疾病史和家族过敏史,且近两周无急性呼吸道感染史的儿童作为对照组。结果：AS,AS/AR,CVA 3组eNO和EOS水平均高于对照组（P＜0.01）;AS/AR组eNO（50.3±6.7 ppb）和EOS水平（5.9±4.2×109）高于AS组（30.5±8.8 ppb,4.2±3.2×109）及CVA组（26.0±3.2 ppb,3.7±6.9×109）（均P＜0.05）,而AS、CVA组间差异无显著性;AS组eNO与EOS呈正相关（r＝0.51,P＜0.05）,但与FEV1无相关性（r＝0.144,P＞0.05）。结论：eNO在过敏性体质中高表达,且eNO可以反映AS患者气道嗜酸性炎症水平。［中国当代儿科杂志,2009,11（12）：986-988］     

哮喘患儿呼出气一氧化氮水平与肺功能相关性研究

目的 探讨处于稳定期哮喘患儿呼出气一氧化氮水平(FeNO)与肺功能中第一秒用力呼气容积(FEVl)的相关性.方法 选取2009年2月至2009年7月于中国医科大学附属盛京医院小儿哮喘门诊就诊的5～14岁的稳定期哮喘患儿53例,根据其是否应用吸入糖皮质激素规范化治疗分为激素治疗组和非激素治疗组,分别测定其FeNO水平和肺功能,分析FeNO水平和肺功能在两组患儿之间是否存在统计学差异,并比较两组患儿FeNO水平和肺功能指标是否存在相关性.结果 非激素治疗组患儿FeNO水平明显高于激素治疗组,且差异有显著性(P=0.005).激素治疗组患儿FEV1平均值为(95.152±8.993)%,非激素治疗组患儿FEVl平均值为(91.350±11.690)%,两组差异无显著性(P=0.932).非激素治疗组患儿FeNO水平与FEV1呈显著负相关性(r=-0.465,P=0.039).激素治疗组哮喘患儿FcNO水平与FEV1参数不相关(r=0.058,P=0.747).结论 处于稳定期的哮喘患儿,未应用吸入糖皮质激素规范化治疗时,其FeNO水平明显高于已用激素规范治疗患儿,测定FeNO水平可以作为一项很好的指标来评价哮喘患儿的气道炎症.     

不同控制水平的哮喘患儿呼出气一氧化氮浓度水平及其临床意义

目的：研究呼出气一氧化氮浓度（fractional nitric oxide concentration in exhaled breath, FeNO）测定技术在辅助评价儿童哮喘控制水平方面的应用价值。方法：将226例哮喘患儿分为哮喘控制组（n=86）、部分控制组（n=63）和未控制组（n=77）,90例健康儿童为对照组。采用瑞典尼尔斯（NIOX）呼出一氧化氮测定仪测定哮喘患儿和健康对照儿童FeNO浓度。结果：对照组儿童FeNO浓度为14±6 ppb,控制组为29±26 ppb,部分控制组为32±30 ppb,未控制组为40±32 ppb,3组哮喘患儿的FeNO浓度均高于对照组（P<0.05）;哮喘未控制组患儿FeNO浓度高于控制组（P<0.05）;哮喘部分控制组FeNO浓度与未控制和控制组之间差异无统计学意义。结论：哮喘患儿FeNO水平显著高于健康儿童,且与哮喘控制程度相关。     

Unilateral right-sided internal jugular phlebectasia in asthmatic children

The most common cause of a neck mass that increases in size on straining is laryngocele. Internal jugular phlebectasia, which is of unknown cause, may present similarly. We present three cases of internal jugular phlebectasia, all of whom were asthmatic children. This association of asthma and internal jugular phlebectasia has not been reported previously.     

Glucocorticoids and growth in asthmatic children

The effects of asthma and oral and inhaled glucocorticoid therapy on growth in children are reviewed. Previous reports have shown that asthma itself may delay the onset of puberty, an effect which may masquerade as growth suppression. Oral glucocorticoids appear to impair growth; however, lower doses and alternate-day therapy may have less risk of this effect. While a controversial topic, inhaled glucocorticoids in lower doses appear to be associated with a small risk of adverse effects on growth. Minimal data are available for higher doses. Knemometry, a relatively new technique used for measuring small changes in growth, has detected short-term effects with both oral and inhaled glucocorticoids therapy. However, a number of limitations are associated with short-term growth studies. Clinicians should be aware of the potential for growth impairment with glucocorticoid therapy so adequate monitoring can be undertaken and appropriate intervention introduced when deemed necessary.     

