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目的探讨Clara细胞分泌蛋白(CCSP)在喘息性疾病发病中的作用及其诊断价值。方法 62例门诊或住院喘息性肺炎患儿中28例有哮喘高危因素;同期本院健康体检儿童22例作为健康对照组。采集2组空腹静脉血5 mL,分离血清;喘息性肺炎患儿同时留取痰液,离心后吸取上清液。采用双抗夹心ELISA法检测其血清和痰液CCSP水平。喘息性肺炎患儿治疗10～14 d临床症状、体征消失后抽血复查。随访12～18个月,23例诊断为支气管哮喘,在非急性发作期且未使用糖皮质激素时再次抽血复查,并与同期治愈的喘息性肺炎但无支气管哮喘的39例患儿进行比较。结果 1.有哮喘高危因素的喘息性肺炎患儿血清和痰液CCSP水平[(5.71±2.45)μg.L-1,(148.24±34.58)μg.L-1]与无哮喘高危因素的喘息性肺炎患儿血清和痰液CCSP水平[(6.02±3.34)μg.L-1,(155.77±44.03)μg.L-1]比较,差异均无统计学意义(Pa>0.05);但2组喘息性肺炎患儿血清CCSP水平均较健康对照组[(12.3±3.73)μg.L-1]显著降低(Pa<0.001)。2.非哮喘的喘息性肺炎患儿肺炎治愈后血清CCSP水平[(11.03±2.86)μg.L-1]接近健康对照组(P>0.05);哮喘患儿肺炎治愈后血清CCSP水平[(7.71±2.22)μg.L-1]较治疗前[(5.48±1.39)μg.L-1]明显升高(P<0.001),但仍低于非哮喘的喘息性肺炎治愈组和健康对照组(Pa<0.001);随访12～18个月,在非急性发作期且未吸入糖皮质激素情况下,哮喘患儿血清CCSP水平[(8.03±2.44)μg.L-1]无明显增高,与肺炎治愈的哮喘患儿血清CCSP水平比较差异无统计学意义(P>0.05)。结论 CCSP在喘息性肺炎发病中起保护作用;CCSP持续低水平可作为预测哮喘及哮喘早期诊断的指标之一。
Objective To investigate the role of Clara cell secretory protein (CCSP) in the pathogenesis of asthmatic disease and its diagnostic value. Methods Totally 62 outpatients or hospitalized children with asthmatic pneumonia were at high risk of asthma. Twenty-two healthy children in our hospital were taken as healthy control group. 5 mL fasting venous blood was collected and serum was separated; sputum was also collected from children with asthmatic pneumonia and the supernatant was aspirated after centrifugation. The serum and sputum CCSP levels were measured by double-antibody sandwich ELISA. Children with asthmatic pneumonia 10 ~ 14 days of treatment of clinical symptoms, signs disappeared after blood tests. Twenty-two to eighteen months of follow-up, 23 were diagnosed as bronchial asthma. Blood samples were rechecked during non-acute exacerbations and without glucocorticoids and compared with 39 children with asthmatic bronchitis who were cured in the same period . Results 1. CCSP levels of serum and sputum in children with asthmatic pneumonia [(5.71 ± 2.45) μg.L-1, (148.24 ± 34.58) μg.L-1] were significantly correlated with asthmatic wheezing There were no significant differences in the CCSP levels between serum and sputum of children with pneumonia [(6.02 ± 3.34) μg.L-1, (155.77 ± 44.03) μg.L-1] (P> 0.05) Serum CCSP levels in children with Pneumonia were significantly lower than those in healthy controls [(12.3 ± 3.73) μg.L-1] (Pa0.001). The level of serum CCSP in children with asthmatic pneumonia was significantly lower than that in healthy controls [(11.03 ± 2.86) μg.L-1] (P <0.05) ± 2.22) μg.L-1] were significantly higher than those before treatment [(5.48 ± 1.39) μg.L-1] (P <0.001), but still lower than those of the non-asthmatic wheezing pneumonia patients and healthy controls (P <0.001). After 12-18 months of follow-up, there was no significant increase in the serum CCSP level in children with asthma ([8.03 ± 2.44] μg.L-1] and non-acute exacerbation of corticosteroids There was no significant difference in serum CCSP levels between cured asthmatic children (P> 0.05). Conclusions CCSP plays a protective role in the pathogenesis of asthmatic pneumonia. The continuous low level of CCSP may be used as an index to predict the early diagnosis of asthma and asthma.