IgE and atopy in perinatally HIV-infected children

Elevated serum immunoglobulin E (IgE) and increased prevalence of atopy is reported in patients infected with human immunodeficiency virus (HIV). The elevated serum IgE may be attributed to polyclonal stimulation of B cells or IgE production against allergens, viruses, fungi and bacteria. This study investigates the prevalence of atopy in perinatally HIV-infected children, and the relationships between serum IgE (and other serum immunoglobulins) with atopy, CD4+ cell count and HIV-disease stage. Serum immunoglobulin levels, epicutaneous skin test for common aeroallergens, clinical Centers for Disease Control and Prevention (CDC) classification, CD4+ cell counts and allergy history were extracted from the charts of perinatally HIV-infected children on highly active antiretroviral therapy. The prevalence of atopy (52%) and the pattern of aeroallergen sensitivity were comparable with the US pediatric population. Serum IgE levels did not correlate with clinical disease stage. However, in non-atopic patients, serum IgE levels increased with disease progression (p = 0.02). There was an inverse relationship between the prevalence of elevated serum IgE levels and atopy with progression of disease (p = 0.019). Serum IgE did not correlate with atopy, CD4+ cell count, or duration of HIV infection or levels of serum immunoglobulins. This is the first study to show no increased prevalence of atopy in perinatally HIV-infected children compared with the general population. In advanced stages of HIV, elevated serum IgE may be specific for antigens other than those known as allergens.     

Development of specific immunoglobulin E in coughing toddlers: A medical records review of symptoms in general practice

The aim of this study was to study whether young children, originally immunoglobulin E (IgE) negative and who became sensitized to specific inhalation allergens, presented more frequently to their general practi‐tioner (GP) with other allergy‐ and asthma‐related symptoms than children who remained IgE negative. It was also investigated whether asthma was diagnosed more often in children who developed IgE to inhalant allergens. Coughing children, 1–5 years of age, visiting the participating GPs, were tested for IgE antibodies to mites, dogs, and cats by using radioallergosorbent testing (RAST). All IgE‐negative (RAST < 0.2 IU/ml) children were re‐tested after 2 years. The medical records of 162 children were reviewed on asthma‐ and allergy‐related symptoms and on prescribed medication. After 30 months, 27 of the 162 children (17%) had become IgE positive for one or more allergens. Most children (93%) had visited their GP for treatment of respiratory symptoms during this period. However, the children who had become IgE positive had visited their GP more often than the children who remained IgE negative. Differences in visits were seen for: shortness of breath (52% IgE‐positive vs. 19% IgE‐negative children, respectively), wheeze (37% vs. 17%), allergic rhinitis (33% vs. 16%), and pneumonia (22% vs. 8%), but not for coughing (89% vs. 88%). The IgE‐positive children were more frequently diagnosed by their GP as having asthma (48%) than were the IgE‐negative children (23%). In a multivariate analysis, indicators of becoming IgE positive were: a visit for shortness of breath (odds ratio [OR] = 6.9; 95% confidence interval [CI] = 2.1–23.1) and two or more visits for wheeze (OR = 6.0; 95% CI = 1.9–19.2), adjusted for breast‐feeding, age, and asthma or allergy in the family. The positive predictive value (PPV) of being IgE positive with a diagnosis of asthma was 90% (whereas the negative predictive value was 48.0%) for a child attending their GP for treatment of wheeze. For recurrent coughing (six or more visits) and shortness of breath, the PPVs were 73% and 71%, respectively. The development of sensitization to common inhalant allergens is associated with specific allergy and asthma‐related symptoms in young children. IgE‐positive children were more frequently diagnosed as having asthma by their GP. This implies that in general practice it is possible to detect children at high risk for developing allergic asthma early in life by their respiratory symptoms and by subsequent testing for specific IgE to inhalant allergens.     

