血清25(OH)D、总IgE和LTD4对儿童哮喘早期诊断的意义
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摘要
目的探讨血清25羟维生素D[25(OH)D]、总免疫球蛋白E(IgE)、白三烯D4(LTD4)对早期诊断儿童哮喘的临床意义。方法选取2018年2至8月在绍兴市柯桥区妇幼保健院就诊的哮喘患儿90例,根据哮喘患儿的分期标准分为急性发作期组46例和哮喘缓解期组44例,另选取同期体检健康儿童40例作为对照组。采用放射免疫法检测各组患儿血清25(OH)D与血清总IgE水平,采用酶联免疫吸附法(ELISA)测定LTD4水平,分析三种指标在儿童哮喘发病中的作用,并研究各指标的相关性。结果哮喘急性发病期组和缓解期组患儿的血清25(OH)D水平均低于对照组(F=121.266,P<0.05)。哮喘急性发作期组和缓解期组患儿的血清总IgE水平均高于对照组(F=142.904,P<0.05);哮喘急性发作期组患儿血清总IgE水平高于哮喘缓解期组(t=74.280,P<0.05)。哮喘急性发作期组和缓解期组患儿血清LTD4水平均高于对照组(F=75.742,P<0.05);哮喘急性发作期组患儿血清LTD4水平高于缓解期组(t=3.170,P<0.05)。哮喘急性发作期组患儿血清25(OH)D与总IgE水平呈负相关性(r=-0.568,P=0.024);缓解期组患儿血清25(OH)D与总IgE水平无相关性(r=0.254,P=0.093;哮喘急性发作期组和缓解期组患儿血清总IgE与LTD4呈正相关(r=0.632,P=0.012;r=0.402,P=0.029)。结论血清25(OH)D的缺乏是引起儿童哮喘发作的一个重要原因,血清总IgE水平与哮喘的严重程度呈正相关,血清LTD4可作为临床监测儿童哮喘的一项重要指标。
Objective To explore the clinical significance of serum 25-hydroxyvitamin D [25(OH) D], total immunoglobulin E(IgE), leukotriene D4(LTD4) for early diagnosis of asthma in children. Methods Ninety asthmatic children who visited Shaoxing Keqiao District Maternal and Child Health Care Hospital from February to August 2018 were selected and divided into two groups according to staging of asthma, 46 cases in acute attack group and 44 cases in asthma remission group. Another 40 healthy children who had physical examination in the same period were selected as control group. Serum 25(OH) D and total IgE levels were detected by radioimmunoassay, and LTD4 level was determined by enzyme linked immunosorbent assay(ELISA). Role of the three indicators in pathogenesis of asthma was analyzed and correlation of each indicator was studied. Results Level of 25(OH) D in both acute attack group and asthma remission group was lower than that in control group(F=121.266, P<0.05). The serum IgE level in acute attack group and the asthma remission group was higher than that in control group(F=142.904,P<0.05). Serum IgE level in acute attack group was higher than that in asthma remission group(t=74.280, P<0.05). Serum LTD4 level was higher in acute attack group and asthma remission group than in control group(F=75.742,P<0.05). Serum LTD4 level in acute attack group was higher than that in asthma remission group(t=3.170, P<0.05). There was negative correlation between serum 25(OH) D and serum total IgE level in acute attack group(r=-0.568,P=0.024), but there was no correlation between serum 25(OH) D and serum total IgE level in asthma remission group(r=0.254,P=0.093). Serum total IgE and serum LTD4 were positively correlated(r=0.632,P=0.012;r=0.402,P=0.029) in acute attack group and asthma remission group. Conclusion Lack of serum 25(OH) D is an important cause of asthma attacks in children. Serum total IgE levels are positively correlated with severity of asthma. Serum LTD4 can be used as a clinical monitoring indicator for asthma in children.