Effects of salbutamol inhalations on transcutaneous blood gases in children during the acute asthmatic attack: from acute deterioration to recovery

Holmgren D, Sixt R. Effects of salbutamol inhalations on transcutaneous blood gases in children during the acute asthmatic attack: from acute deterioration to recovery. Acta Pædiatr 1994;83:515–19. Stockholm. ISSN 0803–5253
Nine children, 7–16 years of age, were studicd repeatedly during an acute asthmatic attack, from acute deterioration to recovery. The transcutaneous blood gases, forced expiratory volume in l s (FEV₁) and maximum expiratory flow when 25% of vital capacity remained to be expelled (MEF₂₅) were monitored before and after salbutamol inhalation. The flow-volume variables were markedly impaired in the acute phase but improved gradually by the time of recovery. The transcutaneous PO₂ (tcPO₂) decreased in the acute and early recovery phase but improved by the late recovery phase. In the acute phase, the salbutamol inhalations increased the FEV₁, indicating an improvement in central airway function, but also reduced the MEF₂₅ and tcPO₂ in some of the children. The changes in tcPO₂ after the inhalations correlated with the changes in MEF₂₅ ( p< 0.001), thereby indicating a common denominator, probably the condition of the peripheral airways. In the recovery phase, the FEV₁, MEF₂₅ and tcPO₂ improved after the inhalations ( p < 0.05). In conclusion, transcutaneous PO₂ can be used to evaluate the effects of treatment in children with acute asthmatic symptoms and may add information about peripheral airway function which may prove particularly valuable in small children where few methods are available for such measurements.     

Development and validation of a nighttime sleep diary in asthmatic children

The aim of this study was to derive a shorter version of the asthma diary, 'a nighttime sleep diary' from the traditional asthma diary (original version). The nighttime sleep diary mainly consisted of nighttime awakening that met the criteria of validity and practicality necessary for monitoring clinical control in infants and young children with asthma symptoms. Validation of the diary was performed in a 6-week prospective study of 40 children aged 6 months to 6 years treated with nebulized budesonide inhalation suspension or cromolyn sodium nebulized solution. The nighttime awakening score was significantly and positively associated with the nighttime asthma symptom score and daytime asthma symptom score along with the number of days with a cough. Therefore, the nighttime sleep diary is a simple and useful instrument to monitor day-to-day fluctuations in young children with asthma.     

哮喘患儿血小板活化因子乙酰水解酶活性的研究

目的　探讨哮喘患儿血小板活化因子乙酰水解酶 (PAF AH)活性与病情的关系 ,及其活性与基因型的关系。方法　应用酶水解底物显色法测定不同病情哮喘患儿和健康儿童PAF AH活性。应用等位基因特异性聚合酶链式反应 (AS PCR)技术检测PAF AH基因第 9外显子Val2 79Phe基因型。结果　重度哮喘组血浆PAF AH活性明显低于轻、中度哮喘组和对照组 ,酶活性缺失率重度组占 15.4% ,而轻、中度哮喘组和对照组酶活性缺失率占 2 %～ 3 %。哮喘组及对照组 3种基因型 (Val/Val、Val/Phe和Phe/Phe)血浆PAH AH活性间比较有显著性差异 (P均 <0 .0 1) ,同一种基因型PAH AH活性哮喘组与对照组相比无显著性差异 (P >0 .0 5)。结论　血浆PAF AH活性与哮喘严重程度相关联 ,重度哮喘组酶活性显著低于轻、中度哮喘组和对照组 ;血浆PAF AH活性与PAF AH(Val2 79Phe)基因突变相关联     

氯雷他定对哮喘儿童P-选择素表达的抑制作用及临床意义

为评价氯雷他定对哮喘儿童血浆Ｐ－选择素表达的抑制作用及临床应用的意义。应用＾１２５Ｉ－ＳＺ－５１标记的特异性单克卫生抗体放免法。测定６０例急性发作期和缓解期哮喘患儿血浆Ｐ－选择互水平。随机分成治疗组（３０组）,采用吸入激素＿氯均较对照组明显下降和改善,差异显著（Ｐ均〈０．０１）。提示氯雷他定具有抵抑制Ｐ－选择素表达的作用,能有效地减轻变应性炎症,改善哮喘儿童的临床症状和肺功能,可能作为辅佐治疗儿童     

