Lönnkvist K, Hellman C, Lundahl J, Halldén G, Hedlin G
Astrid Lindgren Children's Hospital, Stockholm; and the Department of Laboratory Medicine, Division of Clinical Immunology, Karolinska Hospital, Stockholm.
J Allergy Clin Immunol. 2001 May;107(5):812-7. doi: 10.1067/mai.2001.114246.
Markers of airway inflammation are needed for prediction of asthma deterioration and evaluation of disease severity. Few studies have focused on the dynamics of airway inflammation as reflected by the activity of the eosinophils and their proteins after withdrawal of inhaled corticosteroids.
Our goal was to investigate the effect of withdrawal of inhaled budesonide on eosinophil count in blood and eosinophil proteins in serum and urine and to relate the levels of these markers to the risk of symptoms of asthma, increased bronchial hyperresponsiveness, and deterioration of lung function.
Thirty-three children were randomly selected to continue or discontinue use of inhaled budesonide in a double-blind, placebo-controlled study. They were followed up for 4 months with regular analysis of blood, serum, and urine samples; lung function; and methacholine challenges. Eosinophil activity markers were analyzed. Age-matched healthy children provided reference data for all parameters measured.
The eosinophil number in blood and eosinophil protein levels in serum (serum eosinophil cationic protein [ECP] and serum eosinophil peroxidase [EPO]) increased significantly in the withdrawal group, and the difference between the groups was significant (P =.02 for all). Twenty-nine percent of the children in the withdrawal group remained symptom free. This subgroup had eosinophil counts at baseline below 350/microL, a serum ECP level below 15 microg/L, and a serum EPO level below 25 microg/L, each of which was related to a low risk of exacerbation (relative risk = 0.37, 0.48, and 0.37 respectively; P <.05 for all). All eosinophil markers were lower in the healthy children than in the symptom-free children with asthma.
Our data indicate that eosinophil count and/or ECP and EPO levels can be used to estimate the short-term risk of deterioration and the need for corticosteroid treatment in cases of mild and moderate allergic asthma.
气道炎症标志物对于预测哮喘恶化及评估疾病严重程度至关重要。很少有研究关注吸入性糖皮质激素撤药后嗜酸性粒细胞及其蛋白活性所反映的气道炎症动态变化。
我们的目标是研究撤用吸入性布地奈德对血液中嗜酸性粒细胞计数以及血清和尿液中嗜酸性粒细胞蛋白的影响，并将这些标志物水平与哮喘症状风险、支气管高反应性增加及肺功能恶化相关联。
在一项双盲、安慰剂对照研究中，随机选取33名儿童继续或停用吸入性布地奈德。对他们进行4个月的随访，定期分析血液、血清和尿液样本、肺功能及乙酰甲胆碱激发试验。分析嗜酸性粒细胞活性标志物。年龄匹配的健康儿童为所有测量参数提供参考数据。
撤药组血液中的嗜酸性粒细胞数量以及血清中的嗜酸性粒细胞蛋白水平（血清嗜酸性粒细胞阳离子蛋白[ECP]和血清嗜酸性粒细胞过氧化物酶[EPO]）显著增加，两组间差异有统计学意义（所有P = 0.02）。撤药组29%的儿童无症状。该亚组基线时嗜酸性粒细胞计数低于350/μL，血清ECP水平低于15μg/L，血清EPO水平低于25μg/L，每一项均与低加重风险相关（相对风险分别为0.37、0.48和0.37；所有P < 0.05）。健康儿童的所有嗜酸性粒细胞标志物均低于无症状哮喘儿童。
我们的数据表明，嗜酸性粒细胞计数和/或ECP及EPO水平可用于评估轻度和中度过敏性哮喘恶化的短期风险以及糖皮质激素治疗的必要性。
