Eosinophil cationic protein, myeloperoxidase and tryptase in children with asthma and atopic dermatitis

Serum levels of eosinophil cationic protein (ECP), myeloperoxidase (MPO), tryptase, total IgE and differential blood cell counts were studied in atopic children with: 1) moderate to severe asthma using inhaled steroids and symptom-free for the last 3 weeks (n= 13), 2) mild asthma with sporadic symptoms, using only inhaled β₂-agonists < 3 times/week (n= 15), 3) acute asthmatic attacks admitted to hospital (n= 12), 4) mild to moderate atopic dermatitis (n= 14). Fifteen children without any history of atopy served as controls. ECP, MPO, tryptase and IgE were measured in serum by radioimmunoassays (RIA). The symptom-free children with inhaled steroids had similar median ECP and MPO values as the controls, 8.0 and 360 μg/l, vs. 9.0 and 310 μg/l, while both ECP and MPO were significantly (p < 0.001) increased in the symptom-free children without anti-inflammatory treatment, 32 and 887 μg/l and in those with acute asthma, 28 and 860 μg/l. The children with atopic dermatitis had increased ECP but normal MPO levels, 16.0 and 455 μg/l. Tryptase in serum was not measurable in any patient. All groups except the control group had significantly elevated total IgE levels. The results indicate that in atopic children serum ECP is a good marker of ongoing asthma or atopic dermatitis. The normal levels of ECP and MPO in the children with asthma using inhaled steroids seem to reflect successful anti-inflammatory treatment. The increased levels of ECP and MPO in the children with mild asthma and no anti-inflammatory treatment may indirectly reflect airway inflammation.     

Association between lower hair zinc levels and Neural Tube Defects

Though folic acid supplementation has reduced the incidence of Neural Tube Defects (NTD), NTD still constitutes one of the important congenital malformations having wide medical, social and ethical implications. Zinc deficiency has been reported to produce NTD in animals. This study was designed to evaluate zinc status of the newborn babies with NTD and their mothers. Eighty newborn babies with NTD and their mothers served as cases. Eighty apparently normal newborn babies and their mothers served as controls. Serum and scalp hair zinc levels were analyzed by atomic absorption spectrophotometry. The mean (± SD) serum and hair levels in normal mothers were 74.1 ± 4.1 μg/dl and 142.3 ± 8.0 μg/g respectively. The mean (± SD) serum and hair levels of the mothers who delivered NTD babies were 75.7 ± 5.6 μg/dl and 129.9 ± 5.3 μg/g respectively. The mean (± SD) serum and hair levels in normal newborn babies were 77.8 ± 5.3 μg/dl and 188.8 ± 6.2 μg/g respectively. The mean (± SD) serum and hair levels in NTD babies were 80.1 ± 12.9 μg/dl and 174.2 ± 10.7 μg/g respectively. The hair zinc levels of the affected babies and their mothers were significantly lower (P< 0.001) than the controls. This study has found association between NTD and decreased hair zinc levels and large population based studies are recommended to confirm the association between zinc and NTD and to investigate whether zinc supplementation would reduce the overall incidence of NTD.     

支气管哮喘儿童血清25-（OH）D3和总免疫球蛋白E的变化

目的：研究支气管哮喘儿童血清25-羟维生素D3［25-（OH）D3］和总免疫球蛋白E（TIgE）的变化及临床意义。方法采用放射免疫分析法,检测30例支气管哮喘、40例喘息性支气管炎患儿及40例正常对照儿童血清25-（OH）D3及TIgE含量,比较3组间其血清含量的差异。结果支气管哮喘组血清25-（OH）D3含量（18±3 ng/mL）明显低于喘息性支气管炎组（43±3 ng/mL）和正常对照组（43±3 ng/mL）,且TIgE含量（192±16 IU/mL）明显高于喘息性支气管炎组（123±14 IU/mL）和正常对照组（118±15 IU/mL）,差异均有统计学意义（P＜0.01）。支气管哮喘组血清25-（OH）D3与TIgE呈负相关（r=-0.783,P＜0.01＝,喘息性支气管炎组、正常对照组血清25-（OH）D3与TIgE均无相关性。结论血清25-（OH）D3缺乏可能是导致儿童支气管哮喘发作的原因。血清25-（OH）D3水平增高可以抑制IgE的过度表达,这可能成为预防和治疗支气管哮喘等过敏性疾病的一种新的有效途径。     

