Clara细胞分泌蛋白在喘息性疾病发病中的作用及其诊断价值

目的 探讨Clara细胞分泌蛋白(CCSP)在喘息性疾病发病中的作用及其诊断价值.方法 62例门诊或住院喘息性肺炎患儿中28例有哮喘高危因素;同期本院健康体检儿童22例作为健康对照组.采集2组空腹静脉血5 mL,分离血清;喘息性肺炎患儿同时留取痰液,离心后吸取上清液.采用双抗夹心ELISA法检测其血清和痰液CCSP水平.喘息性肺炎患儿治疗10～14 d临床症状、体征消失后抽血复查.随访12～18个月,23例诊断为支气管哮喘,在非急性发作期且未使用糖皮质激素时再次抽血复查,并与同期治愈的喘息性肺炎但无支气管哮喘的39例患儿进行比较.结果 1.有哮喘高危因素的喘息性肺炎患儿血清和痰液CCSP水平(5.71±2.45) μg·L-1,(148.24±34.58) μg·L-1]与无哮喘高危因素的喘息性肺炎患儿血清和痰液CCSP水平(6.02±3.34) μg·L-1,(155.77±44.03) μg·L-1]比较,差异均无统计学意义(Pa>0.05);但2组喘息性肺炎患儿血清CCSP水平均较健康对照组(12.3±3.73) μg·L-1]显著降低(Pa<0.001).2.非哮喘的喘息性肺炎患儿肺炎治愈后血清CCSP水平(11.03±2.86) μg·L-1]接近健康对照组(P>0.05);哮喘患儿肺炎治愈后血清CCSP水平(7.71±2.22) μg·L-1]较治疗前(5.48 ±1.39) μg·L-1]明显升高(P<0.001),但仍低于非哮喘的喘息性肺炎治愈组和健康对照组(Pa<0.001);随访12～18个月,在非急性发作期且未吸入糖皮质激素情况下,哮喘患儿血清CCSP水平(8.03±2.44) μg·L-1]无明显增高,与肺炎治愈的哮喘患儿血清CCSP水平比较差异无统计学意义(P>0.05).结论 CCSP在喘息性肺炎发病中起保护作用;CCSP持续低水平可作为预测哮喘及哮喘早期诊断的指标之一.

Effect of Clara Cell Secretory Protein in Wheezing Disease and Its Diagnostic Value

Objective To explore the effect of Clara cell secretory protein(CCSP) in wheezing diseases and its diagnostic value. Methods Sixty-two children with wheezing pneumonia and 22 healthy children who were visited in the People′s Hospital of Guangxi Zhuang Autonomous Region were enrolled.Among wheezing pneumonia children,28 children had risk factors of asthma.Venous blood samples were collected in wheezing pneumonia children and healthy children in the morning before breakfast,and then sera were obtained by centrifuge.At the same time,sputum samples were collected in wheezing pneumonia children,supernatant were obtained by centrifuge.The levels of CCSP were measured in sera and sputum by enzyme-linked immunosorbent assay. After treating 10-14 days,blood samples were collected in wheezing pneumonia children without clinical symptoms and signs.Followed up 12-18 months,there were 23 patients diagnosed as asthma.Blood samples were obtained to detect CCSP in non-acute episode of these 23 patients without inhaling glucocorticoid,and compared with 39 children with no asthma. Results 1.In wheezing pneumonia with risk factors of asthma group,the CCSP levels of sera and sputum(5.71±2.45) μg·L-1,(148.24±34.58) μg·L-1]were similar to those in non-risk factors of asthma group (6.02±3.34) μg·L-1,(155.77±44.03) μg·L-1](Pa>0.05),but the sera CCSP levels in both groups were significantly lower than that in healthy control group(12.30±3.73) μg·L-1](Pa<0.001).2.Followed up 12-18 months,there were 23 patients diagnosed as asthma.After recovering from pneumonia,the sera CCSP level had no significant difference between non-asthma children (11.03±2.86) μg·L-1] and healthy control group(P>0.05);although the sera CCSP levels of these 23 patients(7.71±2.22) μg·L-1] were significantly increased compared with themselves before treatment(5.48 ±1.39) μg·L-1](P<0.001),and they were still significantly lower than those in non-asthma children and healthy control group(Pa<0.001).The sera CCSP level of 23 patients without inhaling glucocorticoid had no significant difference compared with that in these patients after pneumonia cured(P>0.05). Conclusions CCSP may play a protective role in the inflammation of wheezing pneumonia.Persistent low level of CCSP may be used as an indicator of early diagnosis of asthma.