目的 研究维生素A营养状况对学龄前支气管哮喘患儿T淋巴细胞亚群、相关细胞因子及预后转归的影响,为支气管哮喘防治提供理论依据。方法 收集2017年6月-2019年6月鄂东医疗集团黄石市妇幼保健院收治的学龄前支气管哮喘患儿120例的临床资料(病例组),同期选择本院体检的健康的学龄期儿童80例对照组。将病例组按照住院期间维生素A营养状况分为维生素A正常组、维生素A边缘缺乏组、维生素A缺乏组。比较病例组和对照组维生素A营养状况,并记录不同维生素A状况组干预前后T淋巴细胞亚群、相关炎症介质及预后转归。结果 病例组维生素A水平[(0.73±0.32)μmol/L]显著低于对照组[(1.02±0.23)μmol/L](t=5.957,P＜0.05),且病例组维生素A营养状况显著差于对照组(Z=4.865,P＜0.05),维生素A缺乏组治疗后的CD4+、CD4+/CD8+均低于另外两组,CD8+高于另外两组,差异有统计学意义(P＜0.05)。维生素A缺乏组治疗后的hs-CRP、EOS、IL-6高于另外两组,差异有统计学意义(P＜0.05)。三组治疗临床疗效比较差异有统计学意义(χ2=13.165,P＜0.05),其中以维生素A缺乏组临床疗效最差(52.17%),维生素A正常组最高(94.74%)。结论 维生素A边缘缺乏或缺乏在学龄前支气管哮喘患儿中较为常见,对患儿细胞免疫功能、炎症反应的改善及疾病的预后转归造成不良影响,临床应当加强患儿维生素A的监测,适时酌情补充维生素A制剂以改善患儿预后。
Abstract
Objective To investigate the effect of vitamin A nutrition on T lymphocyte subsets, related cytokines and prognosis in preschool children with asthma, in order to provide theoretical evidence for the prevention and treatment of bronchial asthma. Methods A total of 120 preschool children with bronchial asthma admitted to Huangshi Maternal and Child Health Hospital of Edong Medical Group from June 2017 to June 2019 were enrolled in this study, and their clinical data were collected retrospectively.Meanwhile, 80 healthy school-age children in this hospital were selected as control group.According to the nutritional status of vitamin A during hospitalization, the case group was divided into three groups: vitamin A normal group, vitamin A marginal deficiency group and vitamin A deficiency group.The nutritional status of vitamin A was compared between the case group and the control group, and the pulmonary function, T lymphocyte subsets, related inflammatory mediators and prognosis were recorded before and after the intervention. Results The vitamin A level in the case group [(0.73±0.32) μmol/L] was significantly lower than that in the control group [(1.02±0.23) μ mol/L](t=5.957, P<0.05), and the vitamin A nutritional status of the case group was significantly worse than that of the control group(Z=4.865, P<0.05).After treatment, the levels of CD4+, CD4+/CD8+ in vitamin A deficiency group were lower than those in the other two groups, and CD8+ was higher than those in the other two groups(P<0.05).The levels of hs CRP, EOS and IL-6 in vitamin A deficiency group were significantly higher than those in the other two groups(P<0.05).The difference in clinical efficacy among the three groups was statistically significant(χ2=13.165, P<0.05), with the worst clinical efficacy in the vitamin A deficiency group(52.17%) and the highest in the normal vitamin A group(94.74%). Conclusions Vitamin A marginal deficiency or deficiency is more common in preschool children with bronchial asthma, which is not conducive to the improvement of children′s cellular immune function and inflammatory response, and has a negative impact on prognosis.Clinical monitoring of vitamin A should be strengthened, and vitamin A preparation is suggested to be supplemented appropriately to improve the prognosis of children.
关键词
维生素A /
支气管哮喘 /
肺功能 /
T淋巴细胞亚群 /
炎症介质 /
预后
Key words
vitamin A /
bronchial asthma /
lung function /
T lymphocyte subsets /
inflammatory mediators /
prognosis
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 洪建国, 鲍一笑.重视儿童支气管哮喘的规范化诊治[J].中华儿科杂志, 2016, 54(3):161-162.
