血清嗜酸粒细胞阳离子蛋白、IgE 和外周血嗜酸粒细胞与儿童支气管哮喘关系的研究

目的：探讨儿童支气管哮喘严重程度与血清嗜酸粒细胞阳离子蛋白（eosinophil cationic protein，ECP）、总IgE（Total IgE，TIgE）、嗜酸粒细胞（eosinophils，EOS）水平的关系；了解儿童支气管哮喘常见过敏原，为儿童支气管哮喘的预防、病情判断及治疗提供依据。方法据儿童哮喘严重程度分级标准将95例哮喘患儿分为间歇发作组（n＝23）、轻度组（n＝29）、中度组（n＝23）、重度组（n＝20）四个组，选取20例健康体检儿作为对照组。采用ImmunoCAP100E体外过敏原检测系统定量测定血清ECP、TIgE、过敏原特异性IgE（Specific IgE，SIgE）的水平，Sysmex XT-2000i血球分析仪进行EOS计数。结果95例患儿吸入性过敏原SIgE阳性率为71.58%，以户尘螨、粉尘螨、屋尘为主，分别占69.47%、68.42%、32.63%；食入性过敏原SIgE阳性率为22.11%，以虾、螃蟹为主，分别占21.05%、18.95%。血清ECP在哮喘各组与对照组；轻、中、重三组间均有显著性差异，P均＜0.05，最高值出现在重度组。血清TIgE在轻度组、间歇发作组、对照组三组之间差异均无统计学意义，P均＞0.05。EOS在哮喘各组与对照组间均有显著性差异， P均＜0.05；在重度与中度，中度与轻度，轻度与间歇发作组间差异均无统计学意义，P均＞0.05。血清ECP水平与TIgE、EOS水平呈正相关（r＝0.615，P＜0.01；r＝0.533，P＜0.01）；TIgE水平与EOS水平呈正相关（r＝0.239，P＜0.05）。结论血清ECP水平更能准确地反映气道炎症的程度，较TIgE和EOS更为敏感，可作为临床检测气道炎症的客观指标。户尘螨、粉尘螨和屋尘是导致3岁以上儿童支气管哮喘病情发作的主要过敏原。

A relative research between serum ECP,IgE, peripheral blood eosinophils and bronchial asthma in children

Objective To investigate relationship between serum ECP, Total IgE, specific IgE, eosinophils counts and the severity of bronchial asthma in children; To understand the allergens categories of children with bronchial asthma and provide scientific basis for its prevention, the condition judgment and therapy. Methods According to the children＆#39;s asthma severity classification standards, 95 asthma cases were divided into intermittent episodes of group （n=23）, mild group （n=29）, moderate group （n=23）, severe group （n=20）. 20 healthy children selected as a control group. The serum levels of ECP, TIgE and SIgE were quantitatively measured by ImmunoCAP 100E automated system （Phadia AB, Sweden）. EOS counts were detected by Sysmex XT-2000i Hematology Analyzer. Results In 95 cases of children, inhalant allergens sIgE positive rate was 71.58% which house dust mites, dust mites and house dust mainly accounted for 69.47%, 68.42% and 32.63%, respectively. Ingested allergens sIgE positive rate was 22.11% which shrimp and crab mainly accounted for 21.05% and 18.95% respectively. Serum ECP in between asthma each group and the control group, in mild, moderate and severe groups among the three groups were significantly different, P＆lt;0.05, the highest value appears in the severe group. Serum TIgE in mild group, intermittent episodes and control group among the three groups showed no significant difference, P＆gt;0.05. Peripheral blood eosinophils in between asthma each group and the control group were statistically significant differences P＆lt;0.05. between severe and moderate, moderate and mild, mild and intermittent group were not statistically significant, P＆gt;0.05. The serum ECP level was positive correlation with TIgE and EOS counts（r=0.615, P＆lt;0.01;r=0.533, P＆lt;0.01）. The serum TIgE level was positive correlation with EOS counts（r=0.239, P＆lt;0.05）. Conclusions Serum ECP levels reflect the degree of airway inflammation more accurately which are more sensitive than TIgE and EOS.ECP can be detected as a clinical objective indicator of airway inflammation. House dust mites, dust mites and house dust are major allergens causing asthmatic attack in children over 3 years.