Bronchial Chlamydia pneumoniae infection, markers of allergic inflammation and lung function in children

A relationship between respiratory Chlamydia pneumoniae infection (RCPI) and bronchial asthma is under discussion. Our objective was to study the frequency of RCPI and whether it is associated with markers of asthma in children with recurrent or chronic bronchitis as well as pneumonia. One‐hundred and forty‐eight children who underwent bronchoscopy were enrolled; 42 children with additional respiratory infections were excluded. Therefore, 106 children were examined, regarding a RCPI, by polymerase chain reaction (PCR) of tracheobronchial aspirate, eosinophilic inflammation of respiratory mucosa (cytology, eosinophilic cationic protein [ECP]), total serum immunoglobulin E (IgE) and specific IgE for six important allergens, as well as lung function tests if possible. There was a RCPI in 55 of 106 children (51.9%); 25.4% of PCR positives (14/55) were weakly positive (double cut‐off), which was more prevalent in the 2–5‐year age‐group and teenagers. Children with RCPI, inclusive of weak positives, showed a milder eosinophilia of nasal mucosa than children without RCPI (5.58% vs. 9.35%, p=0.039). Eosinophilia of ≥13% in nasal‐ and/or bronchial swab, as a marker for respiratory allergy, was less frequent in patients with RCPI too (7.3% vs. 21.6%, p=0.035). There were no differences in ECP. Total IgE was lower in PCR‐positive children (101 vs. 179 IU/ml, p=0.032). Specific IgE with a radioallergosorbent test (RAST) of at least class 3 (as a marker for a relevant allergy), as well as any RAST above zero (to characterize early forms of allergy), were both less frequent in the RCPI group. In contrast, weak positives showed the highest rates of sensitization, surpassing RCPI negatives. In lung‐function tests, vital capacity was lower in RCPI patients (87.5% vs. 95.3%, p=0.045); all parameters characterizing obstructive disturbance tended to be higher. Weak positives had both the greatest reduction of vital capacity (75.3%) and the most impaired obstructive parameters. All differences were accentuated in children of 11–18 years of age. Hence, our results indicate that in the children selected, a RCPI is common and not associated with allergic respiratory inflammation. Weak positives, however, differ, having the highest rate of allergic sensitization, reduction of lung volume, and obstructive disturbance. This group might be important in clinically observed asthma after pneumonia caused by C. pneumoniae. In these children, early diagnosis and treatment of a RCPI is recommended.     

Analysis of basophil activation by flow cytometry in pediatric house dust mite allergy

Detection of allergen‐induced basophil activation by flow cytometry has been shown to be a useful tool for allergy diagnosis. The aim of this study was to assess the potential of this technique for the diagnosis of pediatric house dust mite allergy. Quantification of total and specific IgE and basophil activation test were performed to evaluate mite allergic (n = 24), atopic (n = 23), and non‐allergic children (n = 9). Allergen‐induced basophil activation was detected as a CD63‐upregulation. Receiver operating characteristics (ROC) curve analysis was performed to calculate the optimal cut‐off value of activated basophils discriminating mite allergic and non‐allergic children. ROC curve analysis yielded a threshold value of 18% activated basophils when mite‐sensitized and atopic children were studied [area under the curve (AUC) = 0.99, 95% confidence interval (CI) = 0.97–1.01, p < 0.001] with a sensitivity and specificity of 96% for 16 μg/ml mite extract. Analysis of the data obtained with 1.6 μg/ml mite extract defined a cut‐off value of 8% activated basophils (AUC = 0.96, 95% CI = 0.91–1.01; p < 0.001) with a sensitivity of 82% and specificity of 100%. Comparison between mite allergic and non‐allergic children produced a cut‐off of 8% activated basophils (AUC = 1.0) with 16 μg/ml allergen extract and a sensitivity and specificity of 100%. The same threshold and specificity values were obtained with 1.6 μg/ml extract (AUC = 97%, 95% CI = 0.92–1.02; p < 0.001) but sensitivity decreased to 83%. Two atopic children showed negative skin prick and basophil activation tests and high specific IgE (>43 kU/l) values for Dermatophagoides pteronyssinus allergen. They also showed positive prick (wheal diameter >1.0 cm) and basophil activation (>87%) tests and high specific IgE (>100 kU/l) with shrimp allergen. Shrimp sensitization was demonstrated by high levels of Pen a 1‐specific IgE (>100 kU/l). Cross‐reactivity between mite and shrimp was confirmed by fluorescence enzyme immunoassay (FEIA‐CAP) inhibition study in these two cases. This study demonstrated that the analysis of allergen‐induced CD63 upregulation by flow cytometry is a reliable tool for diagnosis of mite allergy in pediatric patients, with sensitivity similar to routine diagnostic tests and a higher specificity. Furthermore, this method can provide additional information in case of disagreement between in vivo and in vitro test results.     