Objective To explore the clinical significance of serum 25-hydroxyvitamin D [25(OH) D], total immunoglobulin E(IgE), leukotriene D4(LTD4) for early diagnosis of asthma in children. Methods Ninety asthmatic children who visited Shaoxing Keqiao District Maternal and Child Health Care Hospital from February to August 2018 were selected and divided into two groups according to staging of asthma, 46 cases in acute attack group and 44 cases in asthma remission group. Another 40 healthy children who had physical examination in the same period were selected as control group. Serum 25(OH) D and total IgE levels were detected by radioimmunoassay, and LTD4 level was determined by enzyme linked immunosorbent assay(ELISA). Role of the three indicators in pathogenesis of asthma was analyzed and correlation of each indicator was studied. Results Level of 25(OH) D in both acute attack group and asthma remission group was lower than that in control group(F=121.266, P<0.05). The serum IgE level in acute attack group and the asthma remission group was higher than that in control group(F=142.904,P<0.05). Serum IgE level in acute attack group was higher than that in asthma remission group(t=74.280, P<0.05). Serum LTD4 level was higher in acute attack group and asthma remission group than in control group(F=75.742,P<0.05). Serum LTD4 level in acute attack group was higher than that in asthma remission group(t=3.170, P<0.05). There was negative correlation between serum 25(OH) D and serum total IgE level in acute attack group(r=-0.568,P=0.024), but there was no correlation between serum 25(OH) D and serum total IgE level in asthma remission group(r=0.254,P=0.093). Serum total IgE and serum LTD4 were positively correlated(r=0.632,P=0.012;r=0.402,P=0.029) in acute attack group and asthma remission group. Conclusion Lack of serum 25(OH) D is an important cause of asthma attacks in children. Serum total IgE levels are positively correlated with severity of asthma. Serum LTD4 can be used as a clinical monitoring indicator for asthma in children.
引文
[1]孙立平,王助衡,底建辉,等.婴儿支气管哮喘的危险因素分析[J].中国妇幼健康研究,2018,29(6):792-795.
[2]Lajqi N,Ilazi A,Kastrati B,et al.Comparison of glucocorticoid (budesonide) and antileukotriene (montelukast) effect in patients with bronchial asthma determined with body plethysmography[J].Acta Inform Med,2015,23(6):347-351.
[3]Ismail A M,Aly S S,Fayed H M,et al.Serum 25-hydroxyvitamin D and CD4+CD25(+high) foxP3+ regulatory T cell as predictors of severity of bronchial asthma in children[J].Egypt J Immunol,2015,22(1):9-18.
[4]Ho V,Danieli C,Abrahamowicz M,et al.Predicting serum vitamin D concentrations based on self-reported lifestyle factors and personal attributes[J].Br J Nutr,2018,120(7):803-812.
[5]中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.儿童支气管哮喘诊断与防治指南(2016年版)[J].中华儿科杂志,2016,54(3):167-181.
[6]全国儿科哮喘协作组.第三次中国城市儿童哮喘流行病学调查[J].中华儿科杂志,2013,51(10):729-735.
[7]Han Y Y,Rosser F,Forno E,et al.Exposure to polycyclic aromatic hydrocarbons,vitamin D,and lung function in children with asthma[J].Pediatr Pulmonol,2018,53(10):1362-1368.
[8]Frieri M.Asthma linked with rhinosinusitis:an extensive review[J].Allergy Rhinol (Providence),2014,5(1):41-49.
[9]喻志东,王红宇.髓系抑制细胞、Th17细胞在哮喘患儿外周血中的表达[J].中国妇幼健康研究,2017,28(2):124-125.
[10]Giri M,Upreti B,Joshi R,et al.Efficacy of high dose vitamin D supplementation in improving serum 25-hydroxyvitamin D among laboratory personnel working at the Nepal National Center for Rheumatic Diseases[J].Biomed Rep,2017,7(6):543-546.
[11]Rath N,Raje N,Rosenwasser L.Immunoglobulin E as a biomarker in asthma[J].Immunol Allergy Clin North Am,2018,38(4):587-597.
[12]Ladjemi M Z,Gras D,Dupasquier S,et al.Bronchial epithelial IgA secretion is impaired in asthma.Role of IL-4/IL-13[J].Am J Respir Crit Care Med,2018,197(11):1396-1409.
[13]王建荣,冯瑞华,多力坤·木扎帕尔.白细胞介素-4受体基因多态性及IgE水平与哮喘预测指数相关性研究[J].中国当代儿科杂志,2015,17(12):1306-1310.
