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Objective@#To investigate the clinical significance of asthma prediction index (API), Eotaxin(Eot), interleukin-4 (IL-4), interferon-γ (IFN-γ), eosinophil (Eos) in predicting recurrent wheezing in infants.@*Methods@#Ninety-six infants with first wheezing attack due to bronchiolitis from April 2015 to April 2016 at the Department of Pediatrics, the Second Hospital of Tianjin Medical University were selected.The medical history and other clinical data were collected, and the peripheral blood samples were collected to detect Eot, IL-4, IFN-γ, Eos count and serum specific immunoglobulin E(sIgE). Then all infants were followed up by telephone until 2-year-old to find whether recurrent wheezing attack occurred and then API was calculated.According to the recurrent wheezing times during the follow-up, they were divided into 2 groups: the observation group (recurrent attacks≥2 times, 33 cases) and the control group (no recurrent wheezing during follow-up, 60 cases). The infants in the observation group were divided into the API positive group (18 cases) and the API negative group (14 cases) according to API.The differences in clinical data and peripheral blood indexes were analyzed by independent sample t test for measuring data and χ2 test for counting data.@*Results@#Thirty-three cases (35.48%) infants in the study had recurrent wheezing attacks within 2 years followed by bronchiolitis.The average age of the recurrent wheezing attack was (13.59±5.89) months.Compared with the control group, the levels of serum Eot[(135.45±44.45) ng/L vs.(110.91±22.50) ng/L, t=3.44, P<0.05], IL-4[(58.56±43.55) ng/L vs.(34.91±12.18) ng/L, t=3.78, P<0.05] and peripheral blood Eos proportion(0.034 0±0.025 6 vs.0.003 3±0.006 4, t=4.56, P<0.05) increased in the observation group, and the differences were statistically significant.The food allergy history [18.18%(6/33 cases) vs.5.00%(3/60 cases), χ2=4.23, P<0.05]and the positive proportion of sIgE allergens[38.46%(10/26 cases) vs.9.09%(2/22 cases), χ2=5.48, P<0.05] increased, and the differences were statistically significant.There was no difference between the 2 groups in IFN-γ level (P>0.05). The level of serum Eot [(146.59±59.35) ng/L vs.(114.14±13.60) ng/L, t=3.71, P<0.05], airway sIgE[45.00%(9/20 cases) vs.0(0/6 case), χ2=4.13, P<0.05]and food allergens sIgE [50.0%(10/20 cases) vs.0(0/6 case), χ2=4.88, P<0.05)] in the API positive group was higher than that in the API negative group, and the differences were statistically significant.@*Conclusions@#The elevated serum Eot levels during the first asthmatic attack of bronchiolitis in infants and food sIgE positive levels suggest an increased risk of recurrent wheezing, and the elevated serum Eot levels and sIgE positive levels are associated with API positive levels.
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Objective To analyze the correlation between the fractional exhaled nitric oxide (FeNO) levels and blood eosinophil (EOS) count and the frequency of wheeze in infants with recurrent wheezing.Methods From February 2015 to August 2016 in the General Hospital of Northern War Zone,outpatient department of Pediatrics treatment and hospitalization of age less than or equal to 3 year old children with recurrent wheezing,101 cases were induded as the research object.On the basis of asthma predictive index (API) score were divided into API positive group (n =55) and API negative group (n =46),according to the wheeze frequency of the two groups children were divided into 3 ～ 4 times wheezing groups and more than 5 times.Select 37 cases of healthy children as control group.The concentration of FeNO and blood EOS count are detected in all the children.The correlation between the three groups of children with FeNO concentration,the correlation between FeNO and blood EOS count,the correlation between the the frequency of wheeze and FeNO in experimental groups were analyzed.Results (1) API positive group mean FeNO (19.3 ± 6.2) ppb was significantly higher than API negative group (7.7 ± 2.9) ppb,there was no difference (P ＞ 0.05).API negative group mean FeNO (7.7 ± 2.9) ppb is lower than the normal control group (9.5 ± 2.0) ppb,there was no difference (P ＞0.05).(2) API positive group mean EOS count (124.7 ± 1.6) x 106/L is higher than API negative group (86.1 ± 1.9) x 106/L,there was significant difference (P ＜ 0.01);(3) There was a correlation between FeNO level and blood EOS count in API positive group,there was no correlation between FeNO level and blood EOS count in API negative group and con~ol group.(4) No statistical differences were found in ≤4 times wheezing groups and more than 5 times of the mean FeNO.Conclusion There is no significant difference in the mean value of FeNO between different times of wheezing in children with recurrent wheezing.The combination of medical history,EOS,FeNO and API might be used to predict the wheezing episode of infants.
