Specific IgE antibodies and serum eosinophil cationic protein in children with atopic dermatitis alone

Both eosinophils and specific immunoglobulin E (IgE) to foods and mites have been considered involved in the pathogenesis of atopic dermatitis (AD). The relationship between eosinophils and specific IgE, however, remains to be elucidated. Blood eosinophil counts, serum eosinophil cationic protein (ECP) and IgE to egg white, cow's milk, soybean, rice and Dermatophagoides pteronyssinus (Dp) were measured in subjects with AD alone or bronchial asthma (BA) alone. Subjects with positive IgE titers (Pharmacia radioallergosorbent test (RAST) units > 0.7) of one or more items were defined as RAST-positive. Immunoglobulin E titers to egg white, cow's milk and soybean of subjects with AD were high in early childhood and declined with aging, whereas the titers of subjects with BA were negative or low. Immunoglobulin E titers to Dp were elevated after 1 year of age in both disease groups. Eosinophil cationic protein (ECP) levels and blood eosinophil counts in the AD and BA groups were significantly higher than those of non-atopic controls. No difference in ECP levels or blood eosinophil counts were observed between RAST-positive and negative groups. It is concluded that IgE to foods such as egg white, cow's milk and soybean might have a role in the pathogenesis of AD of young children, while IgE to mites might be involved in older children. Eosinophils may also participate in AD. However, different mechanisms may be responsible for the rise in specific IgE and high ECP levels and blood eosinophil counts.     

异丁司特对哮喘豚鼠气道嗜酸性粒细胞凋亡的作用及其机制

研究异丁司特 (ibudilast) 对哮喘豚鼠气道嗜酸性粒细胞 (eosinophil, EOS) 凋亡的作用及其机制。采用卵白蛋白致敏法制备豚鼠哮喘模型。收集支气管肺泡灌洗液 (BALF) 并进行白细胞计数及分类计数, TUNEL技术原位检测EOS凋亡, RT-PCR技术检测EOS的Fas mRNA表达, 酶联免疫吸附 (ELISA) 法测定BALF中粒细胞-巨噬细胞刺激因子 (GM-CSF) 及白介素-5 (IL-5) 的含量。结果表明, 异丁司特可明显减少哮喘豚鼠的白细胞总数和EOS数目; 在异丁司特剂量组, EOS凋亡细胞明显增多, Fas mRNA的表达显著增强, BALF中GM-CSF、IL-5含量显著降低, 与模型组比较有显著性差异。因此, 异丁司特抑制哮喘豚鼠气道EOS数目的增加、诱导EOS凋亡、增强Fas mRNA的表达、降低GM-CSF、IL-5含量可能是其拮抗哮喘的重要机制。     

嗜酸性阳离子蛋白在慢性阻塞性肺疾病与支气管哮喘诊断中的临床价值

目的检测慢性阻塞性肺疾病（chronic Obstructive pulmonary diseases, COPD） 患者血清中的嗜酸性阳离子蛋白（eosinophil cationic protein, ECP）,探讨ECP在COPD中的鉴别诊断价值及其与病情的相关关系。方法采用荧光酶免疫法检测53例COPD急性发作期患者、40例哮喘急性发作患者和39例健康对照的血清ECP。对结果进行对比分析。结果COPD患者ECP水平（48．09±31．33）μg／L明显高于健康对照组（7．83±3．65）μg／L而低于哮喘组（97．17±54．30）μg／L,差异均有统计学意义（P〈0．01）。通过ROC曲线分析,当ECP为66．85μg／L时,对COPD和哮喘的鉴别诊断具有最大灵敏度和特异度,分别为88．2％和88．6％。在COPD患者中,ECP水平随病情的加重而升高,重度和极重度患者的ECP水平明显高于中度患者（P〈0．05）,极重度患者的ECP水平与重度患者相比有增高趋势,但差异无统计学意义（P〉0．05）。结论cOPD患者ECP增高,且和疾病严重程度具有一定的相关性。C（）PD和哮喘在某些情况下症状极为相似,但COPD患者ECP的增高程度低于哮喘患者。因此,监测ECP水平对于COPD的诊断和鉴别诊断、病情监测、合理用药、评价抗炎治疗的效果有一定的参考价值。     

Peripheral eosinophil counts as a marker of disease activity in intrinsic and extrinsic asthma