Impact of zinc on sexual maturation of female sickle cell anemia (SCA) children in Enugu,Southeast Nigeria

Adolescence is an important developmental period of childhood. Good health and adequate nutrition consisting major food constituents and trace elements like zinc are fundamental for optimal sexual maturation. To determine the relationship between zinc levels and pattern of breast and pubic hair development, as well as menarcheal age of female SCA children aged 6–18 years and their matched controls with hemoglobin genotype AA. Cross sectional, case-control study. Information on biodata, age at menarche, medical and drug history as well as 24-hour dietary recall was documented using interviewer administered questionnaire. Sexual maturation was assessed using Tanner staging and zinc levels determined using Atomic absorption spectrophotometer. Eighty-one subjects were compared with 81 controls. There was significant delay in the mean age of attainment of various Tanner stages of breast and pubic hair in the subjects. Mean age of 14.81 ± 1.07 years at menarche in subjects was significantly higher than 12.62 ± 1.18 years in controls (p = 0.001). Serum zinc of 58.01 ± 10.58 µg/dl in subjects was significantly lower than 68.37 ± 8.67 µg/dl in controls (p = 0.001). Serum zinc levels were found to have a significant positive relationship with stages of sexual maturation and mean age at menarche. Reduced serum zinc in children with SCA was associated with delayed sexual maturation.     

Blood lead levels of children with pica and surma use

Blood lead levels of 253 Delhi children were estimated by dithizone method. In 82 (controls) children with no symptoms mean blood lead level was 9.6 μg/dl (±SD 6.8: median 10 μg); only 6 had high levels between 30–33 μg/dl. In 88 children with pica, the mean blood lead level was 23.0 μg/dl (±SD 13.82; median 17 μg) which was significantly higher than the control; 26 had high levels between 30–92 μg/dl. Sixteen children with pica and surma- use and 46 children suspected of lead poisoning showed lead level patterns like the pica group. However, 21 surma-using children without pica resembled the control group. Children with pica were significantly more anemic than the controls and showed higher prevalence of abdominal-neurological symptoms. Because, in India, blood lead cannot be estimated in most of the hospitals, it is suggested that children with severe pica, anemia, abdominal-neurological symptoms and exposure to surma or lead, be suspected of lead poisoning, kept in lead-free environment with corrected nutrition, and be given a short cautious therapeutic trial with oral penicillamine.     

A prospective 12-year follow-up study of children with wheezy bronchitis

Eighty children with wheezy bronchitis were followed prospectively for 12 years. At the end of the follow-up period only 22 (28%) still had symptoms of asthma. Forty-three children (54%) had ceased to wheeze before the age of 3 years, four children between 3 and 7 years of age and 11 children between 7 and 11 years of age. Of the 22 children who still had asthma, all but one were much improved, although 70% of them noticed asthmatic symptoms during exercise. Heredity for asthma/wheezing, allergy, the occurrence of eczema, and onset of wheezing after 18 months of age were associated with an increased risk of persistent asthma. Allergy had developed in 59% of the children with persistent asthma and in 10% of those who had stopped wheezing. Serum IgE was above the mean +1 SD in 45% and above the mean +2 SD in 24% of the children at the end of the 12-year follow-up. A serum IgE above the mean +2 SD was found in 8 of 13 children with asthma combined with proven allergy, but only in 1 of 9 children with asthma without allergy. Surprisingly, 8 of 48 children who had stopped wheezing and had no clinical allergy had as high IgE levels as the children with asthma and allergy, which reduced the allergy predictive value of a high serum IgE to 36%. Some of these high IgE levels seemed to be a family trait.     

Urinary eosinophil protein X in children with asthma: Influence of atopy and airway infections