Accuracy of ImmunoCAP® Rapid in the diagnosis of allergic sensitization in children between 1 and 14 years with recurrent wheezing: The IReNE study

It is estimated that at least one out of three children with recurrent wheezing is atopic. Reliable diagnostic tools are needed in primary care that allow for adequate identification of these children. The purpose of this study was to assess the value of ImmunoCAP^® Rapid (ICR) Wheeze‐Rhinitis Child in the identification of atopy with the use of 10 selected allergens in children with recurrent episodes of wheezing. A multicenter population study is based on primary care. It included children managed consecutively at the health center, who had three or more episodes of wheezing, at least one of them in the last 12 months. Each child completed a physical examination, an epidemiological survey, one capillary blood sampling (110 μl) for ICR, and one venous blood sampling for determination of Phadiatop Infant, total IgE and 10 specific IgE measurements. The children were identified as atopic, based on their clinical signs and symptoms and at least one positive specific IgE (0.35 kU_A/l or higher), before knowing the results of ICR, Phadiatop Infant and total IgE. ICR was read by two independent observers. Six classes were evaluated, negative without any color and five positive degrees of pink‐red color. Two hundred and fifteen children aged between 1 and 14 years were studied (138 boys); 50.7% were identified as atopic, 39.1% were sensitized only to inhalant allergens, 6.5% to food allergens and 5.1% to both. The predominant allergen was the dust mite (39.3%). For ICR, there were 2134 valid double observations. The Kappa index, comparing the negative results vs. any positive result, was 0.91 (95% CI: 0.88–0.94). The intraclass correlation coefficient was 0.98 (95% CI: 0.98–0.99). In the identification of a child as atopic, the positive post‐test probability of ICR depended on the color degrees considered: 88.4% for any positive and 97.6% for the most intense tones. The positive post‐test probability of Phadiatop Infant and total IgE was 95.6% and 68.2% respectively. ICR showed good reliability for the most prevalent allergen, the dust mite, with a sensitivity of 90.5% (95% CI: 82.1–95.8) and specificity of 88.5% (95% CI: 81.7–93.4). The analysis of the other allergens was limited by the small number of sensitized children. The analysis of receiver operating characteristic curves revealed an area under the curve of 0.84 (95% CI 0.80–0.88) for the cut‐off point of specific IgE of 0.35 kU_A/l and of 0.94(CI 0.91–0.97) for 2 kU_A/l. A greater intensity of color of the lines of ICR was related to higher levels of specific IgE in blood. ICR is a reliable test for the identification of atopy in children, which identifies most children as atopic, and shows a good correlation in allergen‐by‐allergen identification. This suggests that it should be regarded as a first‐rate tool, in the primary care clinic, for the evaluation of children with recurrent wheezing.     

Clinical presentation and outcome of epidemic Kaposi sarcoma in Ugandan children

Background

Kaposi sarcoma (KS) is one of the most common pediatric cancers in sub‐Saharan Africa. Few data are available about the clinical presentation or response to treatment of children with epidemic (HIV‐associated) KS.

Methods

Medical records of all children with KS and HIV infection referred to the Uganda Cancer Institute in Kampala, Uganda from October 2004 to June 2007 were reviewed. Charts were abstracted for age, sex, location of KS lesions at presentation, biopsy results, CD4 T‐cell count and percentage, and KS treatment and outcome.

Results

Seventy‐three children with epidemic KS were identified, 37 males and 36 females. The median age was 10.1 years (range 2–18). KS presented with lymph node (LN) involvement in 60% of cases. The median absolute and percentage CD4 T‐cells at presentation were 210 cells/µl and 7.4%, respectively. Those children with lymphadenopathic KS were younger (mean difference 3.7 years; P = 0.01) and had higher CD4 T‐cell counts (mean difference 242 cells/µl; P = 0.03) than those without LN involvement. Of 32 patients for whom outcome data were available, a complete response to chemotherapy and/or antiretroviral therapy was documented in 20 (62.5%) patients.

Conclusions

In comparison to cutaneous involvement, LN involvement of epidemic KS occurs at younger ages and at higher CD4 levels. This clinical presentation may reflect recent infection with human herpesvirus 8 followed by a rapid progression to malignancy. Favorable response to treatment was observed in the majority of cases, but prospective studies are needed to determine optimal management. Pediatr Blood Cancer 2010;54:670–674. © 2010 Wiley‐Liss, Inc.     

