血清免疫球蛋白水平作为儿童非过敏性哮喘预后较好的一个预测指标
2010/12/29
摘要
儿童哮喘是一种异质性疾病，存在不同的表型。本文旨在研究血清免疫球蛋白水平对哮喘临床表型和预后的影响。78名年龄小于10岁的、诊断为轻度至中度持续性哮喘的、随访时间超过1年的儿童（男性26名，女性52名）（平均年龄8.56 ± 3.23岁）入选本研究。基于入院时的血清免疫球蛋白水平，将哮喘患儿分为2组，对人口统计学数据、变应性致敏、症状评分、药物使用情况、肺功能和非特异性支气管高反应性进行评价。与正常丙球蛋白水平儿童(n = 50)相比，低丙球蛋白血症患儿其发病年龄较早(40.88±32.02 vs. 23.04±26.97月) (p = 0.016)。平均随访时间为3.8 ± 2.1年。变应性致敏率在免疫球蛋白水平正常的患儿中较高（81.2% vs. 17.9%；p < 0.0001）。血清免疫球蛋白水平正常与过敏性哮喘相关(OR, 4.5; 95%CI: 2.0-10.1)。对于过敏性哮喘的预测，正常免疫球蛋白水平的预测价值分别为：敏感性为88.6%；特异性为71.8%；阳性预测值为81.1%；阴性预测值为82.1%。此外，过敏性皮炎和过敏性结膜炎的比率、血清总IgE水平增加、嗜酸性粒细胞增多、支气管高反应性在丙球蛋白水平正常患儿中更为常见（分别为p = 0.040, p = 0.003, p = 0.024, p = 0.030, p = 0.040,）。虽然两组患者在哮喘评分和皮质类固醇激素吸入方面均存在下降，低丙球蛋白血症患儿其下降的速度更快，而且下降的时间较早(分别为p = 0.0001, p = 0.004)。总之，与正常丙球蛋白水平的哮喘患儿相比，低丙球蛋白血症哮喘患儿发病年龄早，过敏症发生比率较低，临床症状改善出现较早，而且糖皮质激素吸入治疗停药时间也更早。
我们的结果显示，对于早期发作的非过敏性哮喘患儿，可能伴有低丙球蛋白血症，这也为儿童哮喘不同表现型提供了证据。
（刘国梁 审校）
Pediatr Allergy Immunol. 2010 Oct 20. doi:10.1111/j.1399-3038.2010.01105.x. [Epub ahead of print]
Serum immunoglobulin levels as a predictive factor for a better outcome of non-atopic childhood asthma.
Baris S, Karakoc-Aydiner E, Ozen A, Ozdemir C, Bahceciler NN, Barlan IB.
Division of Pediatric Allergy and Immunology, Marmara University, Istanbul, Turkey.
Abstract
Childhood asthma is a heterogeneous condition with different phenotypes. Hereby, we aimed to study impact of serum immunoglobulin levels on clinical phenotypes and outcome of asthma. Seventy-eight children (M: 26, F: 52) aged less than 10 yrs (mean = 8.56 ± 3.23 yrs) and diagnosed as mild-moderate persistent asthma, followed up for at least 1 yr were included into the study. Asthmatic children were divided into two groups based on serum immunoglobulin levels at admission and were evaluated with respect to demographic data, allergic sensitization, symptom scores, medication usage, pulmonary functions, and non-specific bronchial hyper-reactivity. The age at onset of symptoms (40.88 ± 32.02 vs. 23.04 ± 26.97 months) was significantly younger in children with hypogammaglobulinemia (n = 28) compared to normogammaglobulinemia group (n = 50) (p = 0.016). Mean follow-up duration was 3.8 ± 2.1 yrs. Atopic sensitization rate was higher in those with normal immunoglobulin levels (81.2% vs. 17.9%), (p < 0.0001). Normal serum immunoglobulin levels were associated with atopic asthma (OR, 4.5; 95% confidence interval (CI): 2.0-10.1). For the prediction of atopic asthma, having normal immunoglobulin levels yielded predictive values of: sensitivity = 88.6%, specificity = 71.8%, positive predictive value = 81.1%, negative predictive value = 82.1%. Furthermore, percentages of atopic dermatitis and allergic conjunctivitis, elevated serum total IgE levels, eosinophilia, and bronchial hyper-reactivity were more common in normogammaglobulinemia with asthma group (p = 0.040, p = 0.003, p = 0.024, p = 0.030, p = 0.040, respectively). Although marked reductions in asthma scores and inhaled corticosteroid usage were observed in both groups over time, the rate of decline was significantly higher and earlier in hypogammaglobulinemia group (p = 0.0001, p = 0.004, respectively). In conclusion, asthmatic children with hypogammaglobulinemia presented at an earlier age, with lower rates of atopy, and earlier clinical improvement accompanied with earlier discontinuation of inhaled corticosteroids than children with normal immunoglobulin levels. Our data demonstrated that in children currently named as early-onset non-atopic asthma, hypogammaglobulinemia might be accompanying, providing evidence for a different phenotype of childhood asthma.
