Application of asthma predictive index-based group therapy in wheezing children under 5 years of age / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the application value of asthma predictive index (API)-based group therapy in wheezing children under 5 years of age.</p><p><b>METHODS</b>A total of 239 wheezing children under 5 years of age were divided into API-positive (n=126) and API-negative groups (n=113). Each group was randomly assigned to inhaled corticosteroids (ICS) subgroup and montelukast sodium (leukotriene receptor antagonist, LTRA) subgroup. The ICS and LTRA subgroups received the same drug therapy at the same dosage within the first four weeks of treatment. In the stable period of disease, the ICS subgroup only received aerosol inhalation of budesonide suspension, while the LTRA group was orally given montelukast sodium only. Asthma symptom scores were assessed and recorded at different time points.</p><p><b>RESULTS</b>In the first four weeks of treatment, ICS and LTRA were effective both in the API-positive and API-negative groups; the two groups showed significant improvements in asthma symptom scores, and the asthma symptom score showed no significant difference between the ICS and LTRA subgroups of each group. After 24 weeks of treatment, the two therapies were still effective; in the API-positive group, the LTRA subgroup had a better treatment outcome than the ICS subgroup, but there was no significant difference in treatment outcome between the LTRA and ICS subgroups of the API-negative group.</p><p><b>CONCLUSIONS</b>For wheezing children under 5 years of age, therapeutic strategies can be chosen based on API in the stable period of disease, so as to better control wheezing.</p>

Changes of natural killer T cells levels in peripheral blood of children with asthma and clinical significance / 中华实用儿科临床杂志

Objective To study the changes of natural killer T cells (NKT cells) in peripheral blood and the ability of NKT cells to proliferate in response to alpha-galactosyl ceramide (α-Galcer) in children with asthma.Methods Fifty-two asthmatic children who were diagnosed by Pediatric Clinic of Renji Hospital Affiliated to Shanghai Jiaotong University Medical College from Feb.2009 to Mar.2012 were selected as asthmatic group (26 cases in intermittent group,14 cases in mild persistent group and 12 cases in moderate persistent group).Twenty healthy children were selected as healthy control group.Peripheral blood mononuclear cells were collected by way of density gradient centrifugation method from blood samples.The ratio of peripheral blood NKT and CD4 + NKT cells were assessed by immunolluorescence and flow cytometry assays.The relationships between the NKT cells number,CD4 + NKT cells and atopic indexes such as the total IgE,eosinophil cationic protein (ECP) and the severity of asthma were investigated.The levels of IFN-γ,IL-4,IL-10 in peripheral blood were measured by enzyme-linked immunosorbent assay after proliferate in response to α-Galcer.The data were analyzed by using statistics software.Results Compared with healthy control group,the ratio of peripheral blood NKT and CD4 + NKT cells in asthmatic patients were significantly decreased (all P ＜0.01) ; There were no significant differences in asthmatic patients among the subgroups in terms of severity (P ＞ 0.05).There was no significant correlation between the NKT cells,CD4 + NKT cells and atopic indexes such as the total IgE and ECP(all P ＞ 0.05).The level of IL-4 in serum secreted by NKT cells in asthmatic group was significantly higher than that of healthy control group (P ＜0.01) ;The level of IL-10 in serum secreted by NKT cells in asthmatic group was decreased significantly (P ＜0.01) ;There was no significant difference in IFN-γ secreted by NKT cells between the asthmatic group and healthy control group (P ＞ 0.05).Conclusion The pathogenesis of asthma may be related to the ratio and dysfunction of NKT cells and CD4 + NKT cells.

Levels of serum interleukin-15 and the expression of T-helper lymphocyte subsets in peripheral blood of children with juvenile rheumatoid arthritis / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the changes of serum interleukin-15 (IL-15) levels and the expression of CD4(+)T (T-helper lymphocyte) subsets CD4(+)CD45RA(+) and CD4(+)CD45RO(+) in peripheral blood of children with juvenile rheumatoid arthritis (JRA).</p><p><b>METHODS</b>The serum concentration of IL-15 was detected using ELISA in 39 children with JRA. The expressions of CD4(+)CD45RA(+)T and CD4(+)CD45RO(+)T in peripheral blood were detected by flow cytometry in 24 out of the 39 patients with JRA. Twenty-six age and sex-matched healthy children were used as the Control group.</p><p><b>RESULTS</b>The mean serum IL-15 level in JRA patients was significantly higher than that in controls (1.37 +/- 0.98 pg/mL vs 0.96 +/- 0.41 pg/mL, P <0.05). Among the 39 JRA patients, the serum IL-15 level in 17 patients with systemic JRA increased remarkably (P < 0.01), but not in patients with the other two types of JRA, the oligoarthritis and polyarthritis (n=13, n=9, respectively), compared with that in controls. The mean serum IL-15 level of the JRA patients was significantly reduced after conventional treatment (P < 0.01). The serum IL-15 level in JRA patients positively correlated with white blood cell count (r=0.347, P <0.05) and C reactive protein (r=0.452, P < 0.01) but not with the erythrocyte sedimentation rate. The patients with high serum IL-15 levels (> or = medium level 1.73 pg/mL) had higher expression of CD4(+)CD45RO(+)T than those with low serum IL-15 levels (< medium level) (16.29 +/- 5.46% vs 11.75 +/- 3.15 %, P < 0.05).</p><p><b>CONCLUSIONS</b>The serum IL-15 levels in JRA patients increased significantly. An increased IL-15 level can transform CD45RA into CD45RO in peripheral blood of patients with JRA, and then result in T lymphocyte activation and mediate the immunopathological impairment. IL-15 may be used a marker for the evaluation of severity of JRA.</p>

Thirty-Nine Children with Refractory Systemic Juvenile Idiopathic Arthritis Treated by Glucocorticoid / 实用儿科临床杂志

Objective To investigate clinical characteristics of refractory systemic juvenile idiopathic arthritis(JIA)and the efficiency of glucocorticoid in therapy on this kind of disease.Methods Thirty-nine children with systemic JIA were divided into low dose group 0.5-1.0 mg/(kg?d)and high dose group 1.0-1.5 mg/(kg?d).And the efficiency was observed by change of active index after 10 and 20 days.Results The effective power was 58.8% and 72.7% after 10 days,respectively.After 20 days,the power was 76.5% and 90.9%,respectively.The power in high dose group was significantly higher than that in low dose group.It had no difference in statistical analysis for efficiency of 2 kind of glucocorticoid dosage to control fever,but it had obvious difference to control arthralgia,arthrocele,erythrocyte sedimentation rate(ESR),C-reactive protein(CRP).Conclusion Glucocorticoid therapy is very effective to control the activity of disease in patients with systemic JIA.