O'Brien Caitlin E, Tsirilakis Kalliope, Santiago Maria Teresa, Goldman David L, Vicencio Alfin G
Department of Pediatrics, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York.
Department of Pediatrics, Cohen Children's Medical Center of New York, Hofstra University School of Medicine, New Hyde Park, New York.
Pediatr Pulmonol. 2015 Dec;50(12):1200-4. doi: 10.1002/ppul.23165. Epub 2015 Mar 4.
The treatment of children with severe-persistent asthma remains problematic. Recent studies suggest that stratification of this cohort by inflammatory type may be useful in designing effective treatment strategies. In this study, we examined the inflammatory profile in bronchoalveolar lavage fluid from children with severe-persistent asthma and compared this profile with serum IgE levels.
The inflammatory profile in the bronchoalveolar fluid from 32 children who met criteria for severe-persistent asthma as defined by the Severe Asthma Research Program (SARP) were analyzed retrospectively. Inflammatory patterns were classified as neutrophilic, eosinophilic, mixed, or pauci-granulocytic. Serum total IgE was measured prior to bronchoscopy and determined by ELISA at each hospital's lab by standard procedures.
The most common pattern of inflammation in this cohort was neutrophilic (37.5%) followed by eosinophilic (28.1%), mixed (21.9%), and pauci-granulocytic (11.1%). The odds ratio of an eosinophilic BAL pattern for patients with an elevated serum IgE was 4.67 (CI 0.78-28, P = 0.12). A correlation between serum IgE levels and BAL eosinophil percentages was present (P = 0.04).
To our knowledge, ours is one of few studies to systematically investigate the pattern of lower airway inflammation in children with severe-persistent asthma. Our results differ from a recent investigation in children, showing more heterogeneity and a greater proportion of neutrophilic inflammation. Further investigation is required to determine whether specific inflammatory patterns are associated with specific etiologies, and whether individualized therapy is warranted.
重度持续性哮喘患儿的治疗仍然存在问题。最近的研究表明，根据炎症类型对该队列进行分层可能有助于设计有效的治疗策略。在本研究中，我们检查了重度持续性哮喘患儿支气管肺泡灌洗液中的炎症特征，并将其与血清IgE水平进行了比较。
回顾性分析了32名符合重度哮喘研究项目（SARP）定义的重度持续性哮喘标准的儿童支气管肺泡灌洗液中的炎症特征。炎症模式分为中性粒细胞性、嗜酸性粒细胞性、混合性或少粒细胞性。在支气管镜检查前测量血清总IgE，并由各医院实验室按照标准程序通过ELISA法测定。
该队列中最常见的炎症模式是中性粒细胞性（37.5%），其次是嗜酸性粒细胞性（28.1%）、混合性（21.9%）和少粒细胞性（11.1%）。血清IgE升高的患者出现嗜酸性粒细胞性BAL模式的比值比为4.67（CI 0.78 - 28，P = 0.12）。血清IgE水平与BAL嗜酸性粒细胞百分比之间存在相关性（P = 0.04）。
据我们所知，我们的研究是少数系统研究重度持续性哮喘患儿下气道炎症模式的研究之一。我们的结果与最近一项针对儿童的调查不同，显示出更多的异质性和更高比例的中性粒细胞性炎症。需要进一步研究以确定特定的炎症模式是否与特定病因相关，以及是否有必要进行个体化治疗。