Pediatr Allergy Immunol. 2010 Oct 20. doi:
10.1111/j.1399-3038.2010.01105.x. [Epub ahead of print]
儿童哮喘是一种异质性疾病，存在不同的表型。本文旨在研究血清免疫球蛋白水平对哮喘临床表型和预后的影响。78名年龄小于10岁的、诊断为轻度至中度持续性哮喘的、随访时间超过1年的儿童（男性26名，女性52名）（平均年龄8.56 ± 3.23岁）入选本研究。基于入院时的血清免疫球蛋白水平，将哮喘患儿分为2组，对人口统计学数据、变应性致敏、症状评分、药物使用情况、肺功能和非特异性支气管高反应性进行评价。与正常丙球蛋白水平儿童(n = 50)相比，低丙球蛋白血症患儿其发病年龄较早(40.88±32.02 vs. 23.04±26.97月) (p = 0.016)。平均随访时间为3.8 ± 2.1年。变应性致敏率在免疫球蛋白水平正常的患儿中较高（81.2% vs. 17.9%；p < 0.0001）。血清免疫球蛋白水平正常与过敏性哮喘相关(OR, 4.5; 95%CI: 2.0-10.1)。对于过敏性哮喘的预测，正常免疫球蛋白水平的预测价值分别为：敏感性为88.6%；特异性为71.8%；阳性预测值为81.1%；阴性预测值为82.1%。此外，过敏性皮炎和过敏性结膜炎的比率、血清总IgE水平增加、嗜酸性粒细胞增多、支气管高反应性在丙球蛋白水平正常患儿中更为常见（分别为p = 0.040, p = 0.003, p = 0.024, p = 0.030, p = 0.040,）。虽然两组患者在哮喘评分和皮质类固醇激素吸入方面均存在下降，低丙球蛋白血症患儿其下降的速度更快，而且下降的时间较早(分别为p = 0.0001, p = 0.004)。总之，与正常丙球蛋白水平的哮喘患儿相比，低丙球蛋白血症哮喘患儿发病年龄早，过敏症发生比率较低，临床症状改善出现较早，而且糖皮质激素吸入治疗停药时间也更早。
我们的结果显示，对于早期发作的非过敏性哮喘患儿，可能伴有低丙球蛋白血症，这也为儿童哮喘不同表现型提供了证据。
（刘国梁 审校）
Pediatr Allergy Immunol. 2010 Oct 20. doi:10.1111/j.1399-3038.2010.01105.x. [Epub ahead of print]
Serum immunoglobulin levels as a predictive factor for a better outcome of non-atopic childhood asthma.
Baris S, Karakoc-Aydiner E, Ozen A, Ozdemir C, Bahceciler NN, Barlan IB.
Division of Pediatric Allergy and Immunology, Marmara University, Istanbul, Turkey.
Abstract
Childhood asthma is a heterogeneous condition with different phenotypes. Hereby, we aimed to study impact of serum immunoglobulin levels on clinical phenotypes and outcome of asthma. Seventy-eight children (M: 26, F: 52) aged less than 10 yrs (mean = 8.56 ± 3.23 yrs) and diagnosed as mild-moderate persistent asthma, followed up for at least 1 yr were included into the study. Asthmatic children were divided into two groups based on serum immunoglobulin levels at admission and were evaluated with respect to demographic data, allergic sensitization, symptom scores, medication usage, pulmonary functions, and non-specific bronchial hyper-reactivity. The age at onset of symptoms (40.88 ± 32.02 vs. 23.04 ± 26.97 months) was significantly younger in children with hypogammaglobulinemia (n = 28) compared to normogammaglobulinemia group (n = 50) (p = 0.016). Mean follow-up duration was 3.8 ± 2.1 yrs. Atopic sensitization rate was higher in those with normal immunoglobulin levels (81.2% vs. 17.9%), (p < 0.0001). Normal serum immunoglobulin levels were associated with atopic asthma (OR, 4.5; 95% confidence interval (CI): 2.0-10.1). For the prediction of atopic asthma, having normal immunoglobulin levels yielded predictive values of: sensitivity = 88.6%, specificity = 71.8%, positive predictive value = 81.1%, negative predictive value = 82.1%. Furthermore, percentages of atopic dermatitis and allergic conjunctivitis, elevated serum total IgE levels, eosinophilia, and bronchial hyper-reactivity were more common in normogammaglobulinemia with asthma group (p = 0.040, p = 0.003, p = 0.024, p = 0.030, p = 0.040, respectively). Although marked reductions in asthma scores and inhaled corticosteroid usage were observed in both groups over time, the rate of decline was significantly higher and earlier in hypogammaglobulinemia group (p = 0.0001, p = 0.004, respectively). In conclusion, asthmatic children with hypogammaglobulinemia presented at an earlier age, with lower rates of atopy, and earlier clinical improvement accompanied with earlier discontinuation of inhaled corticosteroids than children with normal immunoglobulin levels. Our data demonstrated that in children currently named as early-onset non-atopic asthma, hypogammaglobulinemia might be accompanying, providing evidence for a different phenotype of childhood asthma.
Pediatr Allergy Immunol. 2010 Oct 20. doi:
10.1111/j.1399-3038.2010.01105.x. [Epub ahead of print]
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