Effects of dermatophagoides pteronyssinus allergen-specific immunotherapy on the serum interleukin-13 and pulmonary functions in asthmatic children / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Airway remodeling is the specific pathological characteristics of asthma, which is related to the clinical symptoms, pulmonary function, and airway hyperreactivity. This study aimed at exploring the effects of dermatophagoides pteronyssinus allergen-specific immunotherapy (SIT) on the serum interleukin (IL)-13 and pulmonary functions in asthmatic children.</p><p><b>METHODS</b>Fifty-eight pediatric asthma patients allergic to dust mite participated in this study. Thirty-five children received SIT with a standardized dermatophagoides pteronyssinus extract for one year (SIT group), and the other 23 children treated with inhaled corticosteroids (ICS group) according to the Global Initiative for Asthma (GINA) for one year. Serum levels of IL-13, IL-4 and interferon (IFN)-gamma were examined and the pulmonary functions were checked before and after the treatment.</p><p><b>RESULTS</b>After the treatment, the number of emergency visiting for asthma attack in SIT group was significantly less than that in ICS group. The serum levels of IL-4 and IL-13 were clearly reduced, IFN-gamma and the ratio of IFN-gamma/IL-4 were significantly increased, the pulmonary functions (forced vital capacity (FVC), forced expiratory volume in one second percentage (FEV(1)%) and peak expiratory flow percentage (PEF%) were significantly improved in the SIT group. Meanwhile, IFN-gamma and the ratio of IFN-gamma/IL-4 were greatly increased, but serum levels of IL-4 and IL-13 had less changes, the pulmonary functions (FVC, FEV(1)% and PEF%) were poorly improved in ICS group. The basic pulmonary functions in both groups were at the same level, which had made more improvement in SIT group than in ICS group one year later.</p><p><b>CONCLUSIONS</b>One year of dermatophagoides pteronyssinus SIT can significantly reduce the frequencies of emergency visiting for asthma attack and improve the pulmonary functions of children with allergic asthma, and that is attributed to SIT, which can reduce the levels of IL-4 and IL-13 and regulate the imbalance of the Th1/Th2 cells in asthmatic children. All of these might be effective in preventing the asthmatic airway from remodeling.</p>

Effects of Dermatophagoides pteronyssinus allergen-specific immunotherapy on the prognosis of asthmatic children / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effects of Dermatophagoides pteronyssinus allergen-specific immunotherapy (SIT) on the prognosis of asthmatic children.</p><p><b>METHODS</b>Sixty-five children with established diagnosis of allergic asthma to dust mite were enrolled in this study, of whom 42 children received treatment with standardized SIT for 12 month and the other 23 served as the control group with inhaled corticosteroids according to Global Initiative for Asthma (GINA). The serum levels of interleukin-4 (IL-4) and interferon-gamma (IFN-gamma) were detected and the pulmonary functions examined before and after the one-year treatment in all the patients.</p><p><b>RESULTS</b>After the one-year treatment with SIT, the asthmatic children showed obviously reduced serum levels of IL-4, significantly increased IFN-gamma levels and the IFN-gamma/IL-4 ratio (P<0.05), and markedly improved pulmonary functions (FVC, pre-FEV1% and pre-PEF%) (P<0.05). In the control group, the children exhibited significantly increased IFN-gamma levels and IFN-gamma/ IL-4 ratio (P<0.05) without obvious reduction of serum IL-4 levels or pulmonary function improvement (P>0.05). With comparable basic pulmonary functions in the two groups before the treatment, the children in SIT group showed significantly greater improvement in the pulmonary functions than those in the control group after the one-year treatment.</p><p><b>CONCLUSION</b>The one-year treatment with SIT can significantly improve the pulmonary functions of children with allergic asthma, and this effect is attributed to the regulation of Th1/Th2 cell balance and inhibition of asthmatic airway remodeling by SIT.</p>

