原標(biāo)題：兒童哮喘進(jìn)展過(guò)程中過(guò)敏原敏感性、外周血嗜酸性細(xì)胞和骨膜蛋白之間的關(guān)系
　?、俦尘?目前缺乏預(yù)測(cè)兒童哮喘發(fā)病的生物標(biāo)志物，最好是非侵入性的②目的:對(duì)早期2型炎癥的生物標(biāo)志物與哮喘發(fā)病的關(guān)系知之甚少。我們?cè)u(píng)估了空氣變應(yīng)原致敏、外周血嗜酸性粒細(xì)胞和血清骨膜蛋白作為兒童哮喘的潛在生物標(biāo)志物。③方法:對(duì)參與哮喘兒童起源研究的兒童從出生起進(jìn)行前瞻性隨訪。收集2歲、4歲、6歲和11歲的血液樣本，測(cè)量244名兒童的血清特異性IgE水平、血嗜酸性細(xì)胞計(jì)數(shù)和骨膜球蛋白水平。評(píng)估這些生物標(biāo)志物、年齡和哮喘之間的關(guān)系。④結(jié)果:兒童血清骨膜蛋白水平大約比以前觀察到的成人水平高2- 3倍。最高水平為2歲(145 ng/mL)， 4 - 11歲(128 - 130 ng/mL)無(wú)明顯變化。2歲時(shí)，骨膜蛋白水平為150 ng/mL或更高，預(yù)測(cè)6歲時(shí)哮喘(優(yōu)勢(shì)比[or]， 2.3;95%可信區(qū)間,1.3 - -4.4)。嗜酸性粒細(xì)胞數(shù)為300個(gè)/mL或更多，2歲時(shí)空氣變應(yīng)原致敏均與6歲時(shí)哮喘風(fēng)險(xiǎn)增加有關(guān)(or, 3.1;95% CI, 1.7-6.0; OR, 3.3;95%可信區(qū)間,1.7 - -6.3)。具有任何2種生物標(biāo)記物的兒童到學(xué)齡時(shí)患哮喘的風(fēng)險(xiǎn)顯著增加(>_2種生物標(biāo)記物vs .無(wú):OR, 6.6;95%可信區(qū)間,2.7 - -16.0)。⑤結(jié)論:兒童血清骨膜蛋白水平明顯高于成人，可能與骨更新有關(guān)，骨更新影響了其在兒童中的臨床應(yīng)用。生命早期空氣變應(yīng)原致敏和血嗜酸性粒細(xì)胞升高是哮喘發(fā)展的可靠預(yù)測(cè)因子。有證據(jù)表明，兒童早期激活多種途徑的2型炎癥是哮喘發(fā)展的最大風(fēng)險(xiǎn)。(J Allergy Clin Immunol 2016;nnn:nnn-nnn.)
延伸閱讀
JACI                                          
Relationships among aeroallergen sensitization, peripheral blood eosinophils, and periostin in pediatric asthma development  
https://dio.org/10.1016/j.jaci.2016.05.033
Abstract:
Background: Biomarkers, preferably noninvasive, that predict asthma inception in children are lacking.
Objective: Little is known about biomarkers of type 2 inflammation in early life in relation to asthma inception. We evaluated aeroallergen sensitization, peripheral blood eosinophils, and serum periostin as potential biomarkers of asthma in children.
Methods: Children enrolled in the Childhood Origins of Asthma study were followed prospectively from birth. Blood samples were collected at ages 2, 4, 6, and 11 years, and serum- specific IgE levels, blood eosionophil counts, and periostin levels were measured in 244 children. Relationships among these biomarkers, age, and asthma were assessed.
Results: Serum periostin levels were approximately 2- to 3-fold higher in children than previously observed adult levels. Levels were highest at 2 years (145 ng/mL), and did not change significantly between 4 and 11 years (128 and 130 ng/mL). Age2 year periostin level of 150 ng/mL or more predicted asthma at age 6 years (odds ratio [OR], 2.3; 95% CI, 1.3-4.4). Eosinophil count of 300 cells/mL or more and aeroallergen sensitization at age 2 years were each associated with increased risk of asthma  at age 6 years (OR, 3.1; 95% CI, 1.7-6.0 and OR, 3.3; 95% CI,1.7-6.3). Children with any 2 of the biomarkers had a significantly increased risk of developing asthma by school age (>_2 biomarkers vs none: OR, 6.6; 95% CI, 2.7-16.0).
Conclusions: Serum periostin levels are significantly higher in children than in adults, likely due to bone turnover, which impairs clinical utility in children. Early life aeroallergen sensitization and elevated blood eosinophils are robust predictors of asthma development. Children with evidence of activation of multiple pathways of type 2 inflammation in early life are at greatest risk for asthma development. (J Allergy Clin Immunol 2016;nnn:nnn-nnn.)
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All Author:
Halie M. Anderson, MD,a Robert F. Lemanske, Jr, MD,a Joseph R. Arron, MD, PhD,b Cecile T. J. Holweg, PhD,b    Victoria Rajamanickam, MS,c Ronald E. Gangnon, PhD,c James E. Gern, MD,a and Daniel J. Jackson
　　創(chuàng)建過(guò)敏性疾病的科研、科普知識(shí)交流平臺(tái)，為過(guò)敏患者提供專業(yè)診斷、治療、預(yù)防的共享平臺(tái)。