氣喘兒童使用類固醇治療後血清eotaxin, eosinophil cationic protein,與eosinophil count之變化

The changes of serum eotaxin, eosinophil cationic protein, and eosinophil count while treating pediatric asthmatic patients with steroids

朱育德(Yu-Te Chu)

指導教授 ： 吳俊仁

高雄醫學大學/醫學院/醫學研究所/碩士(2006年)

https://doi.org/10.6832/KMU.2006.00022

摘要

背景：血清中Eotaxin濃度增加與成人氣喘發作與緩解相關，但是在氣喘兒童的治療過程中，尚未有探討口服類固醇與吸入類固醇對於血清Eotaxin、嗜伊紅性血球陽離子蛋白濃度、嗜伊紅性血球數改變的相關報告。
方法：本研究是一個前瞻追蹤型的計畫。利用氣喘兒童在急性發作後，以口服類固醇治療一週，並且隨後用吸入性類固醇與長效支氣管擴張劑治療二個月，追蹤血中的eotaxin、嗜伊紅性血球陽離子蛋白、 與血中的嗜伊紅性血球數目的變化，並與臨床上常用的肺部功能指標吐氣尖峰流速﹙PEF﹚作相關性研究。
結果：經過口服性類固醇治療一週後，病童的血中嗜伊紅性血球數目與嗜伊紅性血球陽離子蛋白下降，但是血中的eotaxin尚維持在較高的範圍；使用吸入性類固醇與支氣管擴張劑時，血中的eotaxin下降﹙85.7±36.8 vs. 64.7±22.6 pg/ml, p<0.001﹚，但是在此時，嗜伊紅性血球數目與嗜伊紅性血球陽離子蛋白卻又反彈至原本的血中數量與濃度；在口服性類固醇與吸入性類固醇與支氣管擴張劑治療過程中，病童的吐氣尖峰流速均逐步上升。血清嗜伊紅性血球陽離子蛋白的下降與嗜伊紅性血球數的下降呈現正相關﹙r2 =0.28, p=0.016﹚。但是eotaxin與PEF在吸入治療過程中並不具有相關性。
結論：在治療氣喘時血清eotaxin、嗜伊紅性血球總數與嗜伊紅性血球陽離子蛋白變化相異。由本研究結果可提出：比起嗜伊紅性血球數目與嗜伊紅性血球陽離子蛋白，血清eotaxin濃度可在氣喘緩解期當作Th2殘餘活性﹙residual activity﹚指標。由於eotaxin與PEF在吸入治療過程中並不具相關性，因此單以eotaxin濃度無法預估PEF的改變。

關鍵字

氣喘 ； 嗜伊紅性血球趨化激素 ； 嗜伊紅性血球 ； 嗜伊紅性血球陽離子蛋白 ； 吐氣尖峰流速

並列摘要

Background: Increased serum level of eotaxin is related to asthma severity in adult study. There is little data about pediatric asthma patients with regards to the effects of oral and inhaled corticosteroids on serum eotaxin, eosinophil cationic protein (ECP) concentrations and eosinophil counts.
Methods: We investigated prospectively the changes of serum level of eotaxin, eosinophil counts, and ECP after oral steroid for one week and then inhaled corticosteroids with a long–acting β2 agonist (Seretide) treatment for 2 months in the pediatric population. The data of serum eotaxin, ECP, and blood eosinophil count were collected. The peak expiratory flow (PEF) was used as outcome index and correlation study with previous inflammation markers was performed.
Results: The serum level of eotaxin persisted after one-week oral prednisolone treatment, but decreased after subsequent inhaled corticosteroids with a long–acting β2 agonist treatment (85.7±36.8 vs. 64.7±22.6 pg/ml, p<0.001). The eosinophil count and ECP declined soon after oral steroid treatment, but rebounded to the same level during inhaled treatment. The decline of ECP is positively correlated with the decline of eosinophil count while oral steroid treatment (r2 =0.28, p=0.016). There was no correlation between changes in eotaxin and PEF.
Conclusion: There is discrepancy of serum concentration of eotaxin, ECP and blood eosinophil count during the treatment of oral steroid and inhaled corticosteroids. Our data suggested that the serum eotaxin level, not eosinophil count or ECP, declined during inhaled corticosteroids with a long–acting β2 agonist treatment and might serve as a surrogate marker of Th2 residual activity in treating pediatric asthma. The concentration of eotaxin could not predict the changes of PEF.

並列關鍵字

asthma ； eotaxin, eosinophil, eosinophil cationic protein, peak expiratory flow

參考文獻

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