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目的研究IL-5、IgE水平在不同亚型中重度患儿哮喘发病中的变化及意义。方法选取2009年9月-2010年3月于本院儿科哮喘专科门诊就诊的中重度哮喘患儿65例(哮喘组),将哮喘组中急性发作期患儿按诱导痰的细胞分类分为嗜酸性粒细胞(EOS)型哮喘(EA)组及非EOS型哮喘(NEA)组。选取20例健康儿童为健康对照组。采用ELISA法检测不同亚型哮喘患儿血清IgE水平。将哮喘组及健康对照组儿童外周血单个核细胞(PBMC)与CD3单克隆抗体及CD28单克隆抗体共培养,ELISA法检测PBMC在抗体刺激下分泌的IL-5水平。并对IL-5表达水平与IgE水平进行相关性分析,了解IL-5、IgE在不同亚型中重度哮喘患儿中的作用。结果 EA组诱导痰EOS百分比明显高于NEA组(P=0.000)。哮喘组患儿PBMC表达的IL-5水平显著高于健康对照组,急性发作组明显高于临床缓解组,急性发作重度持续组显著高于中度持续组,EA组显著高于健康对照组及NEA组。EA组血清IgE水平显著高于NEA组(P=0.010)。哮喘患儿外周血及EOS诱导痰EOS比例与IL-5、IgE水平呈显著正相关(Pa=0.000);哮喘患儿IL-5水平与IgE水平也呈显著正相关(r=0.482,P=0.001)。结论 IL-5、IgE参与哮喘的发病,IL-5、IgE在EA中的作用较NEA更为突出。IL-5水平与哮喘病情分度密切相关。
Objective To study the changes and significance of IL-5 and IgE levels in the pathogenesis of asthma in children with severe and severe subtypes. Methods Sixty-five children with moderate-to-severe asthma (asthma group) were selected from September 2009 to March 2010 in our Pediatric Asthma Outpatient Department. The patients with acute episode of asthma were divided into three groups according to the cell classification of induced sputum Acidophil granulocyte (EOS) -type asthma (EA) group and non-EOS-type asthma (NEA) group. Twenty healthy children were selected as healthy control group. Serum IgE levels were measured by ELISA in children with different subtypes of asthma. Peripheral blood mononuclear cells (PBMCs) were co-cultured with CD3 monoclonal antibody and CD28 monoclonal antibody in the asthmatic and healthy controls, and the levels of IL-5 secreted by the PBMCs stimulated by the antibodies were measured by ELISA. And IL-5 expression levels and IgE levels were analyzed to understand the role of IL-5, IgE in different subtypes of severe asthma in children. Results The percentage of induced EOS in EA group was significantly higher than that in NEA group (P = 0.000). The level of IL-5 in PBMC of children with asthma was significantly higher than that in healthy controls, the rate of IL-5 in acute exacerbation group was significantly higher than that in clinical remission group, the severity of acute exacerbation was significantly higher than that in moderate persistent group, EA group was significantly higher than that in healthy control group NEA group. The level of serum IgE in EA group was significantly higher than that in NEA group (P = 0.010). The level of IL-5 and IgE in peripheral blood of asthmatic children and EOS-induced sputum were positively correlated (Pa = 0.000). There was also a significant positive correlation between IL-5 level and IgE level in asthmatic children (r = 0.482, P = 0.001). Conclusion IL-5 and IgE are involved in the pathogenesis of asthma. The effect of IL-5 and IgE in EA is more prominent than NEA. IL-5 levels are closely related to the degree of asthma.