血清嗜酸粒细胞阳离子蛋白在儿童慢性咳嗽诊断中的意义

Clinical significance of serum eosinophil cationic protein in the diagnosis of children with chronic cough

目的探讨血清嗜酸粒细胞阳离子蛋白(ECP)在儿童慢性咳嗽尤其与哮喘相关的慢性咳嗽诊断中的临床意义。方法测定117例5～16岁慢性咳嗽患儿的血清ECP和肺功能,其中哮喘发作组53例,哮喘缓解组30例,咳嗽变异型哮喘组22例,鼻后滴流综合征(PNDS)组12例;另设24例健康儿童为对照组。结果血清ECP水平在哮喘发作组及咳嗽变异型哮喘组均显著高于正常对照组(P<0.01);哮喘缓解组、PNDS组与正常对照组比较差异无统计学意义(P均>0.05)。各组最大呼气峰流速(PEF)预计值、一秒钟用力呼气容积(FEV1)预计值、用力肺活量(FVC)预计值哮喘发作组与正常对照组比较差异有统计学意义(P均<0.01);哮喘缓解组、PNDS组与正常对照组比较差异无统计学意义(P>0.05);咳嗽变异型哮喘组PEF与正常对照组比较差异无统计学意义(P>0.05),FEV1、FVC与正常对照组比较差异有统计学意义(P均<0.01)。结论ECP是导致气道炎症和组织损伤的重要介质,血清ECP水平可反映气道高反应性发展的早期阶段,在反映病情严重程度方面具有特异性及敏感性。ECP可作为慢性咳嗽鉴别诊断的一个参考指标,可用于筛选不典型哮喘。

Objectives To investigate the clinical significance of serum eosinophil cationic protein （ECP） in the diagnosis of children with chronic cough, especially in those caused by asthma. Methods Serum levels of ECP and lung function tests were determined in 117 children aged from 5-16 years. Among them, 53 cases were diagnosed with acute stage asthma, 30 cases with remission stage asthma, 22 cases with acute stage cough variantasthma （CVA）, 12 cases with post-nasal drip syndrome （PNDS） . Twenty four cases of normal controls were also recruited to this study. Results The serum levels of ECP were significantly higher in the groups with acute stage asthma and acute stage CVA compared to the control group （P 〈 0.01 ） . No difference was found among the groups of control, remission stage asthma and PNDS （P 〉 0.05） . There were significant differences in PEF, FEV1 and FVC between the groups of acute stage asthma and control （P 〈 0.01） while no difference among the groups of remission stage asthma, PNDS and control （P 〉 0.05） . There was no significant difference in PEF between the groups of CVA and control （P 〉 0.05） while significant differences in FEV1 and FVC were found （P 〈 0.01） . Conclusions Eosinophil cationic protein is an important factor that may cause airway inflammatory and tissue injury in asthma. Serum ECP level may be used as the indicator for the early development of bronchial hyperactivity. It is also a specific and sensitive indicator that can reflect the severity of asthma. Serum ECP level may be a useful marker for differential diagnosis of chronic cough caused by atypical asthma.