It has been suggested that urinary eosinophil protein X (U‐EPX) can be used to monitor bronchial inflammation in childhood asthma. However, the influence of atopy and airway infections is not well elucidated. To determine the clinical value of measuring U‐EPX in children with asthma and to evaluate the influence of atopy and airway infections, U‐EPX was measured in 170 children with asthma (mean age 69 months, range 12–179 months), in 79 children with lower or upper respiratory tract infections (mean age 41 months, range 1–165 months), and in 64 controls. U‐EPX was elevated in children with acute asthma (median 132 µg/mmol of creatinine, quartiles 77–195 µg/mmol of creatinine, n = 51, p < 0.001) and chronic asthma (median 93 µg/mmol of creatinine; quartiles 46–149 µg/mmol of creatinine, n = 119, p < 0.01) compared with controls (median 54 µg/mmol of creatinine; quartiles 40–89 µg/mmol of creatinine, n = 39). Atopic children had higher levels of U‐EPX than non‐atopics with acute asthma (median 155 µg/mmol of creatinine, quartiles 113–253 µg/mmol of creatinine, n = 27, vs. median 102 µg/mmol of creatinine, quartiles 56–168 µg/mmol of creatinine, n = 24, p < 0.05), as well as with chronic asthma (median 110 µg/mmol of creatinine, quartiles 65–162 µg/mmol of creatinine, n = 63, vs. median 60 µg/mmol of creatinine, quartiles 39–123 µg/mmol of creatinine, n = 56, p < 0.01). In chronic asthma, children without atopy had levels of U‐EPX similar to values of controls; levels were similar in symptomatic and asymptomatic patients, and not influenced by treatment with inhaled corticosteroids. Moreover, U‐EPX levels were higher in children with pneumonia (median 207 µg/mmol of creatinine, quartiles 111–280 µg/mmol of creatinine, n = 35, p < 0.001), laryngitis (median 109 µg/mmol of creatinine, quartiles 65–161 µg/mmol of creatinine, n = 24, p < 0.01), and rhinitis (median 172 µg/mmol of creatinine, quartiles 123–254 µg/mmol of creatinine, n = 19, p < 0.001) than in controls (median 62 µg/mmol of creatinine, quartiles 41–93 µg/mmol of creatinine, n = 64). There was significant overlap among all groups of children with disease, as well as between children with disease and controls. Hence, U‐EPX may reflect differences in eosinophil involvement and activation between children with atopic and non‐atopic asthma, but the individual spread within groups and the influence of airway infections limits the clinical value of U‐EPX in childhood asthma.     

A Prospective 12-Year Follow-up Study of Children with Wheezy Bronchitis

Eighty children with wheezy bronchitis were followed prospectively for 12 years. At the end of the follow-up period only 22 (28 %) still had symptoms of asthma. Forty-three children (54 %) had ceased to wheeze before the age of 3 years, four children between 3 and 7 years of age and 11 children between 7 and 11 years of age. Of the 22 children who still had asthma, all but one were much improved, although 70 % of them noticed asthmatic symptoms during exercise. Heredity for asthma/wheezing, allergy, the occurrence of eczema, and onset of wheezing after 18 months of age were associated with an increased risk of persistent asthma. Allergy had developed in 59 % of the children with persistent asthma and in 10 % of those who had stopped wheezing. Serum IgE was above the mean +1 SD in 45 % and above the mean +2 SD in 24 % of the children at the end of the 12-year follow-up. A serum IgE above the mean +2 SD was found in 8 of 13 children with asthma combined with proven allergy, but only in 1 of 9 children with asthma without allergy. Surprisingly, 8 of 48 children who had stopped wheezing and had no clinical allergy had as high IgE levels as the children with asthma and allergy, which reduced the allergy predictive value of a high serum IgE to 36 %. Some of these high IgE levels seemed to be a family trait.     

Exhaled carbon monoxide levels in preschool‐age children with episodic asthma

Background: The concentration of exhaled carbon monoxide (eCO) in young children with stable asthma and during acute asthma attack is not known. Methods: A sampling bag was developed to collect the exhaled air of preschool children. A total of 257 preschool‐age children (≥3 years and ≤6 years old) were studied; 111 had a diagnosis of asthma (43 suffering a mild asthma attack and 68 without active asthmatic symptom), 99 had upper respiratory infection (URI) and 47 were healthy. Results: In preschool‐age children, eCO levels of those with asthma attacks (mean ± SE, 2.7 ± 0.3 p.p.m., n= 43) were significantly higher than those of subjects with asymptomatic asthma (0.5 ± 0.1 p.p.m., P < 0.05), URI (0.8 ± 0.1 p.p.m., P < 0.05) and healthy children (0.4 ± 0.1 p.p.m., P < 0.05). A multivariate linear regression model showed that eCO was higher in children with asthma attacks independent of age and gender. In 33 asthmatic children followed before and after treatment, eCO levels during asthma attacks significantly decreased after inhalation therapy with a combination of salbutamol and sodium cromoglycate (before therapy, 2.9 ± 0.4 p.p.m.; after therapy, 0.6 ± 0.1 p.p.m., P < 0.0001). Conclusions: The measurement of eCO using a novel collecting system is useful in the recognition of asthma in preschool children.     

