儿童变应性鼻炎严重度与血清嗜酸粒细胞阳离子蛋白的相关性

Correlation of serum eosinophil cationic protein with the severity of allergic rhinitis in childhood

目的探讨儿童变应性鼻炎（allergic rhinitis，AR）严重度与患者外周血嗜酸粒细胞（eosinophil，EOS）计数、血清嗜酸粒细胞阳离子蛋白（eosinophil cationic protein，ECP）、血清总IgE（totalIgE，tIgE）和变应原特异性IgE（specific IgE，sIgE）水平的相关性。方法儿童AR患者138例，年龄3～17岁，平均（i±s，以下同）年龄（9．96±3．78）岁；发病时间3个月至12年，平均病程（4．21±2．72）年。所有患儿均为持续性AR，对屋尘螨和（或）粉尘螨过敏。采用视觉模拟量表（visual analogue scale，VAS）对患者的病情严重度进行评价，对所有病例检测外周血EOS计数，ImmunoCAP体外变应原检测系统测定血清ECP、tIgE和sIgE水平。以SPSS11．0软件进行统计学分析。结果138例AR患儿的病情总体严重程度VAS评分为（5．32±2．16）分，鼻塞症状VAS评分为（4．78±2．45）分。外周血EOS计数为0．39[0．24；0．63]×109个／ml（以中位数[25分位数；75分位数]表示，以下同），血清ECP水平为10．60[3．26；30．80]μg/L，血清tIgE水平（10gkU／L）为2．50±0．53，屋尘螨sIgE水平为58．20[24．75；〉100]kUA／L，粉尘螨sIgE水平为54．95[24．55；〉100]kUA／L。其中，AR病程长短（r=0．215，P=0．011）、血清ECP水平（r=0．196，P=0．022）与鼻塞症状VAS评分呈正相关，但与病情总体严重程度VAS评分无相关性（P值均〉0．05）。血清ECP水平与外周血EOS计数也呈正相关（r=0．295，P=0．000）。外周血EOS计数、血清tIgE、屋尘螨和粉尘螨sIgE水平与病情总体严重程度、鼻塞症状VAS评分之间均未见相关性（P值均〉0．05）。结论尘螨致敏的儿童持续性AR鼻塞症状严重程度与患者发病时间的长短及血清ECP水平呈正相关，提示疾病严重度与慢性炎性反应状态有关。

Objective To investigate the relationships between the severity of childhood allergic rhinitis （AR） and the peripheral blood eosinophil count, serum eosinophil cationic protein （ECP） , total IgE （tIgE）, and allergen-specific IgE （sIgE） levels. Methods A total of 138 children with AR aged 3 to 17 （9.96 ± 3.78, x ＋ s ） years old were enrolled in the study. All children had persistent AR sensitized to house dust mites with a clinical history of 3 months to 12 （4. 21± 2. 72 ） years. The disease severity was evaluated using 10 cm-visual analogue scale （VAS） , and the serum levels of ECP, tIgE and sIgE were determined using an ImmunoCAP system. Statistical analysis was conducted with SPSSll. 0 software. Results Among 138 children with AR, the VAS scores for global severity of rhinitis and nasal obstruction symptom were 5.32 ±2. 16 and 4. 78 ±2.45, respectively. Blood eosinophil count was 0. 39[0. 24; 0. 63 ] （M[P25; P75 ] ） ×109/ml. Serum levels of ECP and total IgE were 10. 60[3.26; 30. 80 ]μg/L and （2.50±0.53 ） log kU/L, respectively. Serum levels of allergen-slgE against Dermatophagoides pteronyssinus and Dermatophagoides farinae were 58.20 [ 24. 75; 〉 100 ~ kUA/L and 54. 95 [ 24. 55 ; 〉 100 ] kUA/L, respectively. The VAS scores of nasal obstruction symptom, but not global severity of rhinitis, were positively related to the duration of AR （r = 0. 215, P = 0. 01 l ） and the levels of serum ECP （r = 0. 196, P = 0. 022） in bivariate correlation analysis. There was also a significant correlation between the serum ECP level and the blood eosinophil count （r = 0. 295, P = 0. 000）. No relationships of blood eosinophil count, and serum tIgE and sIgE levels with global severity of rhinitis as well as nasal obstruction symptom were found （ all P 〉 0. 05 ）. Conclusions These results suggested that the severity of nasal obstruction was positively correlated with the duration of rhinitis and the levels of serum ECP in childhood persistent AR due to house dust mites, indicating the disease severity might be related to chronic inflammatory process.