The role of serum leptin in infants with wheezing after respiratory syncytial virus infected / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To determine the role of serum leptin in infants with wheezing after respiratory syncytial virus infected.</p><p><b>METHODS</b>43 infants infected with RSV were given blood samples to detect leptin concentration with radioimmunoassays (RIA) within 24 hours after admission into hospital, discharged and 12 weeks later. Then, they were followed up for 2 years. 10 healthy children of the same age served as controls.</p><p><b>RESULTS</b>41.9% infants developed asthma after infected with RSV. Compared to control group, the serum level of leptin in the asthma group and non-asthma group were significantly higher before treatment (t = 3.41 and 2.64 respectively, P < 0.05). When they were discharged, the serum level of leptin in the asthma group was significantly higher than that in non-asthma group and control group (t = 5.74 and 6.23, respectively, P < 0.05). 12 weeks later, the serum level of leptin in the asthma group was still significantly higher than that in non-asthma group and control group (t = 6.32 and 6.11, respectively, P < 0.05), but there were no difference between non-asthma group and control group (t = 0.81, P > 0.05).</p><p><b>CONCLUSION</b>The serum level of leptin in infants with asthma after RSV infected was higher than that in healthy and non-asthma children. Persistent higher level of leptin may play an important role in infants with asthma after RSV infected.</p>

Significance of changes of T lymphocytes subsets in children with infectious mononucleosis and the effects of different interventions / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To investigate changes of T lymphocytes subsets in children with infectious mononucleosis (IM) and the effects of different interventions.</p><p><b>METHODS</b>Forty-eight children with IM were enrolled, 28 cases were assigned to the group treated with intravenous immunoglobulin (IVIG) 400 mg/(kg x d) for 5 continuous days or IVIG 1 g/(kg x d) for 2 continuous days, the remaining 20 cases were treated with ganciclovir (GCV) 5-10 mg/(kg x d) for 5 consecutive days. All these children were given general supportive therapies. Twenty healthy children from healthcare clinic serviced as control group.</p><p><b>RESULTS</b>CD4 (%), CD8 (%) and the CD4/CD8 ratio in healthy control group were (34.12 +/- 3.53)%, (26.22 +/- 4.43)% and (1.41 +/- 0.3), in IVIG group were (24.2 +/- 4.3)%, (36.4 +/- 6.8)% and (0.72 +/- 0.12), and in GCV group were (23.7 +/- 5.1)%, (37.3 +/- 7.8)% and (0.67 +/- 0.13), respectively. CD4 (%), CD8 (%) and the ratio CD4/CD8 in the control group were significantly different from those in both groups with IM (P < 0.05). Compared with pre-treatment levels, the 28 cases treated with IVIG had significant improvement, the CD4 (%) increased, CD8 (%) decreased and the ratio of CD4/CD8 increased after treatment (P < 0.05). However, 20 cases in GCV treatment group made less changes (P > 0.05) . Meanwhile, the clinical symptoms and signs in the IVIG group were improved faster than that in the GCV group (P < 0.05). The rate of remission in IVIG group was 88.7% vs. 59.2% of GCV group (P < 0.05); the hospital days in IVIG group were (9.2 +/- 4.3) days vs. (13.8 +/- 5.1) days in the GCV (P < 0.05).</p><p><b>CONCLUSION</b>It is indicated that the subsets of T lymphocytes in peripheral blood are obviously abnormal in children with IM caused by EBV infection in acute phase. IVIG can regulate the immunological derangements of T lymphocytes subsets, on which anti-viral therapy alone may have little impact.</p>

Analysis of the risk factors of pulmonary fungal infections related to mechanical ventilation and prognosis of the patients / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the risk factors of pulmonary fungal infections related to mechanical ventilation and the prognosis of patients.</p><p><b>METHODS</b>A retrospective case-controlled study was conducted to analyze the culture results of the pulmonary secretions in patients with pulmonary fungal and nonfungal infections in association with mechanical ventilations. The risk factors of pulmonary fungal infections related to mechanical ventilation were identified and their impact on the clinical outcome of the patients was evaluated.</p><p><b>RESULTS</b>Of the 127 patients included in this study, 81 (63.78%) were positive and 46 (36.22%) negative for pulmonary fungal infections according to the diagnostic criteria of ventilator-associated pneumonia (VAP). The mortality of the patients with fungal infection was 82.7%, significantly higher than that of patients with non-fungal infection (67.39%, chi2=3.910, P<0.05). Univariate analysis and multivariate logistic regression showed that such factors as old age, duration of mechanical ventilation, tracheal intubation or incision for over 7 days, diabetes, blood glucose over 6.1 mmol/L, multi-organ dysfunction, combined use of antibiotics, at least 3-time changes antibiotics, administration of glucocorticosteroid for over 7 days, and immunodepressant use were all the independence risk factors of pulmonary fungal infection related to mechanical ventilation. Old age, multi-organ dysfunction, blood glucose over 6.1 mmol/L, glucocorticosteroid use for over 7 days, anesthetic use for over 3 days and high APACHE III scores were the risk factors for mortality in patients with the infections.</p><p><b>CONCLUSIONS</b>Pulmonary fungal infection associated to mechanical ventilation is often the results of presence of multiple risk factors, and early identification of these factors for timely antifungal treatment may improve the prognostics of the patients and help reduce the mortality rate.</p>

