Department of Pediatrics, Institute of Laboratory Medicine, University of Padova, Padova, Italy.
Allergy. 2010 Aug;65(8):978-85. doi: 10.1111/j.1398-9995.2009.02282.x. Epub 2009 Dec 11.
Recent studies performing fiberoptic bronchoscopy in children have improved our understanding of asthma pathophysiology. Eosinophilic, but also neutrophilic, inflammation has been described in asthma, but the relationship with atopy was incompletely investigated. The aim of this study is to examine inflammatory cells and mediators in children with asthma compared to the appropriate controls, i.e. atopic children without asthma and children with no atopy or asthma. Moreover, asthmatic children were analysed separately based on the presence of atopy and stratified by age.
We recruited 191 children undergoing fiberoptic bronchoscopy for appropriate indications: 91 asthmatics (aged 1.4-17 years), 44 atopics without asthma (1.6-17.8 years) and 56 nonasthmatic nonatopic controls (1.4-14 years). In bronchoalveolar lavage, total and differential cell counts and inflammatory mediators, including ECP, eotaxin, IL-8 and TNFalpha, were analysed.
Eosinophils and ECP levels were increased in asthmatic children when compared to controls (P = 0.002 and P = 0.01, respectively), but also atopic children without asthma had increased ECP levels compared to controls (P = 0.0001). Among asthmatic children, eosinophils and ECP levels were not different between atopic and nonatopic individuals. Neither neutrophils nor the related mediators (IL-8 and TNFalpha) differed significantly in the three groups. This pattern of inflammation was observed in both preschool and school-aged asthmatic children.
This study suggests that markers of eosinophilic, but not neutrophilic inflammation, are increased in asthmatic children and also in atopic children without asthma. Of interest, in asthmatic children, the activation of the eosinophilic response is not solely because of the presence of atopy.
最近对儿童进行纤维支气管镜检查的研究提高了我们对哮喘病理生理学的认识。哮喘中已描述了嗜酸性粒细胞，还有中性粒细胞炎症，但与过敏的关系尚未完全研究清楚。本研究的目的是比较哮喘患儿与适当对照组（即无哮喘的过敏儿童和无过敏或哮喘的儿童）之间的炎症细胞和介质。此外，还根据过敏的存在对哮喘患儿进行了分析，并按年龄进行分层。
我们招募了 191 名因适当适应证而行纤维支气管镜检查的儿童：91 例哮喘患儿（年龄 1.4-17 岁），44 例无哮喘的过敏患儿（1.6-17.8 岁）和 56 例非哮喘非过敏对照儿童（1.4-14 岁）。在支气管肺泡灌洗中，分析了总细胞和分类细胞计数以及炎症介质，包括 ECP、嗜酸性粒细胞趋化因子、IL-8 和 TNFalpha。
与对照组相比，哮喘患儿的嗜酸性粒细胞和 ECP 水平升高（P = 0.002 和 P = 0.01），但无哮喘的过敏患儿的 ECP 水平也高于对照组（P = 0.0001）。在哮喘患儿中，嗜酸性粒细胞和 ECP 水平在过敏和非过敏个体之间无差异。三组中性粒细胞和相关介质（IL-8 和 TNFalpha）也无明显差异。这种炎症模式在学龄前和学龄期哮喘患儿中均观察到。
本研究表明，在哮喘患儿和无哮喘的过敏患儿中，嗜酸性粒细胞而非中性粒细胞炎症的标志物增加。有趣的是，在哮喘患儿中，嗜酸性粒细胞反应的激活不仅仅是因为过敏的存在。