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Objective To discuss the polymorphisms of asthma susceptibility gene ORMDL3 in infantile wheezing,in order to provide a theoretical basis for early diagnosis of asthma.Methods One hundred and fifty wheezing infants were recruited and divided into 2 groups as asthma predictive index(API) positive group(n =80) and negative group (n =70).Taqman probe was applied to detect the genotypes of 2 single nucleotide polymorphisms (SNPs)in childhood asthma susceptibility gene ORMDL3,which were rs4794820 and rs7216389.The genotype distributions were analyzed and compared between 2 groups,and the correlations among genotype distribution and tidal breath pulmonary function,fractional exhaled nitric oxide (FeNO) concentration,percentage of eosinophils (EOS％),serum immune globulin E (total IgE) levels respectively were also analyzed,respectively.Results (1) The frequencies of rs4794820 AG and rs7216389 TC heterozygotes in the API positive group were the highest,which were significantly higher than those in the negative group(58.75％ vs.31.42％,56.25％ vs.32.86％ respectively,all P ＜0.01).The frequencies of GG and TT homozygotes in the API negative group were the highest,which were significantly higher than those in the positive group (58.57％ vs.30.00％,57.14％ vs.31.25％ respectively,all P ＜0.01).(2)The time to reach the peak expiratory flow in tidal breathing over the total expiratory time (TPTEF/TE) and the volume to reach the peak expiratory flow in tidal breathing over the total expiratory volume (VPEF/VE) of the infants in the API positive group were less than those in the API negative group(16.87 ±5.31 vs.20.12 ± 5.23,20.87 ± 5.92 vs.25.56 ± 6.77,respectively),and the FeNO concentration was higher than that in the API negative group [(22.44 ± 9.77) ppb vs.(13.23 ± 7.90)ppb],and the differences were significant (t =-3.776,-4.490,6.377,respectively;all P ＜ 0.01).(3) In the API positive group,the TPTEF/TE and VPEF/VE of the infants who expressed AG/TC genotype were lower than those who expressed GG/TT genotype (14.55 ± 4.83 vs.19.91 ± 4.17,18.85 ± 4.26 vs.25.20 ± 7.06,respectively,t =-4.727,-3.976,all P ＜ 0.01);while the FeNO concentrations,EOS％ and total IgE levels were higher than those who expressed GG/TT genotype [(25.02 ± 8.77) ppb vs.(18.39 ± 6.56) ppb,7.16 ± 2.62 vs.5.50 ± 1.34,(366 727 ±275 533) IU/L vs.(166 826 ± 62 865) IU/L,respectively] (t =3.484,3.409,4.589 respectively;all P ＜ 0.01).Conclusions Childhood asthma susceptibility gene ORMDL3 SNPs rs4794820 AG and rs7216389 TC heterozygotes are the risk factors for API positive infantile wheezing.The pulmonary function damage and airway inflammation of the infants who expressed AG/TC genotype are more serious than those who expressed GG/TT genotype,and more likely to develop persistent asthma.