Relationship between Vitamin D and Childhood Asthma: A Case–Control Study

Objective:

Studies determining the relationship between serum vitamin D status and childhood asthma have yielded controversial results. Findings indicated that vitamin D deficiency is associated with asthma and airway hyper responsiveness. The aim of this study was to assess the relationship between serum vitamin D status and childhood asthma.

Methods:

Data were obtained from 200 asthmatic children (age 3–12 years) and 200 healthy controls. Serum levels of 25(OH) vitamin D, total IgE, calcium, phosphorus, parathormone (PTH) and eosinophil count were measured in both asthmatic children and healthy controls. Also, the mean values of 25(OH) vitamin D were compared with asthma symptom severities.

Findings:

There was a significant decrease in the concentration of serum 25(OH) vitamin D in the asthmatic patients as compared with the controls (20.34±2.8 vs 25.39±4.1 ng/mL, 95%CI: 1.46–3.86, P=0.01). Out of total asthmatic subjects, 40 (20%) were vitamin D sufficient, 48 (24%) were insufficient, and 112 (56%) were deficient. Total IgE concentration was also significantly higher in asthmatic patients having vitamin D deficiency (132.4±20.1 IU/ml, 95%CI: 1.38–3.75, P=0.03). Comparing asthmatic patients with healthy controls, odds of having vitamin D level less than 20ng/mL was 2.47.

Conclusion:

Our findings suggest that vitamin D deficiency or insufficiency may be positively related to the prevalence of asthma in children.     

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。     

Lipid profile in the progeny of parents with ischemic heart disease

Lipid profile of 50 offsprings of parents with ischemic heart disease and 15 control children aged 5–16 years was studied. The children in both the groups were categorized into 3 sub groups, 5–10, 11–15 & >15 years. The Serum total cholesterol levels (mean ±S.D.) (in mg/dl) in the test group were 169.8±15.13, 173.34±33.56, 177.4±27.89 respectively for the 3 age subgroups. The Serum LDL cholesterol levels (mean ±S.D) (in mg/dl) in the test group were 102.2±15.25, 95.13±30.38, 101.09±26.96 respectively. The serum total cholesterol levels (mean ±S.D) (in mg/dl) in the control group were 123±1.33, 118±7.51 and 127.4±5.77 respectively for the 3 age subgroups. The serum LDL cholesterol levels (mean +S.D) (in mg/dl) in the control group were 56.64±8.75, 43.36±6.10 and 45.16±6.78 respectively. The serum total cholesterol and LDL cholesterol levels in the test group were significantly higher as compared to controls (p>0.05). Among test subjects, 54% had elevated total cholesterol (>170 mg/dl) and 38% had elevated LDL cholesterol (>110 mg/dl). These cases had a significant correlation with elevated parental total cholesterol and LDL cholesterol levels (p>0.05). Thus, a selective screening of the offsprings of parents with premature ischemic heart disease and hypercholesterolemia is advocated.     

Eosinophil cationic protein (ECP), eosinophil chemotactic activity (ECA), neutrophil chemotactic activity (NCA) and tryptase in serum before and during bronchial challenge in cat-allergic children with asthma

In order to study ECP, ECA, NCA and tryptase levels in serum in 18 cat-allergic children with asthma scrum samples were obtained before and during an allergen bronchial challenge. All children were on regular treatment with inhaled steroids (200-800 μg/day) and bronchodilators. Peak expiratory flow (PEF) was recorded twice daily for at least a week before the challenge. The baseline ECP levels were significantly higher in the children who had a baseline PEF 80-95% of pred. compared to those who had PEF >95% of pred. (mean 24. 3 μg/l and 14. 3 μg/l respectively, p <0.02). ECP in serum before the ehallenge correlated significantly to PEF in % of the expected optimal PEF obtained from the PEF curve (r= 0. 48, p <0.05). During the challenge ECA and NCA increased significantly from mean 96. 2% and 97. 9% to 122. 7% and 118. 7% (p <0.05 for both), while ECP did not change significantly, mean 20. 4 μg/l before and 17. 5 μg/l after the challenge. Tryptase levels in serum were not detectable (<0. 5 ng/ml) before or during the asthmatic attack.
We eoncludc that there are significantly raised ECP levels in serum in symptom-free asthmatic children on long-term treatment with topical steroids possibly indicating remaining airway inflammation. Acute asthma results in an increase of ECA and NCA while ECP levels seem to reflect the chronic rather than the acute phase of asthma in children.     