Lack of an inverse association between tuberculosis infection and atopy: By T-cell-based immune assay (RD1–ELISpot)

The association between mycobacterial exposure, vaccination with bacillus Calmette-Guerin (BCG) in early life and atopy remains controversial. Distinguishing between environmental mycobacterial exposure, TB infection and BCG-vaccination is not possible with the tuberculin skin test (TST) but new accurate blood-tests for TB infection present an opportunity to differentiate TB infection from environmental mycobacterial exposure and BCG-vaccination. We used a new blood test in parallel with TST to investigate whether Mycobacterium tuberculosis infection and/or BCG vaccination are associated with development of atopy in children with prior household TB contacts. All children who had contact with adult active pulmonary TB during the last 6 months underwent TST, chest radiography, and RD1–ELISpot assay. The presence of a BCG scar was documented, and assessment of atopy was carried out by International Study of Asthma and Allergies in Childhood questionnaire, allergy skin prick testing (SPT) and evaluation of serum total IgE. Among 361 children enrolled 39 (11%) had a positive SPT, 236 (63%) positive TST, and 189 (52%) positive RD1–ELISpot. The frequency of SPT positivity, ever wheezing, allergic rhinitis, doctor-diagnosed asthma, high serum IgE level, and median total serum IgE levels did not differ significantly different by TST or RD1–ELISpot status. On the other hand, presence of BGC scar was associated with lower median total serum IgE level (p = 0.01) and lower frequency of high IgE (p = 0.003). M. tuberculosis infection whether measured by TST or RD1–ELISpot, was not associated with atopy in children with household TB contact. Presence of a BCG vaccination scar was inversely associated with atopy, as measured by serum IgE.     

IL13 variants are associated with total serum IgE and early sensitization to food allergens in children with atopic dermatitis

Increased total and specific serum immunoglobulin E (IgE) levels are common characteristics of atopic diseases and their basal production is proposed to be under strong genetic control. Interleukin 13 (IL13) variants have been consistently associated with total serum IgE levels in white populations with a strongest association in non‐atopics. The aim of this study was to test the IL13 p.R130Q and c.1‐1111C>T variants in children with atopic dermatitis (AD) for associations with total serum IgE and early sensitization to common food and inhalant allergens and with asthma. We included 453 children with AD [participants of the Early Treatment of the Atopic Child (ETAC) study] that were followed from the age of 12–24 months for 3 yr. Total and specific IgE were determined at four time points. We genotyped the IL13 p.R130Q and c.1‐1111C>T variants by melting curve analysis. In children up to 4 yr of age, the 130Q allele was related to slightly higher total IgE levels compared to heterozygotes and 130R homozygotes. More importantly, both IL13 variants were significantly associated with sensitization to food allergens, with most significant results for sensitization to egg (p = 0.0001). Although early sensitization to hen’s egg represents a strong risk factor for subsequent sensitization to inhalant allergens and asthma, the investigated IL13 variants were not associated with these phenotypes at the age of 48–60 months. In summary IL13 variants contribute to elevated levels of total serum IgE in young atopic children and are strongly associated with sensitization to food allergens, particularly to hen’s egg. These findings suggest that IL13 variants play a major role not only in non‐cognate but also in allergen specific IgE synthesis.     

The C−159T polymorphism in the CD14 promoter is associated with serum total IgE concentration in atopic Chinese children

Activation of macrophages through CD14 by microbes is crucial in inducing immunity by type 1 T helper cells. A C-to-T polymorphism at position −159 of CD14 was associated with serum total IgE level in Caucasians but not in Japanese subjects. The objective of this study is to determine whether this polymorphic marker is associated with atopy and asthma phenotypes in Chinese children. Restriction fragment length polymorphism was used to characterize CD14/−159 genotypes. Microparticle immunoassay was used to measure serum total IgE level; fluorescent enzyme immunoassay was performed to measure serum concentrations of specific IgE to aeroallergens; and enzyme-linked immunosorbent assay was used to measure serum levels of soluble CD14 (sCD14). Lung function in asthmatics was assessed by spirometry. Two hundred and fifty-eight patients and 92 control children were recruited. Their mean serum total IgE concentrations were 331 and 74 kIU/l, respectively (p < 0.0001). Atopy, defined as the presence of at least one allergen-specific IgE in serum, was found in 220 (85%) patients and in 41 (45%) controls (p < 0.0001). Serum sCD14 levels were significantly associated with CD14/−159 genotypes (p = 0.004). Atopic subjects with CC genotype in CD14/−159 had the highest serum total IgE levels compared with CT and TT genotypes, with the respective mean values being 661, 427 and 380 kIU/l (p = 0.015). Similarly, a higher proportion of subjects with CC genotype had increased serum total IgE concentration (p = 0.039). This polymorphic marker was not associated with asthma or aeroallergen sensitization in our cohort. Our results suggest that the C−159T of CD14 was associated with serum total IgE concentration in atopic Chinese children.     