Efficacy of pulmicort suspension plus salbutamol and ipratropium bromide for management of acute asthma exacerbation in children: a comparative study / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the efficacy of 3 commonly used protocols for management of acute exacerbation of asthma in children.</p><p><b>METHODS</b>Totally 113 asthmatic children were randomized into 3 groups. In group A (53 cases), the children were treated with inhalation of nebulized budesonide suspension plus salbutamol and ipratropium bromide twice daily for 5 days; in group B (41 cases), budesonide plus salbutamol and ipratropium aerosol was administered, and in group C (29 cases), dexathmisone plus aminophylline injection was given once daily for 5 days. All the children received basic treatment with fluid infusion, antibiotics or/and anti-virus medications.</p><p><b>RESULTS</b>The children in both groups A and C showed effectively controlled asthma attack, with significant differences in the therapeutic effects (P>0.05). In contrast, only a few children showed improvement in group B, suggesting the ineffectiveness of the treatment.</p><p><b>CONCLUSION</b>Nebulized medicine is one of the best means for management of acute asthma exacerbation in children, and inhalation of budesonide suspension plus salbutamol and ipratropium bromide can effectively relieve the asthmatic symptoms in these children with good compliance and convenient administration.</p>

Immunoregulants improves the prognosis of infants with wheezing / 南方医科大学学报

<p><b>OBJECTIVE</b>To assess the value of immunoregulants in improving the prognosis of infants with wheezing.</p><p><b>METHODS</b>Forty-three infants with wheezing with given oxygen support, injection or inhalation of glucocorticosteroids or bronchodilatator to relieve the symptoms. Of these infants, 24 received immunoregulant treatment with bronchovaxom at the daily dose of 3.5 mg for 10 days every a month for a treatment course of 3 months. The other 19 infants were managed with budesonide aerosol at 200 microg once or twice daily for 3 months (basic treatment group). All the infants were followed up for 1 year to record the number of wheezing episode and infections. Ten healthy infants were also included in this study as the control group.</p><p><b>RESULTS</b>In infants with bronchovaxom treatment, 25% reported more than 3 wheezing episodes within the 1-year follow-up, a rate significantly lower than that in the control group (63.2%, Chi(2)=6.344, P<0.05). The episodes of respiratory infection were similar between bronchovaxom group and the healthy control group (t=0.72, P>0.05), but significantly higher in the basic treatment group than in bronchovaxom and the healthy control group (t=3.11 and 3.92, respectively. P<0.05).</p><p><b>CONCLUSIONS</b>Bronchovaxom can effectively reduce the recurrence of wheezing and respiratory infections in the infants with wheezing attack to reduce the risks of asthma development.</p>

