Bernard Alfred, Carbonnelle Sylviane, Nickmilder Marc, de Burbure Claire
Unit of Toxicology, Catholic University of Louvain, 30.54 Clos Chapelle-aux-Champs 1200 Brussels, Belgium.
Toxicol Appl Pharmacol. 2005 Aug 7;206(2):185-90. doi: 10.1016/j.taap.2004.10.022.
To date, airways injury or inflammation caused by air pollutants has been evaluated mainly by analysis of bronchoalveolar lavage, an invasive technique totally unsuitable to children. The assessment of respiratory risks in this particularly vulnerable population has thus for a long time relied on spirometric tests and self-reported symptoms which are relatively late and inaccurate indicators of lung damage. Research in the field of biomarkers is now opening new perspectives with the development of non-invasive tests allowing to monitor inflammation and damage in the deep lung. Blood tests measuring lung-specific proteins (pneumoproteins) such as Clara cell protein (CC16) and surfactant-associated proteins (A, B or D) are now available to evaluate the permeability and/or the cellular integrity of the pulmonary epithelium. The application of these tests to children has recently led to the discovery of a lung epithelium hyperpermeability caused by trichloramine (nitrogen trichloride), an irritant gas contaminating the air of indoor-chlorinated pools. Serum CC16 can also serve to detect increases of airway permeability during short-term exposures to ambient ozone. Indicators measurable in exhaled air such as nitric oxide (NO) appear more useful to detect airway inflammation. By applying the exhaled NO test to children attending summer camps, we recently found that ambient ozone produces an acute inflammatory response in children from levels slightly lower than current air quality guidelines. In a study exploring the links between atopy, asthma, and exposure to chlorination products in indoor pools, we also found that the exhaled NO test can serve to detect the chronic airway inflammation associated with excessive exposure to trichloramine. Lung-specific proteins measurable in serum and markers in exhaled air represent sensitive tools that can be used to assess non-invasively the effects of air pollutants on the respiratory tract of children.
迄今为止，空气污染物导致的气道损伤或炎症主要通过支气管肺泡灌洗分析来评估，这是一种完全不适用于儿童的侵入性技术。因此，长期以来，对这个特别脆弱群体的呼吸风险评估一直依赖于肺活量测定测试和自我报告的症状，而这些都是肺损伤相对滞后且不准确的指标。随着能够监测深部肺部炎症和损伤的非侵入性测试的发展，生物标志物领域的研究现在开启了新的前景。目前可以通过血液检测来测量肺特异性蛋白（肺蛋白），如克拉拉细胞蛋白（CC16）和表面活性剂相关蛋白（A、B或D），以评估肺上皮的通透性和/或细胞完整性。这些测试应用于儿童后，最近发现了由三氯胺（三氯化氮）引起的肺上皮通透性增加，三氯胺是一种污染室内氯化泳池空气的刺激性气体。血清CC16还可用于检测短期暴露于环境臭氧期间气道通透性的增加。呼出气体中可测量的指标，如一氧化氮（NO），似乎对检测气道炎症更有用。通过对参加夏令营的儿童进行呼出NO测试，我们最近发现，环境臭氧在略低于当前空气质量指南的水平时就会在儿童中产生急性炎症反应。在一项探索特应性、哮喘与室内泳池氯化产物暴露之间联系的研究中，我们还发现呼出NO测试可用于检测与过度暴露于三氯胺相关的慢性气道炎症。血清中可测量的肺特异性蛋白和呼出气体中的标志物是敏感工具，可用于非侵入性评估空气污染物对儿童呼吸道的影响。
