支气管哮喘患儿血清骨膜蛋白水平变化及其意义

目的：探讨支气管哮喘患儿血清中骨膜蛋白水平的变化，阐明其在哮喘中的作用。方法：随机选取支气管哮喘患儿65例作为观察组，健康儿童50人作为对照组，采用酶联免疫吸附测定（ELISA）法检测受试者外周血中骨膜蛋白、IgE和嗜酸细胞阳离子蛋白（ECP）水平及嗜酸性粒细胞计数，并检测呼出气一氧化氮（FeNO）、一秒用力呼气容积占预计值百分比（FEV₁% pred）、用力肺活量（FVC）和FEV₁/FVC比值。结果：与对照组比较，观察组患儿外周血中骨膜蛋白、IgE和ECP水平、嗜酸性粒细胞计数和FeNO均明显升高（P<0.05），FEV₁% pred和FEV₁/FVC比值均明显降低（P<0.05）；采用血清骨膜蛋白水平诊断哮喘，受试者工作特征曲线（ROC曲线）下面积（AUC）为0.668（P=0.02），骨膜蛋白水平诊断哮喘界点为80.89 μg·L^-1（95% CI：0.570~0.766），灵敏度为29.23%，特异度为92.00%；骨膜蛋白水平与嗜酸性粒细胞计数和FeNO呈正相关关系（r=0.519，P=0.019；r=0.602，P=0.008）。结论：哮喘患儿血清中骨膜蛋白水平升高，骨膜蛋白可以作为初步排查儿童哮喘的指标，抑制Th2介导的炎性反应过程是治疗哮喘的靶点。

Change of serum periostin level in children with bronchial asthma and significance

Objective: To explore the change of serum periostin level in peripheral blood of the children with bronchial asthma,and to clarify its role in asthma.Methods: Sixty-five children with bronchial asthma were randomly chosen as observation group,and 50 healthy children were also randomly chosen as control group.The levels of periostin,IgE,eosinophil cationic protein(ECP) and the number of eosinophils in peripheral blood of all subjects were detected by enzyme-linked immunosorbent assay (ELISA). The fractional exhaled nitric oxide (FeNO) levels and pulmonary function test indexes including forced expiratory volume in one second/predicted value ratio (FEV₁% pred),forced vital capacity (FVC) and FEV₁/FVC ratio were also detected.Results: Compared with control group,the serum periostin,IgE,and ECP levels,the number of eosinophils and FeNO in observation group were significantly increased (P<0.05),while the FEV₁%pred and FEV₁/FVC ratio were significantly decreased (P<0.05).The area under ROC curve (AUC) was 0.668 (P=0.02) and the threshold for periostin to identify asthma was 80.89 μg·L^-1 (95% CI:0.570-0.766) with the sensitivity of 29.23% and specificity of 92.00%. Periostin was positively correlated with the eosinophil count as well as FeNO (r=0.519, P=0.019;r=0.602,P=0.008).Conclusion: The periostin level in peripheral blood of the children with asthma is significantly increased and it can be used as a preliminary indicator to rule out asthma in the children.Inhibiting Th2-mediated inflammatory response is one target for the treatment of asthma.