Department of Pediatrics, Seoul National University Hospital, Seoul, Korea Asthma and Allergy Center, Inje University Sanggye-Paik Hospital, Seoul, Korea.
Pediatr Allergy Immunol. 2011 Feb;22(1 Pt 2):e101-6. doi: 10.1111/j.1399-3038.2010.01110.x.
The relationship between atopy and bronchial hyperresponsiveness (BHR), both key features of asthma, remains to be clarified. BHR is commonly evaluated by bronchial challenges using direct and indirect stimuli. The aim of this study was to investigate the degree of BHR to methacholine (direct stimulus) and adenosine 5'-monophosphate (AMP) (indirect stimulus) according to the presence and degree of atopy in children with asthma. We performed a retrospective analysis of data from 120 children presenting with a diagnosis of asthma. These children were characterized by skin-prick tests (SPTs), spirometry and bronchial challenges with methacholine and AMP. Atopy was defined by at least one positive reaction to SPTs, and its degree was measured using serum total IgE levels, number of positive SPTs and atopic scores (sum of graded wheal size). A provocative concentration causing a 20% decline in FEV(1) (PC(20) ) was determined for each challenge. Patients with atopy(n=94) had a significantly lower AMP PC(20) than non-atopic patients (n=26), whereas methacholine PC(20) was not different between the two groups. Among the patients with atopy, there was no association between methacholine PC(20) and any atopy parameter. In contrast, a significant association was found between AMP PC(20) and the degree of atopy reflected in serum total IgE, number of positive SPTs and atopic scores (anova trend test, p=0.002, 0.001, 0.003, respectively). AMP responsiveness was associated with the presence and degree of atopy, whereas such a relationship was not observed for methacholine responsiveness. These findings suggest that atopic status may be better reflected by bronchial responsiveness assessed by AMP than by methacholine.
特应性与支气管高反应性（BHR）之间的关系，两者均为哮喘的关键特征，仍有待阐明。BHR 通常通过使用直接和间接刺激物进行支气管挑战来评估。本研究的目的是根据哮喘患儿特应性的存在和程度，研究对乙酰甲胆碱（直接刺激）和单磷酸腺苷（AMP）（间接刺激）的 BHR 程度。我们对 120 名患有哮喘的儿童进行了回顾性数据分析。这些儿童通过皮肤点刺试验（SPTs）、肺量测定和乙酰甲胆碱及 AMP 支气管挑战来进行特征描述。特应性通过至少一项 SPT 阳性反应来定义，其程度通过血清总 IgE 水平、阳性 SPT 数量和特应性评分（分级风团大小总和）来测量。为每个挑战确定引起 FEV1 下降 20%的激发浓度（PC20）。特应性患者（n=94）的 AMP PC20 显著低于非特应性患者（n=26），而两组间乙酰甲胆碱 PC20 无差异。在特应性患者中，乙酰甲胆碱 PC20 与任何特应性参数之间均无相关性。相比之下，在 AMP PC20 与反映在血清总 IgE、阳性 SPT 数量和特应性评分中的特应性程度之间发现了显著相关性（anova 趋势检验，p=0.002、0.001、0.003）。AMP 反应性与特应性的存在和程度相关，而乙酰甲胆碱反应性则无此关系。这些发现表明，与乙酰甲胆碱相比，通过 AMP 评估的支气管反应性可能更好地反映特应性状态。