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Objective To investigate the relationship between fractional exhaled nitric oxide (FENO) and asthma predictive index (API) in infants under 3 years of age. Methods Totally 62 cases (under 3 years of age) who were hospitalized from June 2015 to June 2016 and had more than 3 times wheezing over the past year were enrolled in this study. They were divided into two groups according to API:API positive group with 37 cases and API negative group with 25 cases. FENO levels and peripheral blood eosinophil levels were detected and skin prick allergy test (inhalation and ingestion of allergens)was done in all selected children, did skin prick allergy test (inhalation and ingestion of allergens), simultaneous detected peripheral blood eosinophil levels. The parents of the children were investigated by questionnaire to know the children′ history about atopic dermatitis (such as urticaria, eczema, etc) and parents′ wheezing history. Above information was recorded and statistics analysis was made. Results There were no significant differences between two groups in atopic dermatitis inhalation and ingestion of allergens (P<0.01 or <0.05). The level of FENO in API positive group and API negative group was (16.70 ± 11.07), (13.52 ± 11.01) ppb(1 ppb=1 × 10- 9 mol/L), and there was significant difference (P<0.01). Conclusions There are associations between FENO and API, and they have good reference value in predicting the risk of asthma.
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La lactancia materna es considerada el mejor alimento para el niño, aunque su relación con el desarrollo atopia en lactantes con sibilancias es controvertido.Objetivo: analizar la relación entre la lactancia materna, la exposición al humo de tabaco y la condición atópica en niños que presentan sibilancias persistentes en edad preescolar. Material y Métodos: Diseño retrospectivo, observacional, transversal Se incluiyeron 243 niños de entre 3 y 6 años con sibilancias persistentes estudiados en la División de Alergia e Inmunología del Hospital de Niños (2007-2011)...
Breastfeeding is considered the best food for the child, but its relationship to the development of atopy in infants with wheezing is controversial. Aim: to analyze the relationship between brestfeeding, cigarette smoke exposure and atopic status in preschool children with persistent wheezing. Material and Methods: Retrospective, observational, transversal design of 243 children aged 3 to 6 years with persistent wheezing studied in the Allergy and Immunology Division of Children's Hospital (2007-2011)...
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Niño , Lactante , Lactancia Materna , Preescolar , Estudios Transversales , Lactante , Ruidos Respiratorios , Estudios Retrospectivos , Contaminación por Humo de TabacoRESUMEN
PURPOSE: We compared the asthma predictive index(API) and the modified asthma predictive index (mAPI) of the Tuscon Children's Respiratory Study Group in Korean children with recurrent wheezing. We investigated the atopic profiles and presence of allergen sensitization of each risk group, and ascertained the significant clinical risk factors. METHODS: Two hundred and sixty two children, who visited for recurrent wheezing from 1998 to 2005, were enrolled and divided into groups by API and mAPI. We investigated the history of the patients and their families, atopic profiles, and sensitization to aeroallergen and food allergens. Twenty nine children were followed up to 6 years of age and we evaluated the sensitivity, specificity and positive and negative predictive value of both indices. RESULTS: The high risk group of API were of older age, were more likely to be sensitized to aeroallergen(P=0.001) and food allergen(P=0.034) and had higher levels of total eosinophil count, eosinophil percent, serum ECP, total IgE, and D.p-, D.f-specific IgE. High risk group of mAPI showed higher levels of atopic markers such as egg-, milk-, D.p- and D.f-specific IgE. Even though API did not include allergen sensitization, the high risk group was more significantly sensitized to common allergens than the low risk group. Twenty nine children were followed up until 6 years of age; therefore 15 children were diagnosed as asthma, clinically. The sensitivity, specificity, positive and negative predictive values of mAPI were higher than API. CONCLUSION: Both high risk groups of API and mAPI had higher levels of atopic markers and were more sensitized to common allergens. These findings suggest that sensitization to aeroallergens and food allergens are more objective markers as asthma predictive indices. In addition, mAPI is a more reliable index in predicting asthma in Korean children with recurrent wheezing than is API. But only 29 patients were followed until the age of 6, so we need to include more children with long term follow up for future study.