哮喘儿童吸入糖皮质激素疗效与白三烯水平的相关性探讨

Relationship between the efficacy of inhaled corticosteroids and the leukotriene expression in children with asthma

摘要:

目的：探讨哮喘儿童半胱氨酰白三烯合成与分泌水平与吸入糖皮质激素（ICS）疗效个体差异的相关性。方法：32例5～12岁已规律使用ICS 6个月以上非急性发作期哮喘儿童，按病情控制程度分为ICS控制良好组（14例）与ICS控制不良组（18例），取10例健康儿童作为对照组，比较3组儿童外周血多形核白细胞(PMNL)白三烯C4合成酶（LTC4S ）mRNA表达与尿白三烯E4（LTE4）分泌水平。LTC4S mRNA表达水平以qCt值表示，qCt值与基因表达水平呈负相关。结果：哮喘儿童组PMNL LTC4S mRNA 表达（qCt值:1.12±0.27）明显高于对照组（qCt值:1.42±0.12），P<0.05。ICS控制不良组PMNL LTC4S mRNA表达水平最高（qCt值:1.03±0.17），与ICS控制良好组（qCt值:1.24±0.33）和健康对照组(qCt值:1.42±0.12)比较差异均有显著性意义（分别P<0.05和P<0.01）。3组间尿LTE4比较差异无显著性意义。结论：哮喘儿童外周血LTC4S mRNA表达水平增高，且规范使用ICS控制不良患儿显著高于ICS控制良好患儿，提示体内白三烯水平增高可能与ICS控制不良有关。［中国当代儿科杂志，2009，11（6）：441-444］

Abstract:

OBJECTIVE: To evaluate the relationship between leukotriene expression in blood polymorphonuclear leukocytes (PMNL) and the efficacy of inhaled corticosteroids (ICS) in children with asthma. METHODS: Thirty-two children with asthma (5-12 years) and ten healthy children (control group) were enrolled. The asthmatic children were subdivided into ICS well-controlled and ICS poorly-controlled groups based on their clinical symptoms and lung function. The level of leukotriene C4 synthase (LTC4S) mRNA in PMNL was detected by fluorescence quantitative polymerase chain reaction. The level of LTC4S mRNA was expressed by the value of qCt, and the value of qCt was diversely correlated with the level of LTC4S mRNA expression. The concentration of urinary leukotriene E4 (LTE4) was measured using ELISA. RESULTS: The expression of LTC4S mRNA in PMNL was significantly higher in children with asthma (qCt: 1.12±0.27) than that in the control group (qCt: 1.42±0.12;P<0.05). The expression of LTC4S mRNA in PMNL in the ICS poorly-controlled group (qCt: 1.03±0.17) was significantly higher than that in the ICS well-controlled group (qCt: 1.24±0.33; P<0.05) and the control group(1.42±0.12;P<0.01). There was no significant difference in the level of urinary LTE4 among the the ICS poorly-controlled, the ICS well-controlled and the control groups. CONCLUSIONS: LTC4S mRNA expression in PMNL in asthmatic children increases, and the LTC4S mRNA expression in the ICS poorly-controlled group is higher than that in the ICS well-controlled group. This suggests that an increased leukotriene expression might be associated with poorly-controlled asthma.［Chin J Contemp Pediatr, 2009, 11 (6):441-444］