[2] 宋芬乐,成焕吉,李艳春, 等.支气管哮喘儿童哮喘控制与治疗现状的临床观察[J].中国妇幼保健,2016,31(9):1891-1893.
[3] Chiu M, Dillon A, Watson S.Vitamin A deficiency andxerophthalmia in children of a developed country [J].J Paediatr Child H, 2016, 52(7): 699-703.
[4] 中华医学会儿科学分会呼吸学组.儿童支气管哮喘诊断与防治指南(2016年版)[J].中华儿科杂志, 2016, 54(3):167-181.
[5] 中华医学会儿科学分会儿童保健学组.儿童微量营养素缺乏防治建议[J].中华儿科杂志, 2010, 48(7):502-509.
[6] 王雅丽, 宋少峰, 马正民.匹多莫德对哮喘患儿血清IgE、T淋巴细胞亚群水平的影响[J].中国实验诊断学, 2017, 21(6):977-979.
[7] Bazan-Socha S, Mastalerz L, Cybulska A, et al.Prothrombotic State in asthma is related to increased levels of inflammatory cytokines, IL-6 and TNF-α, in peripheral blood[J].Inflammation, 2017, 40(4):1-11.
[8] 苗青,王燕,任亦欣, 等.支气管哮喘患儿外周血不同T淋巴细胞亚群的表达及其临床意义[J].中国妇幼保健,2017,32(18):4438-4441.
[9] 陈秀芳, 罗群燕, 管敏昌,等.儿童支气管哮喘血液CD4+/CD8+T淋巴细胞亚群水平变化[J].中国卫生检验杂志, 2019, 29(5):562-564.
[10] 王玉芳,张景丽,石得荣, 等.不同剂量维生素D3对哮喘患儿T淋巴细胞的调节及临床疗效研究[J].中国儿童保健杂志,2018,26(3):314-317.
[11] 刘春红,完艳勋颜.血清IL-4、hs-CRP、IL-17、IL-33及Ang-2浓度变化在儿童支气管哮喘中的意义[J].实验与检验医学,2019,37(6):1035-1037,1049.
[12] Brusselle G, Germinaro M, Weiss S, et al.Reslizumab in patients with inadequately controlled late-onset asthma and elevated blood eosinophils[J].Pulm Pharmacol Ther, 2017, 43(8):39-45.
[13] Charrad R, Berraïes A, Hamdi, et al.Anti-inflammatory activity of IL-37 in asthmatic children: Correlation with inflammatory cytokines TNF-α, IL-β, IL-6 and IL-17A[J].Immunobiology, 2016, 221(2):182-187.
[14] 许颖,苏艳琦,郎会利,等.抚顺地区6766例0～14岁儿童血清维生素A水平调查研究[J].中国儿童保健杂志,2020,28(2):211-214.
[15] 张旭光,陈彦平,陈冬凯, 等.儿童血清维生素A在不同年龄阶段横断面研究[J].中国儿童保健杂志,2019,27(11):1215-1218.
[16] 尤珮,雷后兴,王双虎, 等.社区获得性肺炎患儿血清维生素A水平变化及意义[J].临床儿科杂志,2018,36(3):188-191.
[17] 金春华,王晓燕,张丽丽, 等.儿童维生素A缺乏与血红蛋白水平及呼吸道感染相关性研究[J].临床儿科杂志,2017,35(10):755-758.
[18] 柏翠,于晓峰,王芳,等.维生素A制剂对支气管哮喘患儿外周血辅助性T淋巴细胞17和调节性T淋巴细胞功能的影响[J].中华实用儿科临床杂志, 2016, 31(9):675-678.
[19] Cui W,Zhang P,Gu J,et al.Vitamin A deficiency promotes inflammation by induction of type 2 cytokines in experimental ovalbumin-induced asthma murine model [J].Inflammation, 2016, 39(5):1798-1804.
PDF(670 KB)