[14]贾凯,杨玉琮.小儿喘息型支气管炎血清25-(OH)D3和IgE水平的检测及临床意义[J].中国保健营养,2018,28(21):11-12.
[15]郭晓军,卢敏君,魏丽华.小儿喘息型支气管炎血清25-(OH)D3和IgE水平的检测及临床意义[J].中国医药科学,2015,5(14):48-50.
[16]Kaaviyaa A T,Krishna V,Arunprasath T S,et al.Vitamin D Deficiency as a Factor Influencing Asthma Control in Children[J].Indian Pediatr,2018,55(11):969-971.
[17]关伟杰,高怡,蒋才玉,等.呼出气一氧化氮浓度测定与白三烯D4支气管激发试验对支气管哮喘的诊断和评估价值[J].中国呼吸与危重监护杂志,2012,11(4):342-348.
[2]Lajqi N,Ilazi A,Kastrati B,et al.Comparison of glucocorticoid (budesonide) and antileukotriene (montelukast) effect in patients with bronchial asthma determined with body plethysmography[J].Acta Inform Med,2015,23(6):347-351.
[3]Ismail A M,Aly S S,Fayed H M,et al.Serum 25-hydroxyvitamin D and CD4+CD25(+high) foxP3+ regulatory T cell as predictors of severity of bronchial asthma in children[J].Egypt J Immunol,2015,22(1):9-18.
[4]Ho V,Danieli C,Abrahamowicz M,et al.Predicting serum vitamin D concentrations based on self-reported lifestyle factors and personal attributes[J].Br J Nutr,2018,120(7):803-812.
[5]中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.儿童支气管哮喘诊断与防治指南(2016年版)[J].中华儿科杂志,2016,54(3):167-181.
[6]全国儿科哮喘协作组.第三次中国城市儿童哮喘流行病学调查[J].中华儿科杂志,2013,51(10):729-735.
[7]Han Y Y,Rosser F,Forno E,et al.Exposure to polycyclic aromatic hydrocarbons,vitamin D,and lung function in children with asthma[J].Pediatr Pulmonol,2018,53(10):1362-1368.
[8]Frieri M.Asthma linked with rhinosinusitis:an extensive review[J].Allergy Rhinol (Providence),2014,5(1):41-49.
[9]喻志东,王红宇.髓系抑制细胞、Th17细胞在哮喘患儿外周血中的表达[J].中国妇幼健康研究,2017,28(2):124-125.
[10]Giri M,Upreti B,Joshi R,et al.Efficacy of high dose vitamin D supplementation in improving serum 25-hydroxyvitamin D among laboratory personnel working at the Nepal National Center for Rheumatic Diseases[J].Biomed Rep,2017,7(6):543-546.
[11]Rath N,Raje N,Rosenwasser L.Immunoglobulin E as a biomarker in asthma[J].Immunol Allergy Clin North Am,2018,38(4):587-597.
[12]Ladjemi M Z,Gras D,Dupasquier S,et al.Bronchial epithelial IgA secretion is impaired in asthma.Role of IL-4/IL-13[J].Am J Respir Crit Care Med,2018,197(11):1396-1409.
[13]王建荣,冯瑞华,多力坤·木扎帕尔.白细胞介素-4受体基因多态性及IgE水平与哮喘预测指数相关性研究[J].中国当代儿科杂志,2015,17(12):1306-1310.
[14]贾凯,杨玉琮.小儿喘息型支气管炎血清25-(OH)D3和IgE水平的检测及临床意义[J].中国保健营养,2018,28(21):11-12.
[15]郭晓军,卢敏君,魏丽华.小儿喘息型支气管炎血清25-(OH)D3和IgE水平的检测及临床意义[J].中国医药科学,2015,5(14):48-50.
[16]Kaaviyaa A T,Krishna V,Arunprasath T S,et al.Vitamin D Deficiency as a Factor Influencing Asthma Control in Children[J].Indian Pediatr,2018,55(11):969-971.
[17]关伟杰,高怡,蒋才玉,等.呼出气一氧化氮浓度测定与白三烯D4支气管激发试验对支气管哮喘的诊断和评估价值[J].中国呼吸与危重监护杂志,2012,11(4):342-348.
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