Department of Pediatrics, Kuopio University and Kuopio University Hospital, Kuopio, Finland.
Pediatr Allergy Immunol. 2010 Feb;21(1 Pt 1):96-103. doi: 10.1111/j.1399-3038.2009.00873.x. Epub 2009 Sep 30.
Eosinophilic inflammation has a central role in the pathogenesis of asthma. We aimed to elucidate whether elevated blood eosinophil count (B-EOS), eosinophil cationic protein in serum (S-ECP) or in nasopharyngeal aspirate (NPA-ECP) predict later asthma after hospitalization for wheezing in infancy. In 1992-1993, 100 infants aged <24 months were hospitalized for wheezing associated with respiratory infection. B-EOS, S-ECP and NPA-ECP were measured on admission. Asthma status was evaluated at the follow-up visits at the median ages of 4.0, 7.2 and 12.3 yr. Twenty (25%) of 81 children had asthma at all three visits and were considered to have persistent childhood asthma (PCA). Children with B-EOS >or= 0.450 x 10(9) cells/l had a 2.9-fold PCA risk compared with other children. The risk was 6.1-fold when S-ECP was >or=20.0 microg/l and 6.7-fold when NPA-ECP was >or=815.0 ng/g. By these cut-off limits, all these markers were specific (75-93%), but not very sensitive (30-58%) in predicting PCA. At least one marker was elevated in 75% of the children with PCA. The respective figure for NPA-ECP alone was 58%. In adjusted analyses, only elevated NPA-ECP was an independent risk factor for PCA (OR 4.09). In conclusion, eosinophil activity in early life predicts the development of childhood asthma after hospitalization for wheezing in infancy. The results highlight NPA-ECP as an independent predictor of the persistence of asthma at school age.
嗜酸粒细胞炎症在哮喘发病机制中起核心作用。我们旨在阐明婴儿期因喘息住院后，升高的血嗜酸粒细胞计数（B-EOS）、血清（S-ECP）或鼻咽抽吸物（NPA-ECP）中的嗜酸粒细胞阳离子蛋白是否可预测之后的哮喘。1992-1993 年，我们收治了 100 名年龄<24 个月的因呼吸道感染相关喘息住院的婴儿。在入院时检测 B-EOS、S-ECP 和 NPA-ECP。在中位年龄为 4.0、7.2 和 12.3 岁时进行随访以评估哮喘状况。81 名儿童中有 20 名（25%）在所有 3 次就诊时均患有哮喘，被认为患有持续性儿童哮喘（PCA）。B-EOS>或=0.450 x 10(9)个细胞/l 的儿童患 PCA 的风险是其他儿童的 2.9 倍。S-ECP>或=20.0 microg/l 时风险增加至 6.1 倍，NPA-ECP>或=815.0 ng/g 时风险增加至 6.7 倍。通过这些截断值，所有这些标志物在预测 PCA 方面均具有特异性（75-93%），但灵敏度不高（30-58%）。PCA 患儿中至少有 1 种标志物升高的占 75%，而 NPA-ECP 单独升高的比例为 58%。在调整分析中，只有升高的 NPA-ECP 是 PCA 的独立危险因素（OR 4.09）。总之，婴儿期嗜酸粒细胞活性可预测因喘息住院后儿童哮喘的发生。结果突出了 NPA-ECP 作为预测学龄期哮喘持续存在的独立预测因子。