Efficacy of sublingual specific immunotherapy in intermittent and persistent allergic rhinitis in children: an observational case–control study on 171 patients. The EFESO-children Multicenter Trial

Sublingual‐specific immunotherapy (SLIT) is considered as a valid treatment of respiratory allergies. However, there are few data on large sample size regarding its clinical role in ‘real life’ in term of reduction of symptoms, rescue medications and prevention of asthma in patients suffering from allergic rhinitis (AR) especially in children. We performed a multicenter, case–control study to evaluate the effect of SLIT in children (age 6–18 yr) with intermittent or persistent AR. 171 children (27% girls and 73% boys) with AR due to seasonal or perennial allergens were enrolled in a multicenter case–control study. Cases (n = 90) were defined as patients with intermittent (64%) or persistent (36%) AR who were treated for at least two consecutive years with specific SLIT with the related allergen extracts (SLITone^® ALK‐Abellò). Controls (n = 81) were defined as sex‐age‐ and type of allergen matched AR children who were never treated with specific immunotherapy and had no asthmatic symptoms at the beginning of observation period. Main outcomes of the study were the rhinoconjunctivitis symptom score (SS) (sneezing, rhinorrea, nasal itch, congestion, ocular itch and watery eyes) with a ranging scale from 0 (=no symptoms) to 3 (=severe symptoms) and the medication score (MS) evaluating symptomatic drug intake (antihystamine and inhaled corticosteroids). SS and MS were evaluated at the end of the observational period in relation with the period, considering the last 12 months, in which patients suffered the highest symptoms levels (i.e., peak of relevant pollen season (seasonal AR) or during the period of maximum allergen exposure in case of perennial AR). Secondary outcome of the study was the development of asthma symptoms during the observation period. SS (mean ± SD) was 4.5 ± 2.5 in cases and 9.0 ± 3.0 in controls (?50%) (p = 0.0001). MS (mean ± SD) was 2.5 ± 1.9 and 3.6 ± 2.1 in the case and control groups, respectively (?31%) (p = 0.0001). At the end of the observation period asthma symptoms were present in 14 subjects in the case group (15%) and in 20 children (24%) in the control group (p = 0.13). New skin sensitizations appeared in 6% of cases (n = 2) and in 36% (n = 12) of the controls (p = 0.001). The EFESO trial shows that a 2‐yr once daily SLIT treatment in children with intermittent or persistent AR is associated with lower symptom and medication scores in comparison with subjects treated with symptomatic drugs only.     

Serum vitamin A concentrations in asthmatic children in Japan

BACKGROUND: Vitamin A is an essential micronutrient with important roles in immunity and maintenance of normal epithelial cell differentiation. Little information is available regarding the relationship between vitamin A concentrations and asthma despite the repair of epithelial and other structural changes being of utmost importance for the relief of symptoms and control of the disease. The authors evaluated vitamin A and vitamin E concentrations in well-nourished children with asthma. METHODS: The serum vitamin A and vitamin E concentrations were measured by high performance liquid chromatography methods. Statistical analysis was performed using the Mann-Whitney U-test and Peason's correlation coefficient test. RESULTS: According to these methods, the mean serum vitamin A concentrations were significantly lower (19.41+/-7.45 microg/dL, mean+/-SD) in asthmatic children than controls (29.52+/-11.34 microg/dL, P=0.0001). To compare the correlation of C-reactive protein and serum vitamin A concentrations, there was also significant difference between the two groups. CONCLUSION: The data suggest that there is a correlation between vitamin A deficiency and the mechanism of asthmatic response. These data support that the mechanism of hypovitaminosis A in asthmatic children may involve not only the acute phase response but also the various degrees of chronic epitherial damage of airways.     

Childhood asthma and vitamin D deficiency in Turkey: is there cause and effect relationship between them?

Background

Epidemiological studies show that vitamin D deficiency and insufficiency are common worldwide and associated with many diseases including asthma. Our aim was to evaluate vitamin D insufficiency and its clinical consequences.

Methods

This cross-sectional study was carried out on 170 children consisted of 85 who were asthmatic and 85 who were not, aged 2 to 14 years in Tekirdag, Turkey, from September 2009 to May 2010. Children’s basal serum D vitamin levels were determined, and their eating habits, vitamin D intake, exposure to sunlight and use of health services during the previous year were investigated. The severity of asthma and levels of asthma control were assessed according to the Global Initiative for Asthma guidelines.