Detection of serum Th1 and Th2 cytokines and its significance in neonates with cytomegalovirus pneumonia / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To investigate changes in the levels of Th2 cytokine interleukin-4 (IL-4), Th1 cytokine interferon-gamma (IFN-gamma), and TNF-alpha in serum of newborn infants with cytomegalovirus (CMV) pneumonia.</p><p><b>METHODS</b>Twenty-five neonatal cases who were positive for serum IgM antibody to CMV by ELISA were divided into IVIG intervention group and ganciclovir intervention group, and 15 healthy neonates were enrolled into the control group. The levels of IL-4, IFN-gamma, and TNF-alpha were detected by using double antibody ELISA for the control group and the intervention groups at the beginning and end of treatment.</p><p><b>RESULTS</b>The levels of IFN-gamma and TNF-alpha in patients with CMV pneumonia were higher than that in the healthy neonates, while the levels of IL-4 were lower(t= 2.65 and 3.16, p less than 0.05). The level of IL-4 in patients with CMV pneumonia was significantly lower than that of the healthy neonates (t= 2.49, p less than 0.05). There was no significant difference in the levels of IFN-gamma, IL-4 and TNF-alpha between IVIG intervention group and ganciclovir intervention group at the beginning of treatment (t= 1.85, 1.71, 1.76, p greater than 0.05). In IVIG intervention group, the levels of IFN-gamma and TNF-alpha significantly decreased after treatment (t=3.98, 5.16, p less than 0.01), the level of IL-4 in this group was higher than that before treatment (t= 2.55, p less than 0.05). In ganciclovir group, the level of IFN-gamma and TNF-alpha did not change after treatment (t=1.75, 1.16, p greater than 0.05), the level of IL-4 in this group was higher than that before treatment (t= 2.39, p less than 0.05).</p><p><b>CONCLUSION</b>There seems to be an imbalance of Th1 and Th2 cytokines secretion in the infants with CMV pneumonia and, which may lead to immune-inflammation injury. IVIG can regulate imbalanced Th1/Th2 activities, therefore, immunomodulatory treatment should be applied besides antiviral therapy.</p>

Effect of leukotriene receptor antagonist on the levels of Th1 and Th2 cytokines in sera of infants with respiratory syncytial virus pneumonia / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To investigate the effects of leukotriene receptor antagonist on the levels of Th1 and Th2 cytokines and the serum cysteinyl leukotrenes (CysLTs) in infants and young children with respiratory syncytial virus (RSV) pneumonia.</p><p><b>METHODS</b>Thirty-seven infants and young children with RSV pneumonia were divided into two groups after discharge. The cases in group 1 (n=24) were treated with a leukotriene receptor antagonist, Singulair 4 mg once daily for 12 weeks; the cases in group 2 (n=13) were treated with budesonide aerosol 200 ug once or twice daily for 12 weeks. The serum CysLTs, IFN-gamma and IL-4 were detected with enzyme_linked immunosorbent assays (ELISA) for all the 37 cases, and 10 healthy infants of the same age served as controls.</p><p><b>RESULTS</b>The serum CysLTs level in the cases with RSV pneumonia was significantly higher than that in controls (P<0.05). There was an imbalance in expression of Th1 and Th2 cytokines (IFN-gamma and IL-4 ) in these cases. Both Singulair and budesonide aerosol could correct the imbalance of Th1 and Th2 cytokines. The serum CysLTs level declined after treatment with Singulair in 24 cases, but no significant change occurred after treatment with budesonide aerosol in the remaining 13 cases.</p><p><b>CONCLUSIONS</b>The serum CysLTs level in children with RSV pneumonia was higher than that in healthy children, and there was an imbalance of Th1 and Th2 cytokines in these infants, which was similar to those with asthma. Leukotriene receptor antagonist may be effective in preventing children with RSV pneumonia from evolving into asthma.</p>

Effects of BCG-PSN injection on immune and lung function of asthmatic children complicated with allergic rhinitis / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To investigate the effect of polysaccharide nucleic acid of BCG (BCG-PSN) injection on immune and pulmonary function in asthmatic children complicated with allergic rhinitis.</p><p><b>METHODS</b>Thirty-seven cases were separated at random into two groups, the BCG-PSN group (17 cases) was treated with BCG-PSN plus inhaled glucocortisteriods, and the control group (20 cases) was treated with inhaled glucocortisteriods only. The children in both groups were followed up for 6 months to record their lung function, allergic rhinitis scores, frequency of asthmatic attacks and respiratory infection. The levels of interleukin (IL)-4, interferon-gamma (IFN-g) and plasma total IgE were detected by using double antibody sandwich ELISA at the beginning and the end of treatment.</p><p><b>RESULTS</b>In comparison with the control group, after treatment, the levels of IFN-g and the ratio of IFN-g/IL4 in the BCG-PSN group significantly increased, whereas the level of IL-4 and the plasma total IgE significantly decreased (P less than 0.05), while those of the control group had no significant change. The lung function of both groups had significant improvement (p less than 0.05). The frequencies of asthmatic attacks in BCG-PSN and control groups were 0.81 +/- 0.20 vs. 1.72 +/- 0.80, and the difference was statistically significant. The frequencies of respiratory tract infection in BCG-PSN and control groups were 1.15 +/- 0.55 vs. 3.21 +/- 0.73, the difference was significant.</p><p><b>CONCLUSION</b>BCG-PSN may be able to correct the imbalance of Th1/Th2 and improve the lung function of children with asthma complicated with allergic rhinitis, which suggest that the immune adjusting treatment should be emphasized besides anti-inflammation therapy.</p>

