3岁时的尿嗜酸性粒细胞蛋白X、特应性及提示过敏性疾病的症状。

Urinary eosinophilic protein X, atopy, and symptoms suggestive of allergic disease at 3 years of age.

作者信息

Gore Claudia, Peterson Christer G B, Kissen Patricia, Simpson Bridget M, Lowe Lesley A, Woodcock Ashley, Custovic Adnan

机构信息

North West Lung Centre, Wythenshawe Hospital, Manchester, United Kingdom.

出版信息

J Allergy Clin Immunol. 2003 Oct;112(4):702-8. doi: 10.1016/s0091-6749(03)01886-4.

DOI:10.1016/s0091-6749(03)01886-4

PMID:14564347

Abstract

BACKGROUND

Urinary eosinophilic protein X (U-EPX) measurement is easy to perform in children. However, its use for prediction, diagnosis, and monitoring of asthma and atopy is unclear.

OBJECTIVE

We sought to investigate the relationship between U-EPX and clinical phenotypes suggestive of allergic diseases.

METHODS

U-EPX measurement (RIA), respiratory questionnaires, and skin testing were completed at age 3 years in 903 children followed prospectively from birth. Specific airway resistance was measured in 503 currently asymptomatic children by using whole-body plethysmography during tidal breathing.

RESULTS

Nonatopic children with wheezing or eczema had slightly increased U-EPX levels compared with nonatopic asymptomatic children. U-EPX levels (geometric mean EPX/creatinine ratio) were as follows: nonatopic asymptomatic children (n = 313), 61.3 microg/mmol (95% CI, 56.4-66.6 microg/mmol); nonatopic children with wheezing (n = 148), 71.2 microg/mmol (95% CI, 63.2-80.1 microg/mmol); nonatopic children with eczema (n = 90), 65.7 microg/mmol (95% CI, 56.7-76.2 microg/mmol); and nonatopic children with wheezing and eczema (n= 86), 79.7 microg/mmol (95% CI, 67.4-94.3 microg/mmol). Children who had persistent atopy early in life had significantly higher U-EPX levels at age 3 years (nonatopic at 1 and 3 years [n = 263], 63.4 microg/mmol [95% CI, 58.4-69.0 microg/mmol]; atopic at 1 but not 3 years [n = 24], 65.1 microg/mmol [95% CI, 43.8-96.7 microg/mmol]; nonatopic at 1 year and atopic at 3 years [n = 62], 90.0 microg/mmol [95% CI, 74.6-108.4 microg/mmol]; atopic at 1 and 3 years [n = 35], 111.5 microg/mmol [95% CI, 89.2-139.3 microg/mmol]; P <.002). Atopy alone and with wheezing, eczema, or both was associated with significantly increased U-EPX levels (P <.0001). Wheezing appeared to be associated with higher U-EPX levels compared with eczema in both atopic and nonatopic children. The highest U-EPX level was found in atopic children with a history of wheezing and eczema (P <.0001). There was no relationship between U-EPX level and lung function.

CONCLUSION

U-EPX level reflects the presence of atopy and associated symptoms and might be useful for monitoring the progression of allergic disease.

摘要

背景

尿嗜酸性粒细胞蛋白X（U-EPX）检测在儿童中易于实施。然而，其在哮喘和特应性疾病的预测、诊断及监测中的应用尚不清楚。

目的

我们试图研究U-EPX与提示过敏性疾病的临床表型之间的关系。

方法

对903名从出生起就进行前瞻性随访的儿童在3岁时完成U-EPX检测（放射免疫分析法）、呼吸问卷及皮肤试验。对503名目前无症状的儿童在潮气呼吸时使用全身体积描记法测量比气道阻力。

结果

与非特应性无症状儿童相比，有喘息或湿疹的非特应性儿童的U-EPX水平略有升高。U-EPX水平（几何平均EPX/肌酐比值）如下：非特应性无症状儿童（n = 313），61.3微克/毫摩尔（95%可信区间，56.4 - 66.6微克/毫摩尔）；有喘息的非特应性儿童（n = 148），71.2微克/毫摩尔（95%可信区间，63.2 - 80.1微克/毫摩尔）；有湿疹的非特应性儿童（n = 90），65.7微克/毫摩尔（95%可信区间，56.7 - 76.2微克/毫摩尔）；有喘息和湿疹的非特应性儿童（n = 86），79.7微克/毫摩尔（95%可信区间，67.4 - 94.3微克/毫摩尔）。生命早期有持续性特应性的儿童在3岁时U-EPX水平显著更高（1岁和3岁时均为非特应性[n = 263]，63.4微克/毫摩尔[95%可信区间，58.4 - 69.0微克/毫摩尔]；1岁时为特应性但3岁时不是[n = 24]，65.1微克/毫摩尔[95%可信区间，43.8 - 96.7微克/毫摩尔]；1岁时为非特应性且3岁时为特应性[n = 62]，90.0微克/毫摩尔[95%可信区间，74.6 - 108.4微克/毫摩尔]；1岁和3岁时均为特应性[n = 35]，111.5微克/毫摩尔[95%可信区间，89.2 - 139.3微克/毫摩尔]；P <.002）。单独的特应性以及伴有喘息、湿疹或两者均有的情况与U-EPX水平显著升高相关（P <.0001）。在特应性和非特应性儿童中，喘息似乎比湿疹与更高的U-EPX水平相关。U-EPX水平最高的是有喘息和湿疹病史的特应性儿童（P <.0001）。U-EPX水平与肺功能之间无关联。