Results

The difference between mean vitamin D levels in the asthmatic group (mean +/- SD) 16.6 +/- 8.5 ng/mL and the healthy control group (mean +/- SD) 28.2 +/- 19.5 ng/mL was found to be statistically significant (p?<?0.001). Children in the asthma group had less exposure to sunlight and ate a diet less rich in vitamin D (p?<?0.001). A significant difference was observed between the groups regarding the frequency of respiratory tract infections leading to emergency unit admissions and number of hospitalizations (p?<?0.001). It was also shown that a decrease in vitamin D level increased the severity of asthma (p?<?0.001) and decreased the frequency of controlled asthma (p?=?0.010).

Conclusion

This study has demonstrated the correlation between plasma 25 (OH) D levels and childhood asthma. Evidently, this relationship being influenced by multiple factors other than vitamin D, further studies should be conducted to explore the interrelation between all such factors.

     

Physical growth in children with reflux nephropathy with normal or mildly impaired renal function

Ten children aged 11 months to 10 years (means 5.7 years) with reflux nephropathy, vesicoureteric reflux (VUR) and normal or mildly impaired renal function having GFR more than 50 ml/min/1.72 m², were included in the study. The hematological and biochemical parameters were within normal limits. Height standard deviation score (HZ score) was reduced at entry and, decreased further during follow-up (−2.2 and −2.6 at 0 and 12 months, respectively). Weight for height index (WHI) improved significantly (p=0.0004) during follow-up. The basal and stimulated peak growth hormone levels of these patients were found to be elevated, 18.53 ± 11.36 μg/L and 34.20 ± 5.86 μg/L, respectively. The IGF-1 levels were low ranging from 45.00 to 84.40 ng/dl (mean ± SD 61.54 ± 10.21 ng/dl) compared to 51.80 to 247.50 ng/dl (mean ± SD111.20 ± 70.24 ng/dl) in age and sex matched controls, indicating partial insensitivity to growth hormone.     

Bronchoalveolar lavage in asthmatic children: Evidence of neutrophil activation in mild-to-moderate persistent asthma

Little information is available on cell profiles and mediator production in the lower airways of children with asthma by comparison with the adult population. To study the bronchoalveolar lavage (BAL) cell profiles and production of eosinophil cationic protein (ECP) and myeloperoxidase (MPO) in childhood bronchial asthma, a retrospective study was performed in 29 children (13 allergic asthmatic children and 16 controls). Six of the asthmatics had mild-to-moderate persistent disease and seven had intermittent asthma. The BAL cell count and ECP and MPO values of asthmatic children were compared with those from 16 controls. The asthmatic patients had higher values than controls for the total cell count (p=0.08), for neutrophils (p=0.02), and for ECP and MPO (p<0.001). MPO levels (p=0.04), neutrophil count (p=0.06), and ECP values (p=0.06) were higher in patients with mild-to-moderate persistent asthma than in those with intermittent asthma. Our results demonstrate that neutrophil-mediated inflammation is greater in patients with more severe asthma.     

Age related IgG subclass concentrations in asthma.

The prevalence of IgG subclass deficiency in asthma is still controversial. Earlier studies often included patients receiving treatment with systemic steroids which can induce hypogammaglobulinaemia. Concentrations of IgG subclasses were studies in 200 children (aged 2-17 years) with asthma (mean asthma severity score (ASS) 2, range 1-4) who had not received systemic steroids for at least six weeks before investigation, and in 226 healthy age matched controls. The mean concentrations of IgG subclasses in children with asthma were within the 1SD range of those of the control group. In the group with asthma there was a trend towards higher levels of IgG1 and IgG4, whereas the number of children with low concentrations of IgG2 (< 2 SD of control serum samples; absolute concentrations 0.08-1.25 g/l) was slightly greater than in the group who did not have asthma (4.5 v 2.2%). Patients with subnormal concentrations of IgG2 could not be distinguished clinically or on the basis of case history and additional immunological studies did not show further abnormalities. Patients with severe asthma (ASS 3-4) had significantly higher concentrations of IgG4 (mean (SE) 0.53 (0.09) v 0.26 (0.04) g/l) than patients with mild asthma (ASS 1). No significant difference in subclass concentration was found between patients with atopic and those with non-atopic asthma. It is concluded that in an unselected group of children with asthma the mean IgG subclass concentrations do not differ significantly from a group of healthy age matched controls.     

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。