Background: Recently it has been suggested that the bronchospasm and hyperresponsiveness phenomena observed in asthma are secondary to the actions of the eosinophils; the purpose of this study was to evaluate the relationship between the peripheral number of eosinophils and various markers of disease activity in a group of asthmatics examined in childhood (mean age 10 years) and early adulthood (mean age 21 years). Methods: The relationship between eosinophil count and pulmonary function (FEV₁), respiratory symptoms, bronchial responsiveness to histamine and diurnal variation in peak expiratory flow rate (PEF) was studied in 70 subjects with bronchial asthma, of whom 24 had intrinsic and 46 extrinsic asthma. Self-reported symptoms of asthma were graded on a scale from 0 to 5, where 0 = no symptoms within the preceding 12 months and 5 = daily including nocturnal symptoms, and histamine responsiveness was analysed by means of the dose-response slope (DRS). Results: In both childhood and adulthood, a direct correlation was found between blood eosinophil count and symptom score (r= 0.69, P< 0.001 and r= 0.58, P < 0.001, respectively), whereas inverse correlations were observed between number of eosinophils and FEV, % predicted (r= .0.75, P < 0.001 and r= 0.80, P < 0.001. respectively). Furthermore, in adulthood, eosinophil count was found to be significantly correlated to hisiamine responsiveness (log DRS) (r= 0.65, P < 0.001) and diurnal PEF variation (r= 0.81, P < 0.001); these correlations were also noted after dividing the subjects into intrinsic and extrinic asthmatics. In both groups of subjects a significant inverse correlation was also found between histamine responsiveness and pre challenge FEV₁% predicted. The eosinophil count in childhood was weakly correlated to the symptom score in adulthood (r= 0.29, P < 0.02). Conlusions: This study showed a relationship between eosinophil count and seventy of asthmatic symptoms, level of pulmonary function, histamine responsiveness and diurnal variation in PEF in both intrinsic and extrinsic asthma; suggesting that the peripheral eosinophil count reflects asthmatic activity, and possibly the degree of inflammation in the airways, in both children and adults. Furthermore, a low number of eosinophils in childhood might be related to a relatively favourable prognosis with regard to symptoms of asthma in early adulthood.     

5岁以下喘息儿童血清白细胞介素-17表达的意义

目的观察5岁以下喘息儿童血清IL-17水平及外周血嗜酸性粒细胞(EOS)计数,探讨IL-17水平和EOS计数对5岁以下儿童喘息评估的临床意义。方法随机选取在本院就诊的5岁以下反复喘息患儿53例。男43例,女10例。分为有特应质高危因素组(喘息Ⅰ组)(n=27),无特应质高危因素组(喘息Ⅱ组)(n=26)。从同期在本院外科诊治的斜疝、肾结石等非感染性疾病术前患儿中随机抽取同年龄患儿20例作为对照组(n=20)。男11例,女9例。3组儿童均在治疗前抽取静脉血3 mL,离心后留取血清标本置-70℃冰箱保存,双抗体夹心ELISA法测定血清IL-17水平,采用伊红染色法行外周血EOS计数。结果喘息Ⅰ组、喘息Ⅱ组IL-17水平[(1 469.315±978.300)ng.L-1、(263.340±131.800)ng.L-1]明显高于对照组[(36.478±2.000)ng.L-1](Pa<0.01),其中喘息Ⅰ组患儿IL-17水平高于喘息Ⅱ组,差异有统计学意义(P<0.05);喘息Ⅰ组外周血EOS计数[(0.546±0.100)×109L-1]明显高于喘息Ⅱ组[(0.095±0.005)×109L-1]和对照组[(0....     

Circadian variations in serum eosinophil cationic protein, and serum and urine eosinophil protein X

Biochemical evaluation of inflammation may be a useful adjunct to measures of pulmonary function and symptoms in children with asthma. However, little data have been provided to validate the markers in children. The aim of the present study was to assess circadian variations in serum eosinophil cationic protein (ECP), and serum and urine eosinophil protein X (EPX) in children. Five girls and two boys aged 10–14 years were studied. The first sample of urine consisted of urine collected from 24.00 hours the night before until 08.00 hours on the morning of the day of investigation. Thereafter urine was collected at 4-h intervals until 24.00 hours and in another 8-h interval from 24.00 to 08.00 hours. Blood samples for assessment of serum ECP and serum EPX were collected every 2 h during the 24 h. Statistically significant circadian variations in serum ECP (F=3.2, p=0.002), serum EPX (F=3.1, p=0.002) and in urine EPX/creatinine (F=5.4, p=0.003) were detected. The concentrations were higher during the night compared to daytime. Peak levels of serum ECP (mean [± SEM]) were found at 06.00 hours (16.3 [5.3] µg/l), trough levels at 08.00 hours (3.9 [0.7] µg/l) (p=0.01). Peak levels of serum EPX were seen at 06.00 (43.7 [9.5] µg/l) with trough levels at 12.00 hours (22.0 [3.5] µg/l) (p=0.01). Peak levels of urine EPX/creatinine occurred in urine collected from 24.00 to 08.00 hours (90.0 [27.7] µg/mmol), trough levels in the 16.00–20.00 hours sample (29.7 [8.9] µg/mmol) (p=0.02). Serum ECP, serum EPX and urine EPX exhibit a circadian variation in children with nocturnal and early morning peak levels. To avoid confounding influence from circadian variations in ECP and EPX in clinical studies blood or urine should be sampled at consistent times.