Glucocorticoids enhance interleukin‐4 production to neo‐antigen (hyaluronidase) in children immunocompromised with cytostatic drugs

Immunoglobulin E (IgE)‐mediated immediate‐type allergic reactions to hyaluronidase have been observed in children with central nervous system (CNS) tumors. Glucocorticoids, used as therapy for brain edema, are discussed controversially as T helper 2 (Th2) stimulatory factors. In this study we investigated the role of glucocorticoids on a Th2 cytokine‐promoting effect in children with CNS tumors. Peripheral blood mononuclear cells (PBMCs) from: 29 children suffering from malignant brain tumors, of whom 23 received short‐term glucocorticoid treatment (for 3–4 days) during the course of chemotherapy; 18 children with nephrotic syndrome or renal transplantation receiving long‐term glucocorticoid treatment; and 13 healthy children, were incubated with phytohemagglutinin (PHA) and/or anti‐CD28 monoclonal antibody (mAb) and, in a second approach, with hyaluronidase. The concentrations of Th cell‐mediated cytokines – interleukin (IL)‐4, IL‐10, and interferon‐γ (IFN‐γ) – were measured in supernatants. The IL‐4 production of PBMCs incubated with PHA/anti‐CD28 mAb from children with repeated co‐administration of glucocorticoids, hyaluronidase, and cytostatic drugs (median: 249.9 pg/ml; range: 234.4–261.7) was significantly higher (p < 0.0001) than IL‐4 production of PBMC from children of all the other groups (median: 86.18; range: 16.0–212.5). There was no significant difference in the levels of IL‐10 and IFN‐γ within the groups. PBMCs stimulated only with hyaluronidase failed to produce detectable levels of cytokines. The results of this study indicate that repeated co‐administration of glucocorticoids and hyaluronidase (a neo‐antigen) enhance IL‐4 production in vitro and thus may induce the production of specific IgE antibodies in children immunocompromised with cytostatic drugs. Hyaluronidase itself does not stimulate in vitro IL‐4 synthesis in PBMCs of children receiving cytostatic drugs.     

Combined therapy in human immunodeficiency virus-infected children —a 4-year experience

From 1988 to 1991 the long-term efficacy of a combined therapy with a polyvalent immunoglobulin/cytomegalovirus (CMV) hyperimmunoglobulin, oral low dose zidovudine, oral cotrimoxazole or inhaled pentamidine was investigated in three groups of human immunodeficiency virus (HIV)-infected children. Group 1A consisted of three perinatally infected children with a CD4 cell decrease of >400, cells/l per year. Group 1B were 17 perinatally infected children with a CD4 cell decrease of <400 cells/l per year. Group 2 comprised eight haemophilic children infected by clotting factors. Despite combined therapy none of group 1A survived longer than 12 months showing a rapid loss of CD4 cell counts, progressive encephalopathy, wasting syndrome and severe bacterial, fungal and CMV reactivation. Under pure intravenous immunoglobulin (IVIG) therapy severe bacterial infections were seen in 1 of 12 children in group 1B. The majority of these patients showed increases or stabilisation of length and weight percentiles. In this group low dose zidovudine therapy was of benefit in HIV-associated neurological symptoms. Nevertheless combined therapy could not prevent further deterioration of CD4 cell counts. In group 2 severe bacterial infections were not seen under IVIG therapy. In this group a temporary increase (6 months) of CD4 cell counts under IVIG/zidovudine combined therapy occurred.Pneumocystis carinii pneumonia (PCP) prophylaxis with oral cotrimoxazole or inhaled pentamidine successfully prevented PCP in all three groups. Under CMV hyperimmunoglobulins (n=22), ten out of ten patients did not acquire primary CMV infection, whereas CMV reactivations mainly located in the CNS could not be prevented in 5 of 12 patients. Our findings indicate that this combined therapy showed remarkable differences in therapeutic efficacy in children with different modes of HIV progression. These modes must be considered for correct timing, dosage and evaluation of therapeutic measures.     

