哮喘联盟

   摘要
   既往研究显示变应性疾病可能是由各种环境因素导致的上皮功能失常，但是支持这个观点的流行病学证据仍然不足。在本项纳入了835例在校青少年（其中365个男孩；平均年龄15.5岁）的横断面研究中，我们测定了血清中的Club细胞蛋白(CC16)、表面活性物质相关蛋白D(SP-D)、总IgE和吸入性过敏原特异性IgE的浓度。我们把血清CC16/SP-D浓度比值作为反映气道上皮渗透性(SP-D)和分泌功能(CC16)整体变化的一项指标。无论男女，早期在经氯消毒的游泳池中游泳均为血清中低CC16及CC16/SP-D比值的最一致和最有力的预测指标。在女孩中，低CC16/SP-D比值与宠物过敏发生率增加（最低三分位数vs最高三分位数）（优势比 2.97, 95% CI 1.19-8.22）和花粉过敏体质人群的枯草热发生率增加（优势比4.12, 95% CI 1.28-14.4）相关。在男孩中，低CC16/SP-D比值与尘螨(HDM)致敏发生率增加（优势比2.01, 95% CI 1.11-3.73）、尘螨过敏体质人群的过敏性鼻炎发生率增加（优势比3.52，95% CI 1.22-11.1）、吸入性过敏原过敏体质人群的哮喘发生率增加（优势比3.38，95% CI 1.17-11.0）、尘螨过敏体质人群的哮喘发生率增加（优势比5.20，95% CI 1.40-24.2）和花粉过敏体质人群的哮喘发生率增加（优势比5.82，95% CI 1.51-27.4）相关。变应性致敏或鼻炎发生率的增加也与血清中增加的SP-D或者减少的CC16相关。 我们的研究支持这一假设：过敏性疾病的病程发展与由宿主因素或环境因素如早期在经氯消毒游泳池中游泳导致的上皮屏障缺陷相关。
 

（苏欣 审校）
Environ Res. 2015 Apr 3;140:119-126. doi: 10.1016/j.envres.2015.03.034. [Epub ahead of print]

 

Chlorinated pool attendance, airway epithelium defects and the risks of allergic diseases in adolescents: Interrelationships revealed by circulating biomarkers.
 

Bernard A1, Nickmilder M2, Dumont X2.
 

Abstract
It has been suggested that allergic diseases might be epithelial disorders driven by various environmental stressors but the epidemiological evidence supporting this concept is limited. In a cross-sectional study of 835 school adolescents (365 boys; mean age, 15.5yr), we measured the serum concentrations of Club cell protein (CC16), surfactant-associated protein D (SP-D) and of total and aeroallergen-specific IgE. We used the serum CC16/SP-D concentration ratio as an index integrating changes in the permeability (SP-D) and secretory function (CC16) of the airway epithelium. In both sexes, early swimming in chlorinated pools emerged as the most consistent and strongest predictor of low CC16 and CC16/SP-D ratio in serum. Among girls, a low CC16/SP-D ratio was associated with increased odds (lowest vs. highest tertile) for pet sensitization (OR 2.97, 95% CI 1.19-8.22) and for hay fever in subjects sensitized to pollen (OR 4.12, 95% CI 1.28-14.4). Among boys, a low CC16/SP-D ratio was associated with increased odds for house-dust mite (HDM) sensitization (OR 2.01, 95% CI 1.11-3.73), for allergic rhinitis in subjects sensitized to HDM (OR 3.52, 95% CI 1.22-11.1) and for asthma in subjects sensitized to any aeroallergen (OR 3.38, 95% CI 1.17-11.0), HDM (OR 5.20, 95% CI 1.40-24.2) or pollen (OR 5.82, 95% CI 1.51-27.4). Odds for allergic sensitization or rhinitis also increased with increasing SP-D or decreasing CC16 in serum. Our findings support the hypothesis linking the development of allergic diseases to epithelial barrier defects due to host factors or environmental stressors such as early swimming in chlorinated pools.
 

Environ Res. 2015 Apr 3;140:119-126. doi: 10.1016/j.envres.2015.03.034. [Epub ahead of print]