Sahid El-Radhi A, Hogg C L, Bungre J K, Bush A, Corrigan C J
Department of Paediatrics, Queen Mary's Hospital, Sidcup, Kent DA14 6LT, UK.
Arch Dis Child. 2000 Aug;83(2):158-62. doi: 10.1136/adc.83.2.158.
Acute asthma is associated with elevated serum concentrations of products of activated T cells and eosinophils.
To compare the changes in concentrations of these products with disease severity and changes in lung function following oral prednisolone treatment.
Twenty patients (mean age 8.7 years) were recruited on admission with acute asthma to a district general hospital. Disease severity was recorded before and after treatment with oral prednisolone using a validated pulmonary index score. Serum concentrations of interleukin (IL)-4, IL-5, soluble (s)CD25 (soluble IL-2 receptor), using a specific enzyme linked immunosorbent assay, and eosinophil cationic protein (ECP), using radioimmunoassay, were measured concomitantly. Non-asthmatic children (n = 6, mean age 9.2 years) undergoing elective surgery were recruited as controls, and serum samples were obtained on one occasion without treatment. Main outcome measures were changes in serum concentrations of cytokines and ECP, clinical asthma severity score, and peak expiratory flow rate.
As expected, oral glucocorticoid treatment in the children with asthma was associated with clinical improvement and also with significant reductions in serum concentrations of IL-5 (mean 5.59 to 2.19 pg/ml, p = 0.0001), sCD25 (mean 2236 to 1772 pg/ml, p = 0.002), and ECP (mean 54.3 to 33. 1 pg/ml, p = 0.0001). Serum IL-4 concentrations, in most patients and all the controls, remained below the sensitivity of the assay. However, serum concentrations of IL-5, sCD25, and ECP remained significantly higher than in controls, even after treatment with oral glucocorticoids (p = 0.03).
These data suggest that T cell mediated inflammation may persist in childhood asthma despite apparent clinical remission associated with conventional doses of prednisolone. The long term consequences of persistent inflammation after an apparently treated acute attack of asthma require clarification. Clinical assessment and pulmonary function are inadequate surrogates for airway inflammation.
急性哮喘与活化T细胞和嗜酸性粒细胞产物的血清浓度升高有关。
比较口服泼尼松龙治疗后这些产物浓度的变化与疾病严重程度及肺功能变化。
20例急性哮喘患儿（平均年龄8.7岁）入住一家区级综合医院。使用经过验证的肺指数评分记录口服泼尼松龙治疗前后的疾病严重程度。同时，采用特异性酶联免疫吸附测定法测定血清白细胞介素（IL）-4、IL-5、可溶性（s）CD25（可溶性IL-2受体）浓度，采用放射免疫测定法测定嗜酸性粒细胞阳离子蛋白（ECP）浓度。选取6例接受择期手术的非哮喘儿童（平均年龄9.2岁）作为对照，在未治疗的情况下一次性采集血清样本。主要观察指标为细胞因子和ECP血清浓度变化、临床哮喘严重程度评分及呼气峰值流速。
正如预期，哮喘患儿口服糖皮质激素治疗后临床症状改善，血清IL-5（平均从5.59降至2.19 pg/ml，p = 0.0001）、sCD25（平均从2236降至1772 pg/ml，p = 0.002）和ECP（平均从54.3降至33.1 pg/ml，p = 0.0001）浓度也显著降低。大多数患者及所有对照的血清IL-4浓度均低于检测灵敏度。然而，即使在口服糖皮质激素治疗后，血清IL-5、sCD25和ECP浓度仍显著高于对照组（p = 0.03）。
这些数据表明，尽管常规剂量泼尼松龙治疗后临床症状明显缓解，但儿童哮喘中T细胞介导的炎症可能持续存在。哮喘急性发作经治疗后炎症持续存在的长期后果有待阐明。临床评估和肺功能不足以替代气道炎症的评估。