Correlation between plasma leptin level and premature infant weight loss / 中华儿科杂志

<p><b>OBJECTIVE</b>Leptin is an adipocyte-derived hormone regulating body weight and energy balance in animals and human being. Although the physiological functions of leptin in human are still unclear, its secretion is closely related to fat mass and energy expenditure in both adults and children. This study investigated whether the plasma leptin level was reduced in connection with the weight loss during the neonatal period and try to find out the role of leptin in body weight regulation and energy balance of premature infants.</p><p><b>METHODS</b>The radioimmunoassay was used to determine the plasma leptin concentration. The first blood samples were obtained at the delivered, and then collected the samples every two days until the infants' body weight recovered to the birth weight or above. At the same time, the essential fluid and energy for the patients were supplied to keep their physiological functions. One person was appointed to take responsibility to examine the body weight, body length and head circumference. Then computed out their Kaup index from the first day to the seventh or twelfth day.</p><p><b>RESULTS</b>A total of 26 premature infants were selected into the study, of which 14 cases were male and 12 female, and their gestational age ranged from 30 to 36 weeks. There was a significantly positive correlation between the premature newborns' body weight loss and their plasma leptin levels (the 1st day: n = 26, r = 0.766; the 3rd day: n = 26, r = 0.636; the 5th day: n = 26, r = 0.629; the 7th day: n = 26, r = 0.717; the 9th-12th day: n = 24, r = 0.587; P < 0.01). The time of body weight loss and the plasma leptin level which declined to extremely low were positively correlated. (r = 0.611, P < 0.01). The time when body weight loss declined to extremely low in 26 premature infants ranged form the 3rd to the 9th day after birth [(5.2 +/- 1.6) day], and that of the plasma leptin levels ranged form the 3rd to the 8th day after birth (4.7 +/- 1.4) day. The maximal ranges of the body weight loss and the plasma leptin decrease in 26 premature infants were (6.5 +/- 3.0)% and (59.6 +/- 11.3)%, respectively. In addition, there were significantly positive correlations among the plasma leptin level, the premature newborns' body length (the 1st day: n = 26, r = 0.609, P < 0.01; the 3rd day: n = 26, r = 0.419, P < 0.05; the 5th day: n = 26, r = 0.583, P < 0.01; the 7th day: n = 26, r = 0.626, P < 0.01; the 9th-12th day: n = 24, r = 0.482; P < 0.05), and the Kaup index (the 1st day: n = 26, r = 0.634; the 3rd day: n = 26, r = 0.534; the 5th day: n = 26, r = 0.542; the 7th day: n = 26, r = 0.611; the 9th-12th day: n = 24, r = 0.539; P < 0.01). Although the head circumference correlated positively with the plasma leptin level at the first week after the delivery (the 1st day: n = 26, r = 0.580, P < 0.01; the 3rd day: n = 26, r = 0.417, P < 0.05; the 5th day: n = 26, r = 0.426; P < 0.01). There was a lower correlation between them one week after the delivery (the 7th day: n = 26, r = 0.369; the 9th-12th day: n = 24, r = 0.323; P > 0.05).</p><p><b>CONCLUSION</b>There was a significantly positive correlation between the plasma leptin level and the premature newborns weight loss. Leptin may participate in the regulation of energy balance and body weight of premature infants during neonatal life. Leptin may play an important role in growth and development of premature infants.</p>