最大呼气峰流速在儿童哮喘中的应用

目的　探讨最大呼气峰流速 (PEFR)在儿童哮喘诊治中的临床应用价值。方法　用呼气峰速仪测定 43例哮喘患儿急性发作期PEFR。测定缓解期PEFR个人最佳值 ,求出个体化PEFR下降率及警戒值 ,观察2 0例规范监测组和 2 3例非规范监测组个体化PEFR下降率与哮喘发作关系。结果　哮喘发作期时PEFR越低 ,临床表现越重。缓解期规范监测组根据个体化PEFR下降率变化指导预防用药 ,哮喘发作人数、次数及发病呈中、重度表现者分别为 15%、2 3 .5%、2 5% ;非规范监测组分别为 43 .5%、75.5%、76.9% ,两组比较均有显著性差异 (P均 <0 .0 1)。结论　PEFR可作为诊断儿童哮喘和病情严重程度分级依据 ,指导治疗。个体化PE FR下降率较PEFR变异率更灵敏反映病情变化 ,可作为哮喘发作警报 ,指导预防用药 ,以减少发作次数及利于肺功能恢复     

Lymphocyte subsets, sIL2-R and sICAM-1 in blood during allergen challenge tests in asthmatic children

In order to study cell activation in peripheral blood on bronchial allergen provocation up to 24 h, we investigated 32 asthmatic children, sensitive to house-dust mites. Six healthy young adult volunteers served as controls. Lymphocyte subsets (CD3, CD19, CD4, CDS) and activation markers (CD25-T, HLADR-T, CD23) in peripheral blood as well as soluble IL2-R and soluble ICAM-1 in scrum were evaluated. In terms of clinical reaction, 23 children exhibited a DAR, 6 an EAR, 6 a LAR and 3 children did not show a bronchoconstrictor response to allergen challenge with house-dust mite extract (NAR). In comparison to controls, asthmatic children showed a significantly higher expression of CD23 on B-lymphocytcs (p < 0.05). Other subsets were in the same range in both groups. After provocation there was a significant increase of CD4/CD8-ratio only in asthmatic children. Serum levels of sIL2-R were significantly higher in asthmatic children compared to controls at baseline as well as at 12 and 24 h after provocation, without variation during observation period, No differences were noted for SICAM-1. Our results confirm the hypothesis that lymphocytes, as important cells in regulation of allergic immune response, are recruited into peripheral blood under allergen challenge conditions in sensitized asthmatic children.     

The relationship between the intrauterine environment and blood pressure in 3-year-old Japanese children

In 195 Japanese children the systolic pressure at 3 years of age was inversely correlated to the body weight at birth and positively correlated to the mothers' systolic pressure during pregnancy: the average systolic pressure in children whose body weight at birth exceeded 3510 g was 3.0 mmHg, which was lower than that of children whose body weight at birth was 2990 g or less. There was an increase of 0.12 mmHg in the children's systolic pressure with each increment of 1 mmHg in the systolic pressure of their mothers. The systolic pressure at 3 years in children of mothers who had had pretibial oedema during pregnancy (101.0 ± 8.8 mmHg) was significantly higher compared with children whose mothers did not have oedema (96.6 ± 9.6 mmHg).     

Cockroach sensitivity in asthmatic Egyptian children

Cockroach-specific IgE antibodies (CR-IgE) were assayed in the sera of 51 asthmatic and 33 healthy, nonallergic children. Cockroach IgE was detected in 43 asthmatic children (84%), seven of whom showed a high CR-IgE response (> = 1.5 IU/ml). Only three of the healthy children (9%) had a positive response, and none of them were in the strongly positive category. The difference from the asthmatic group was statistically significant ( P < 0.001). Children with clinically mild asthma had a significantly lower CR-IgE posi-tivity rate than moderate and severe cases. The presence of other allergic manifestations or family history of atopy had no relationship to CR-IgE, nor did the residency, age, duration of illness, or total serum IgE levels. However, the CR-IgE titres were positively correlated with the absolute eosinophil counts. Thus, cockroach antigens are common inhalant allergens in Egyptian asthmatic children.