白细胞介素-4受体基因多态性及IgE水平与哮喘预测指数相关性研究

目的研究新疆维吾尔自治区儿童白细胞介素-4受体(IL-4R)基因多态性及Ig E水平与哮喘预测指数(API)的相关性。方法选取167例API(+)、187例API(-)及203例健康婴幼儿(对照组),应用PCR聚合酶链反应和DNA测序法进行基因分型。同时ELISA法检测三组婴幼儿血清Ig E水平。结果 IL-4R基因Arg551Gln位点各基因型频率分布在API(+)组、API(-)组、对照组三组中差异无统计学意义(P0.05);API(+)组血清Ig E水平明显高于API(-)及对照组(P0.01);API(+)患儿中2岁者血清Ig E水平明显低于≥2岁者(P0.01)。结论 Arg551Gln位点多态性与API结果无相关性,而API阳性与Ig E水平升高存在关联性,年龄≥2岁是API阳性的儿童Ig E水平升高的风险因素。     

哮喘患儿单个核细胞表面CD86分子表达和TH源细胞因子水平及之间相关性研究

目的探讨哮喘急性发作患儿T细胞协同刺激途径和T细胞亚群激活状况.方法随机选择哮喘急性发作期患儿35例,对照组31例.用直接免疫荧光流式细胞术检测外周血单个核细胞(PBMC)中白细胞分化抗原14阳性(CD+14)细胞表达CD86的平均荧光强度;经脂多糖刺激后PBMC中CD+19细胞百分率及CD+19CD+86双阳性细胞百分率;ELISA检测植物血凝素刺激后PBMC培养上清白细胞介素(IL)-4、IL-13、IFN-γ水平及血浆总IgE水平,并分析它们之间的相关性.结果 (1)哮喘组CD+14细胞表达CD86的平均荧光强度(31.8±9.2)、CD+19细胞百分率[(13.5±4.0)%]、CD+19CD+86细胞百分率[(4.6±2.0)%]及血浆总IgE水平[186.6(64.3～723.6) kIU/L]与对照组[(23.5±6.4)、(8.2±3.0)%、(2.3±1.4)%、42.0(0.9～115.2)]比较差异有显著性;(2)哮喘组IL-4和IL-13水平均增高,IFN-γ水平降低,与对照组比较差异有显著性;(3)哮喘组CD+14细胞的CD86平均荧光强度与CD+19CD+86细胞百分率、CD+19CD+86百分率与血浆总IgE水平及CD+19、CD+19CD+86百分率与IL-4、IL-13水平均呈显著正相关.结论哮喘急性发作患儿PBMC中抗原递呈细胞表达CD86的强度或数量增高;B细胞和TH2细胞对丝裂原的活化作用应答增强.这提示CD86及TH亚群失衡在哮喘发病机制中起重要作用.     

淋巴细胞亚群绝对计数对儿童难治性肺炎支原体肺炎的早期预测作用

目的探讨淋巴细胞亚群绝对计数对儿童难治性肺炎支原体肺炎（RMPP）的早期预测作用。方法对244例肺炎支原体肺炎（MPP）患儿的临床资料进行回顾性分析。比较普通MPP（166例）和RMPP患儿（58例）的临床特点以及淋巴细胞亚群、乳酸脱氢酶、C反应蛋白、降钙素原、免疫球蛋白E（IgE）等实验室指标,应用ROC曲线评估预测RMMP患者的特异性指标。结果淋巴细胞亚群CD3⁺、CD4⁺、CD19⁺、CD56⁺绝对计数以及血清LDH、CRP、IgE水平两组比较差异均有统计学意义（P < 0.05）。ROC曲线分析显示,CD3⁺、CD4⁺、CD19⁺绝对计数鉴别诊断RMPP和普通MMP的曲线下面积分别为0.866、0.900、0.842,其敏感性分别为86%、90%、82%,特异性分别为75%、70%、80%。结论 CD3⁺、CD4⁺、CD19⁺绝对计数可作为儿童RMPP的预测指标。     

