High-Sensitivity C-Reactive Protein Can Reflect Small Airway Obstruction in Childhood Asthma.
High-Sensitivity C-Reactive Protein Can Reflect Small Airway Obstruction in Childhood Asthma.
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DOI：
10.3349/ymj.2016.57.3.690
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发表时间：
2016-05
影响因子：
2.4
通讯作者：
Kim KE
中科院分区：
文献类型：
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作者：
Ko AR;Kim YH;Sol IS;Kim MJ;Yoon SH;Kim KW;Kim KE
高灵敏度分析使C反应蛋白(hs-CRP)能够在以前无法检测到的水平上被识别出来。我们的目的是通过比较hs-CRP与肺活量、脉冲振荡(IOS)参数和症状严重程度，来确定hs-CRP是否能反映儿童的呼吸道炎症。共有276名哮喘儿童在2012-2014年间到西弗兰斯儿童医院就诊。在同一天进行血清hs-CRP和肺功能检测。将患者分为hs-CRP阳性组和阴性组(临界值为3.0 mg/L)。276例哮喘患儿中，hs-CRP阳性39例，阴性237例，年龄中位数7.5(5.9/10.1)岁，其中男孩171例(62%)。在肺活量参数方面，我们观察到hs-C反应蛋白阳性组和阴性组的最大呼气中段流量、预计最大呼气中段流量百分比(FEF25-75)有显著差异(P=0.010)，且FEF25-75与hs-C反应蛋白呈负相关。Hs-C反应蛋白阳性组与阴性组之间的电抗面积(AX)(P=0.046)、5赫兹与20赫兹电阻之差(R5~R20)(P=0.027)、5赫兹电阻(R5)的预测值(R5)(P=0.027)、5赫兹的电抗值(X5)的预测值(X5)(P=0.041)均有显著差异。高敏C反应蛋白与R5(r=0.163，p=0.008)、X5(r=0.164，p=0.007)呈显著正相关。与hs-CRP相比，中性粒细胞水平较高的患者的肺活量测定和IOS参数更具相关性。Hs-CRP与FEF25-75、R5、X5显著相关。可反映儿童哮喘小气道阻塞，以中性粒细胞为主的炎症反应更为突出。
High-sensitivity assays enabled the identification of C-reactive protein (hs-CRP) at levels that were previously undetectable. We aimed to determine if hs-CRP could reflect airway inflammation in children, by comparing hs-CRP with spirometry and impulse oscillometry (IOS) parameters and symptomatic severities. A total of 276 asthmatic children who visited Severance Children's Hospital from 2012–2014 were enrolled. Serum hs-CRP and pulmonary function tests were performed on the same day. Patients were divided into hs-CRP positive and negative groups (cut-off value, 3.0 mg/L). Of the 276 asthmatic children [median age 7.5 (5.9/10.1) years, 171 boys (62%)], 39 were hs-CRP positive and 237 were negative. Regarding spirometry parameters, we observed significant differences in maximum mid-expiratory flow, % predicted (FEF25–75) (p=0.010) between hs-CRP positive and negative groups, and a negative correlation between FEF25–75 and hs-CRP. There were significant differences in the reactance area (AX) (p=0.046), difference between resistance at 5 Hz and 20 Hz (R5–R20) (p=0.027), resistance at 5 Hz, % predicted (R5) (p=0.027), and reactance at 5 Hz, % predicted (X5) (p=0.041) between hs-CRP positive and negative groups. There were significant positive correlations between hs-CRP and R5 (r=0.163, p=0.008), and X5 (r=0.164, p=0.007). Spirometry and IOS parameters had more relevance in patients with higher blood neutrophil levels in comparison to hs-CRP. Hs-CRP showed significant correlation with FEF25–75, R5, and X5. It can reflect small airway obstruction in childhood asthma, and it is more prominent in neutrophil dominant inflammation.