Kristjánsson S, Strannegård I L, Strannegård O, Peterson C, Enander I, Wennergren G
Department of Paediatrics, University of Göteborg, Sweden.
J Allergy Clin Immunol. 1996 Jun;97(6):1179-87. doi: 10.1016/s0091-6749(96)70182-3.
Bronchial asthma is associated with elevated serum levels of eosinophil products, such as eosinophil protein X (EPX), but the occurrence in urine of this substance in patients with asthma has not previously been studied.
This study was performed to clarify whether increased amounts of eosinophil granulocyte proteins in urine and serum reflect ongoing asthmatic inflammation and whether decreasing values reflect successful treatment.
Twelve children with a median age of 12.5 years who had mild or moderate atopic asthma were studied for 3 months. At the time of inclusion in the study, treatment with inhaled budesonide was initiated. Nine children of the same age without atopic disease served as control subjects. Levels of EPX, eosinophil cationic protein (ECP), and myeloperoxidase in serum and in urine (urinary EPX) were determined at inclusion and then after 3 months of treatment. Spirometry was performed on the same occasions.
At the time of inclusion, urinary EPX and serum ECP were significantly higher in children with atopic asthma than in the control subjects (mean, 116.4 vs 43.0 micrograms/mmol creatinine [p = 0.004] and 37.0 vs 14.8 micrograms/L [p = 0.004]). In the asthma group urinary EPX, as well as serum ECP, decreased significantly after 3 months of treatment with budesonide (116.4 to 68.4 micrograms/mmol creatinine [p = 0.005] and 37.0 to 24.0 micrograms/L [p = 0.04]). At the same time, peak expiratory flow values increased significantly in the children with asthma (76.0% to 87.8% of predicted value [p = 0.005]) but not in the control subjects (87.0% to 90.1%). In the asthma group the levels of myeloperoxidase were similar to those in the control group, both at inclusion and after 3 months.
Increased urinary EPX and serum ECP levels seem to reflect active atopic asthma, whereas decreased levels after antiinflammatory treatment probably reflect normalization of airway inflammation, and indirectly, improved lung function.
支气管哮喘与血清中嗜酸性粒细胞产物水平升高有关，如嗜酸性粒细胞蛋白X（EPX），但此前尚未对哮喘患者尿液中该物质的情况进行研究。
本研究旨在阐明尿液和血清中嗜酸性粒细胞蛋白量的增加是否反映了正在进行的哮喘炎症，以及数值下降是否反映了治疗成功。
对12名中位年龄为12.5岁的轻度或中度特应性哮喘儿童进行了3个月的研究。在纳入研究时，开始吸入布地奈德治疗。9名同龄无特应性疾病的儿童作为对照。在纳入时及治疗3个月后测定血清和尿液（尿EPX）中的EPX、嗜酸性粒细胞阳离子蛋白（ECP）和髓过氧化物酶水平。在相同时间进行肺功能测定。
纳入时，特应性哮喘儿童的尿EPX和血清ECP显著高于对照组（平均值分别为116.4对43.0微克/毫摩尔肌酐[p = 0.004]和37.0对14.8微克/升[p = 0.004]）。在哮喘组中，用布地奈德治疗3个月后，尿EPX以及血清ECP显著下降（116.4至68.4微克/毫摩尔肌酐[p = 0.005]和37.0至24.0微克/升[p = 0.04]）。同时，哮喘儿童的呼气峰值流速值显著增加（从预测值的76.0%增至87.8%[p = 0.005]），而对照组未增加（从87.0%增至90.1%）。在哮喘组中，髓过氧化物酶水平在纳入时和3个月后均与对照组相似。
尿EPX和血清ECP水平升高似乎反映了活动性特应性哮喘，而抗炎治疗后水平下降可能反映了气道炎症的正常化，间接反映了肺功能的改善。