支气管哮喘患儿T细胞亚群和免疫球蛋白变化

目的　探讨外周血T细胞亚群和血清免疫球蛋白的改变在儿童支气管哮喘发病中的作用。方法应用酶联免疫吸附试验 ,SPA直接花环法及单向免疫扩散法对 30例支气管哮喘患儿和 2 0例健康对照小儿的外周血T细胞亚群和血清免疫球蛋白进行测定。结果　对照组CD3 + ,CD4 + 和CD8+ 的百分值分别为 72 .38± 8.19% ,45 .48± 4.2 7% ,31.2 9± 4.0 2 % ,CD4 + /CD8+ 比值为 1.2 8± 0 .2 3。哮喘患儿外周血CD3 + (37.15± 7.16 % )和CD8+(2 6 .5 6± 2 .18% )细胞数明显低于对照组 (P <0 .0 1) ,CD4 + (46 .10± 4.5 2 % )细胞数略高于对照组 ,差异无显著性(P >0 .0 5 ) ,CD4 + /CD8+ (1.5 1± 0 .44 )比值则显著高于对照组 (P <0 .0 5 ) ,对照组IgG ,IgA ,IgM ,IgE分别为10 .6 7± 2 .5 3g/L ,1.18± 0 .6 9g/L ,1.6 0± 0 .5 4g/L ,178± 30IU ;哮喘患儿血清IgE(386± 15 4IU)明显增高 (P <0 .0 1) ,IgM(1.2 9± 0 .41% ) ,IgG(9.35± 2 .2 6 g/L)则显著低于对照组 (P <0 .0 1,P <0 .0 5 ) ,IgA(1.34± 0 .76 g/L)两组差异无显著性 (P >0 .0 5 )。结论　哮喘患儿存在血清免疫球蛋白改变 ;T抑制细胞数量和 (或 )功能不足可能是导致免疫球蛋白改变的主要机制。     

Immunological and Virological Responses to Highly Active Antiretroviral Therapy in HIV-1 Infected Children

Objective

To evaluate immunological and virological outcomes in human immunodeficiency virus (HIV) infected children at six months of highly active antiretroviral therapy (HAART).

Methods

Records of HIV infected children <15-y-old were reviewed to identify those who were initiated highly active antiretroviral therapy between 2010 and 2014 and had CD4+ T cell percentage and HIV-1 viral load report at baseline visit and after 6 mo of initiation of the treatment.

Results

Seventy-four HIV infected children [26% girls, median age IQR 36 (24–108) mo] were included in the study. At the end of six months of HAART, median increase of 11% (6–15%) in CD4+ T cell percentage from the baseline levels was observed; nineteen (26%) children showed an increase in CD4+ T cell percentage of 15% or more at 6 mo. Viral load was undetectable (<47 copies/ml) in 27 (36.4%) children; 21 (28.3%) children had 47- < 500 copies/ml; 16 (21.6%) children had 500- < 10,000 copies/ml and 10 (13.5%) children had ≥10,000 copies/ml. At six months, only 15 (20.2%) children exhibited positive immuno-virological response to HAART (≥ 15% increase in CD4% and <47 HIV-1 RNA copies/ml).

Conclusions

While HAART was effective in improving the immunological and virological parameters in the index cohort of children, virological responses were less robust.

     

PPD反应与发作期哮喘患儿ECP IgE及细胞因子表达的关系

目的：探讨PPD反应与发作期哮喘患儿ECP,IgE及细胞因子表达的关系。方法：实验分健康对照组和哮喘发作组,均进行结核菌素纯蛋白衍化物(PPD)试验。观察PPD反应与哮喘临床症状、肺通气功能测定。血清ECP、IgE等的关系以及PPD试验后哮喘患儿外周血IFN-γ,IL-4,IL-12P40 mRNA的表达。结果：哮喘患儿PPD阴性者(24/32例)明显多于阳性者(8/32例),且PPD反应阴性患儿哮喘中/重度发作(16/24例)较PPD阳性患儿(2/8例)多,P<0.05。PPD阴性的哮喘患儿血嗜酸性细胞阳离子蛋白(ECP)及IgE较PPD阳性的哮喘患儿明显增高(P<0.05)。哮喘患儿PPD试验后IL-12 P40 mRNA,IFN-γ mRNA无明显变化,而IL-4 mRNA升高较对照组明显(P<0.05),致IFN-γ/IL-4 mRNA比值下降。结论：PPD反应阴性的哮喘患儿可能存在着细胞免疫功能低下。PPD正向免疫刺激作用在哮喘患儿中受到抑制。[中国当代儿科杂志,2003,5(1):20-22]     

Different serum interleukin‐12 and sCD30 levels in food‐ and pollen‐sensitized children

