Joseph-Bowen Jacqui, de Klerk Nicholas, Holt Patrick G, Sly Peter D
Telethon Institute for Child Health Research, University of Western Australia, Perth, Australia.
J Allergy Clin Immunol. 2004 Nov;114(5):1040-5. doi: 10.1016/j.jaci.2004.07.051.
The relationship between atopy, asthma, and eosinophilic inflammation is less clear in early childhood than later in life.
We sought to determine the relationships between asthma, atopy, and serum eosinophil cationic protein (ECP), a biomarker of eosinophil activation, in 6-year-old children.
Serum ECP levels were available from 968 six-year-old children who were part of a longitudinal birth cohort being assessed for asthma and atopy. Detailed clinical history and examination, lung function testing, methacholine challenge, and skin prick testing to 4 common allergens were undertaken. Subgroups of the children were compared by using t tests, ANOVA, chi 2 tests, and regression analysis.
One hundred ninety-one (19.7%) children had current asthma, with 114 (59.7%) of these being atopic. The mean serum ECP level for the entire group was 18.0 mug/L (range, 2.0-146.0 mug/L), with no difference between male and female patients. Serum ECP was higher in atopic children (20.5 +/- 18.4), those with asthma (22.4 +/- 19.6), and those with asthma and atopy (26.6 +/- 22.4; all P < .001 compared with children with no asthma or atopy [16.1 +/- 15.9]). Serum ECP levels were highest in children with severe asthma ( P < .001), especially in those with concurrent atopy. Severity of atopy, judged on the basis of wheal size or derived variables combining wheal size and the number of positive skin tests, was a major determinant of serum ECP. Heightened methacholine responsiveness was not associated with increased serum ECP levels.
The higher serum ECP levels seen in 6-year-old children with current asthma and more severe atopy suggest that atopy and eosinophilic inflammation are important in driving this clinical phenotype and that this might represent asthma that persists.
与生命后期相比，特应性、哮喘和嗜酸性粒细胞炎症之间的关系在儿童早期尚不明确。
我们试图确定6岁儿童中哮喘、特应性与血清嗜酸性粒细胞阳离子蛋白（ECP，一种嗜酸性粒细胞活化的生物标志物）之间的关系。
血清ECP水平来自968名6岁儿童，这些儿童是一个正在接受哮喘和特应性评估的纵向出生队列的一部分。进行了详细的临床病史和检查、肺功能测试、乙酰甲胆碱激发试验以及针对4种常见变应原的皮肤点刺试验。通过t检验、方差分析、卡方检验和回归分析对儿童亚组进行比较。
191名（19.7%）儿童患有现患哮喘，其中114名（59.7%）为特应性。整个队列的血清ECP平均水平为18.0μg/L（范围：2.0 - 146.0μg/L），男性和女性患者之间无差异。特应性儿童（20.5±18.4）、哮喘儿童（22.4±19.6）以及哮喘合并特应性儿童（26.6±22.4）的血清ECP水平更高（与无哮喘或特应性的儿童[16.1±15.9]相比，P均＜0.001）。重度哮喘儿童的血清ECP水平最高（P＜0.001），尤其是那些同时患有特应性的儿童。根据风团大小或结合风团大小和阳性皮肤试验数量的衍生变量判断的特应性严重程度是血清ECP的主要决定因素。乙酰甲胆碱反应性增强与血清ECP水平升高无关。
6岁现患哮喘且特应性更严重的儿童血清ECP水平较高，这表明特应性和嗜酸性粒细胞炎症在驱动这种临床表型中起重要作用，并且这可能代表持续存在的哮喘。
