儿童哮喘与血清褪黑素及环氧化酶-2水平的相关性

目的探讨哮喘患儿血清褪黑素（melatonin，MT）、环氧化酶（cyclooxygenase，COX）-2的水平变化，及其在哮喘发病中的临床意义。方法选择2007年3月至2008年3月在南京医科大学附属常州市第二人民医院、南通市第三人民医院儿科呼吸门诊和住院治疗的哮喘发作期儿童59例（根据《儿童支气管哮喘防治常规（试行）》诊断标准确诊），将其纳入哮喘组。其中，男性患儿为39例，女性为20例；年龄为1～6岁。然后，再按采集标本前2周内是否使用糖皮质激素，将哮喘组进一步分为亚组A（n=39，未使用激素），亚组B（n=20，2周内使用激素）。选取同期在上述两所医院进行体检的28例健康儿童（采集标本前2周内无感染、无损伤病史、无用药史，本人及其家族Ⅰ，Ⅱ级亲属无变态反应、湿疹及咳喘病史）纳入对照组。哮喘组与对照组儿童年龄、性别比较，差异无显著意义（P〉0．05）（本研究遵循的程序符合南京医科大学附属常州第二人民医院人体试验委员会所制定的伦理学标准，得到该委员会批准，分组征得患儿家长知情同意，并与试验患儿监护人签署l临床研究知情同意书）。采用酶联免疫吸附法（enzyme linked immunosorbent assay，ELISA）检测两组儿童血清标本中褪黑素及环氧化酶-2水平，并进行统计学分析。结果哮喘组血清褪黑素水平（2．44±0．83）pg／mL]较对照组（4．48±1．11）pg／mL]降低；血清环氧化酶-2水平（57．26±7．92）IU／L]较对照组（46．87±19．41）IU／L]升高，两组比较，差异有显著意义（P〈0．001）。哮喘组中，亚组A，B血清褪黑素水平比较，差异无显著意义（P〉0.05）；但亚组A血清环氧化酶-2较亚组B升高，两组比较，差异有显著意义（P〈0．05）。使用糖皮质激素可使血清环氧化酶-2水平显著降低（P〈0．05）。哮喘组血清褪黑素与环氧化酶-2呈显著负相关（r=-0．453，P〈0．001）。结论血清褪黑素、环氧化酶-2可能参与儿童哮喘的发病过程。血清环氧化酶-2高表达，可能是哮喘患儿气道高反应性和气漕炎症的原因之一。

Level of Serum Melatonin and Cycloxooygenase-2 and Its Relativity in Asthmatic Children

Objective To discuss the interaction and clinical significance of the level of serum melatonin （MT） and cyclooxygenase （COX）-2 in children with asthma. Methods Fifty-nine asthmatic children with acute attack （asthma group, 39 boys and 20 girls, aged 1-6 years old） and 28 sex- and agematched healthy children （control group） from Second People＇ Hospital of Changzhou, Affiliated to Nanjing Medical University and Third People＇s Hospital of Nantong from March 2007 to March 2008 were enrolled in the study. The asthmatic attack diagnosis was based on the Convention of Bronchial Asthma for Child Prevention and Cure. Asthma group children were sub-divided into 2 groups according to the use of adrenal cortex hormone for 2 weeks before serum sample collection, sub-group A（n= 39, without the application of glucocorticoid） and sub-group B（n=20,treated with glucocorticoid）. There had no significant difference of age and gender between asthma group and control group （P〉0. 05）. The serum samples were withdrawn for melatonin and cyclooxygenase-2 measurement. The above tests were performed by using the enzymelinked immunosorbent assay. Informed consent was obtained from all children＇ guardians, and the trial approved by the ethics committee of Second People＇ Hospital of Changzhou. Results Serum melatonin level was significantly lower and cyclooxygenase-2 level was significantly higher in asthma group than those of control group melatonin： （2.44±0.83） pg/mL vs. （4.48±1.11） pg/mL, P〈0. 001; cyclooxygenase-2： （57.26±7.92） IU/L vs. （46.87±19.41） IU/L, P〈0.001, respectively]. In asthma group, the serum melatonin level had no remarkable difference （P〉0.05）between sub-group A and sub-group B, while cyclooxygenase-2 level was significantly higher in sub-group A compared with sub-group B（ P〈 0.05 ）. A significant negative correlation was found between serum melatonin and cyelooxygenase-2 levels in asthma group （r = -0. 453, P〈 0. 001）. The serum level of cyclooxygenase-2 decreased with the using of glucocorticoid（P〈0.05）. Conclusion Melatonin and eyclooxygenase-2 maybe involve in the pathogenesis of asthma, especially the high expression of cyclooxygenase-2 may be one of the reasons that cause respiratory inflammation and airway hyper responsiveness in children with asthma.