It has been proposed that a down-regulation of interleukin (IL)-12 and interferon (IFN)-γ might be related to susceptibility to allergy in early life. The aim of this study was to assess serum IL-12 levels in food-sensitized and pollen-sensitized children and to compare these with another activation marker, sCD30. Twenty children with pollen allergy and 22 food-sensitized children were included. The diagnosis of immunoglobulin (Ig)-E-mediated allergy, suggested by clinical symptoms, was based on skin-prick tests, serum IgE antibodies and total IgE levels. Samples from 24 non-allergic children were used as controls. IL-12 and sCD30 levels were measured by ELISA. It was found that pollen-sensitized patients had normal IL-12 and higher sCD30 levels than controls (114 vs. 63 U/ml, p = 0.028), but, surprisingly, food-sensitized infants showed normal sCD30 and increased serum IL-12 levels (323 vs. 118 pg/ml, p = 0.0001). No differences were found in patients suffering from asthma or allergic dermatitis. Levels of sCD30 and IL-12 determined in May showed a strong correlation with those obtained in November. Interleukin-12 and IgE levels had an inverse correlation (r = –0.494, p = 0.0001) whereas no correlation was found between sCD30 and IgE. Age had a strong negative influence on IL-12 levels in allergic (Z = 4.834, p < 0.0005) and in normal children (Z = 3.00, p < 0.002); by contrast, sCD30 levels were not significantly age-dependent. When IL-12 levels from the food-allergy group were compared with those from normal controls younger than 4 years of age, the difference remained significant (p = 0.001), ruling out an age-bias. The conclusions made in this study were that serum IL-12 and sCD30 showed different behaviors in children with food or pollen allergy. We found IL-12 and sCD30 levels in pollen-allergic patients that agree with the classical T-helper (Th) 1/Th2 paradigm of allergy. In contrast, serum IL-12 levels were increased in food-sensitized children, suggesting a different immunologic pathogenesis.     

Finger clubbing in children with human immunodeficiency virus infection

We investigated the frequency of finger clubbing in 150 HIV-infected children consecutively hospitalized for acute pneumonia in South Africa and described associated clinical, laboratory and radiological features. Clubbing occurred in 30 of 150 (20%) HIV-infected children compared with one of 99 (1%) HIV-negative control patients, p < 0.001. Clubbing was associated with lower presenting heart and respiratory rates and enlarged parotid glands. Total and CD4 + lymphocytes, CD4:CD8 ratio and LDH were lower in children with clubbing, but serum protein and gammaglobulin were higher. No differences in the prevalence or type of microbial pathogens were found between the two groups. Clubbing was associated with a radiological diagnosis of LIP. Children with clubbing had a lower in-hospital mortality rate than those without clubbing (6.7% vs 24.2%, p = 0.035). In geographical areas with high HIV seroprevalence rates, the presence of clubbing in a child hospitalized for respiratory disease should raise the suspicion of HIV infection.     

肺炎支原体致支气管肺炎和大叶性肺炎患儿的临床及实验室检查特征分析

目的分析和探讨肺炎支原体(MP)所致支气管肺炎和大叶性肺炎患儿的临床及实验室检查特征。方法选取于2006年1月—2010年12月住院的社区获得性MP肺炎患儿,根据肺部影像学检查将患儿分为MP-支气管肺炎组151例和MP-大叶性肺炎组89例,收集临床和实验室检查资料并加以分析。结果 MP-支气管肺炎患儿平均年龄为42.7个月,MP-大叶性肺炎患儿平均年龄为63.6个月,差异有统计学意义(P<0.05)。5岁以下患儿以支气管肺炎为多见,而5岁以上患儿以大叶性肺炎多见。MP-支气管肺炎患儿比MP-大叶性肺炎患儿容易出现喘息症状(13.2%对1.1%),而MP-大叶性肺炎患儿更易出现发热(95.5%对78.1%),且发热持续时间长(4 d对8 d),差异均有统计学意义(P<0.05)。MP-大叶性肺炎患儿伴有胸腔积液的比例高于MP-支气管肺炎患儿(9.0%对1.3%)。MP-大叶性肺炎患儿CD3+及CD8+T淋巴细胞的比例高于MP-支气管肺炎患儿,而CD4/CD8比值、CD3-CD19+及CD19+CD23+B淋巴细胞比例低于MP-支气管肺炎患儿,差异均有统计学意义(P均<0.05)。MP-大叶性肺炎患儿的IgA水平高于MP-支气管肺炎患儿,差异有统计学意义(P<0.05),而IgG和IgM的差异无统计学意义。结论 MP-支气管肺炎和MP-大叶性肺炎患儿具有各自的临床和实验室检查特征。MP感染后因不同年龄患儿机体的免疫状态不同,最终导致的疾病转归也不同。