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"Child`s Health" 1 (52) 2014

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On verification of atopic phenotype in children with asthma

Authors: Belashova O.V., Marusik U.I. – Bukovina State Medical University, Department of Pediatrics and Pediatric Infectious Diseases Ukraine, Chernivtsi

Categories: Pediatrics/Neonatology

Sections: Specialist manual

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Introduction. According to current literature, the implementation of inflammation in bronchial asthma (BA) leading value with eosinophilic and neutrophilic granulocytes blood. Inflammatory properties of these cells are shown by major cytotoxic substances that they produce, namely cationic protein, peroxidase. Content cationic protein, peroxidase can associate degree with activation key proinflammatory cells of allergic inflammation, as well as the severity and severity of inflammation in the airways. However, the study focuses more on the definition of data cytotoxic substances in serum than their intracellular contents.

Since asthma in childhood often has features of atopic phenotype is more about improving the functional activity of eosinophils in the presence of atopic reactivity. However, according to other sources, in the form of atopic asthma had been declining functionality of eosinophilic granulocytes, due to the exhaustion of their metabolic capacity for allergen stimulation.

Pathogenetic role of neutrophils as one of the effector cells are more significant in the development of neatopichnoho phenotype asthma trigger factor in the numerous infectious agents. In modern literature insufficient coverage of the issue of the role of the degree of metabolic activity of neutrophilic leukocytes in the blood of atopic and neatopichnoho phenotypes of asthma in children. There is speculation that neutrophilic inflammation is associated primarily with early-onset asthma phenotype and the development of asthma early and late start immediately inflammation is neutrophil – eosinophilic features.

Purpose – to establish the diagnostic values of metabolic activity of blood granulocytes (eosinophils, neutrophils) in the verification of atopic phenotype of asthma in children.

Material and methods. To achieve this goal involved two clinical groups. First (I, purchase of group) group formed 38 children with atopic asthma (presence of positive allergy personal and / or family history), the clinical group II included 26 patients with asthma neatopichnoyu.

As indicators of the functional state of neutrophilic and eosinophilic leukocytes, determined their phagocytic activity (PA, %) and phagocytic number (PN, cu) according to the method Mosyahinoyi E.N. Intracellular eosinophilic and neutrophilic cationic protein (cu) was determined by the method of V.E. Piharevskiy, peroxidase (cu) – the method of Graham – Knoll. Work carried out in accordance with the requirements of a randomized comparative study in parallel groups on an "experiment -control." The results are analyzed by biostatistics and clinical epidemiology.

Results. The representatives of both groups showed a reduction in monitoring the content of cationic proteins and reduced levels of peroxidase activity in eosinophilic and neutrophilic leukocytes blood. This fact may be due to degranulation of these cells in the allergic stimulation is in the systemic circulation.

Thus, in patients with clinical group I the average content of neutrophil cationic proteins and peroxidase was – 0,18 ± 0,02 cu and 1,35 ± 0,1 cu, while the patients in the comparison – 0,13 ± 0,01 and 1,15 ± 0,21 cu (p > 0,05). Despite the absence of probable differences between the above parameters in the comparison group, the children with nonatopic asthma, tendency to reduction of neutrophil cationic proteins and peroxidase. This coincides with published reports of the primary role of these leukocytes in inflammation in nonatopic asthma in childhood.

Intracellular eosinophilic cationic protein (EKP) and peroxidase (EP) in patients in group I was under surveillance 0,15 ± 0,06 and 1,38 ± 0,37 cu, while the comparison group members – 0,20 ± 0,08 and 1,53 ± 0,18 cu (p > 0,05). Despite the lack of significant difference for mean values in patients in group I traced clear trend towards reduction of EKB and EP. Thus, the proportion of patients of the group in which the intracellular content of EKB was less than medium grup value figure reached 60,0 ± 3,2%, and among the comparison group – 51,3 ± 4,2 % (p > 0,05). Proportion of patients in group I, in which the activity of EP was less than medium grup value figure was 43,1 ± 3,6 %, while among the group II –  40,1 ± 4,2 % (p > 0,05).

Evaluation of phagocytic activity of neutrophilic and eosinophilic granulocytes in the blood of clinical observation groups. In children, the comparison group is not established probable differences in terms of phagocytic activity (PA) neutrophils, which in clinical group I ranged from 65  % to 95 % (mean – 79,7 ± 6,5 %), while in group II - from 32 % to 99 % (mean – 81,5 ± 8,1 %) (p < 0,05). For nonatopic asthma phenotype maximum and minimum values of phagocytic neutrophils numbers were slightly higher compared with those in group I patients observation that may be explained by the presence of neutrophil inflammatory response pattern of the organism in neatopichniy asthma and is consistent with some literature reports. Evaluation of phagocytic activity of eosinophilic granulocytes in the blood of most observations in children with atopic asthma phenotype parameters FA and FN eosinophils were significantly lower relative to patients with nonatopic asthma, which may indicate a functional exhaustion of blood granulocytes data.

The value of FA blood eosinophils less than 60 % and FN – less than 2,0 cu in complex application had relatively low rates of diagnostic value in the verification of atopic asthma. Thus, the sensitivity of this test was integrated – 63,3 %, specificity 70 %, positive predictive value – 74,5 %, negative predictive value – 56,8 %. However, clinical and epidemiological risk of having atopic asthma in these values phagocytic activity of blood eosinophils are: BP –3, 8 [95% CI, 2,1–6,9, p < 0,05], odds ratio – 1.7 [CI, 95%, 1,2–2,4, p < 0,05], attributive risk – 30 %, which suggests the feasibility of using this integrated test to verify atopic asthma and improve individualized treatment of inflammatory base.

Conclusions. 1. With the development of atopic asthma phenotype in childhood marked tendency to decrease intracellular cytotoxic basic substances (eosinophilic cationic protein, peroxidase) eosinophilic granulocytes in the blood.

2. Decreasing phagocytic activity (less than 60 %) and phagocytic number (less than 2.0 cu) eosinophilic granulocytes blood is associated with significantly higher risk of having atopic asthma in children.

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