Rosias Philippe P R, Dompeling Edward, Dentener Mieke A, Pennings Herman J, Hendriks Han J E, Van Iersel Monique P A, Jöbsis Quirijn
Department of Pediatric Pulmonology, University Hospital Maastricht, The Netherlands.
Pediatr Pulmonol. 2004 Aug;38(2):107-14. doi: 10.1002/ppul.20056.
Exhaled markers of airway inflammation become increasingly important in the management of childhood asthma. The aims of the present study are: 1) to compare exhaled markers of inflammation (nitric oxide, carbon monoxide, and acidity of breath condensate) with conventional asthma measures (lung function tests and asthma control score) in childhood asthma; and 2) to investigate the detectability of albumin, CRP, IL-6, IL-8, TNF-alpha, sICAM-1, and sTNF-R75 in the exhaled breath condensate (EBC) of asthmatic children. Thirty-two children with mild to moderate persistent asthma and healthy controls aged 6-12 years were studied. We measured exhaled NO and CO, and subsequently EBC was collected. Inflammatory mediators in EBC were measured using an enzyme-linked immunosorbent assay. Respiratory symptoms and asthma control were assessed using the asthma control questionnaire (ACQ) of Juniper et al. (Eur Respir J 1999;14:902-907). Exhaled NO showed a significant correlation with exhaled CO (r = 0.59, P < 0.05) and FEV1 (r = -0.59, P < 0.05), but not with ACQ score (r = 0.48, P = 0.06). Exhaled CO was correlated with prebronchodilator FEV1 (r = -0.45, P < 0.05), but not with asthma control (r = 0.18, P = 0.35). Acidity of EBC was significantly lower in asthmatic children than in healthy controls (P < 0.05), but did not correlate with any of the conventional asthma measures. We were not able to demonstrate the presence of CRP, IL-6, IL-8, TNF-alpha, sICAM-1, and sTNF-R75 in EBC. Albumin was found in two EBC samples of asthmatic children. We conclude that exhaled NO had a better correlation with lung function parameters and asthma control than exhaled CO and acidity of EBC, in mild to moderate persistent childhood asthma. However, exhaled NO, CO, and deaerated pH of EBC did not differ between asthmatic children and controls, possibly because of a too homogeneous and well-controlled study population. To further evaluate the clinical utility of exhaled markers in monitoring childhood asthma, more studies are required on a wider range of asthma severity, and preferably with repeated measurements of markers and of asthma control.
呼出气体中的气道炎症标志物在儿童哮喘管理中变得越来越重要。本研究的目的是：1）比较儿童哮喘中炎症呼出气体标志物（一氧化氮、一氧化碳和呼出气冷凝液酸度）与传统哮喘指标（肺功能测试和哮喘控制评分）；2）研究哮喘儿童呼出气冷凝液（EBC）中白蛋白、CRP、IL-6、IL-8、TNF-α、sICAM-1和sTNF-R75的可检测性。对32名6至12岁的轻度至中度持续性哮喘儿童和健康对照进行了研究。我们测量了呼出的NO和CO，随后收集了EBC。使用酶联免疫吸附测定法测量EBC中的炎症介质。使用Juniper等人的哮喘控制问卷（ACQ）（《欧洲呼吸杂志》1999年；14：902 - 907）评估呼吸道症状和哮喘控制情况。呼出的NO与呼出的CO（r = 0.59，P < 0.05）和FEV1（r = -0.59，P < 0.05）显著相关，但与ACQ评分无关（r = 0.48，P = 0.06）。呼出的CO与支气管扩张剂前FEV1相关（r = -0.45，P < 0.05），但与哮喘控制无关（r = 0.18，P = 0.35）。哮喘儿童EBC的酸度显著低于健康对照（P < 0.05），但与任何传统哮喘指标均无相关性。我们未能证明EBC中存在CRP、IL-6、IL-8、TNF-α、sICAM-1和sTNF-R75。在哮喘儿童的两份EBC样本中发现了白蛋白。我们得出结论，在轻度至中度持续性儿童哮喘中，呼出的NO与肺功能参数和哮喘控制的相关性比呼出的CO和EBC酸度更好。然而，哮喘儿童与对照之间呼出的NO、CO和EBC的脱气pH没有差异，可能是因为研究人群过于同质化且控制良好。为了进一步评估呼出气体标志物在监测儿童哮喘中的临床效用，需要对更广泛的哮喘严重程度进行更多研究，最好重复测量标志物和哮喘控制情况。
