儿童支气管哮喘血清25-OH-VD_3与CD4~+ T淋巴细胞表达的相关性
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摘要
目的探讨血清25-OH-维生素D_3(25-OH-VD_3)的水平与支气管哮喘患儿CD4~+T淋巴的细胞因子的相关性。方法选择5岁以上的临床控制良好能够接受管理和规范治疗的支气管哮喘患儿,在研究过程中所有患儿均没有急性发作,检测血清25-OH-维生素D_3水平,选取能够接受规范化管理的哮喘患儿82例为研究对象,其中25-OH-维生素D_3低于30ng/mL的患儿42例为研究组,维生素D大于30ng/L哮喘患儿40例为对照组,患儿在检测维生素D水平同时抽血检测血清γ干扰素(IFN-γ)、白介素4(IL-4)水平,监测患儿肺功能,所有患儿均按2016版儿童哮喘防治指南[1]规范治疗,研究组给予每天口服维生素D400U治疗3月后,分别抽血检测血清25-OH-VD_3及血清IFN-γ、IL-4水平,并复查肺功能。结果 (1)研究组及对照组维生素D水平差异有统计学意义(P <0.05);研究组每天给予口服维生素D400IU治疗3月,复查维生素D水平与对照组维生素D水平比较差异无统计学意义(P> 0.05))。(2)研究组治疗前与对照组患儿血清IL-4、IFN-γ及IL-4/IFN-γ比较差异有统计学意义(P <0.05),研究组经3月维生素D干预后与对照组比较IL-4、IFN-γ及IL-4/IFN-γ差异无统计学意义(P> 0.05)。研究组经过维生素D干预后IL-4水平有下降,IFN-γ水平有下降,但IL-4/IFN-γ水平有所升高,差异有统计学意义(P <0.05)。(3)研究组治疗前肺功能结果,与维生素D干预治疗3月后肺功能结果比较,给与维生素D干预后肺功能最大呼气流量(PEF)及1秒率(FEV1/FVC),75%肺活量最大呼气流量(MEF25),50%肺活量最大呼气流量(MEF50),25%肺活量最大呼气流量(MEF75)均有所改善,差异有统计学意义(P <0.05)。(4)研究组及对照组的维生素D水平与肺功能PEF%及FEV1/FVC%及EFE25%、EFE50%、EFE75%有相关性(P <0.05),维生素D与肺功能FVC无相关性(P> 0.05)。结论 25(OH)维生素D_3水平可能通过影响哮喘患儿细胞因子的表达,而影响体液免疫,维生素D水平不足或缺乏可能影响哮喘患儿的肺通气功能,提高维生素D水平对肺功能改善有帮助。
Objective To explore the correlation between serum 25-OH-vitamin D_3(25-OH-VD_3) levels and CD4~+T lymphocyte cytokines in children with bronchial asthma. Methods Children over 5 years old who had good clinical control and were able to receive management and standardized treatment were selected.During the study,all the children did not have acute attacks,and the serum 25-OH-vitamin D_3 level was detected.82 children with asthma who could receive standardized management were selected as research objects.Among whom,42 children with serum 25-OH-vitamin D_3 lower than 30 ng/mL were included in the study group while 40 children with serum 25-OHvitamin D_3 greater than 30 ng/L were included in the control group.When Children were tested for vitamin D level,their blood was taken to detect serum interferon-gamma(IFN-γ) and interleukin-4(IL-4) levels.Pulmonary Functions of children were monitored.All children were treated in accordance with the 2016 edition of the guidelines for the prevention and treatment of asthma in children.The study group was treated with oral vitamin D400 U daily.After 3 months,children in the study group were given hemospasia to respectively detect serum 25-OH-vitamin D_3 level and serum IFN-γ and(IL-4) levels. Results(1)There were statistically significant differences in vitamin D levels between the study group and the control group(P < 0.05).The study group was treated with oral vitamin D400 U daily.After 3 months,there was no difference in vitamin D levels between the study group and the control group(P > 0.05).(2)There were significant differences in serum IL-4,IFN-γ and IL-4/IFN-γ between the study group and the control group before treatment(P < 0.05).After 3 months of vitamin D intervention,there was no statistically significant difference in IL-4,IFN-γ and IL-4/IFN-γ between the study group and the control group(P > 0.05).After vitamin D intervention,the IL-4 and IFN-γ levels of the study group were both decreased,but IL-4/IFN-γ level were increased.The differences were statistically significant(P < 0.05).(3)The pulmonary function before treatment and that after 3 months of vitamin D intervention in the study group were compared.After intervention with vitamin D,pulmonary function peak expiratory flow(PEF) and 1 second rate(FEV1/FVC),75% vital capacity maximal expiratory flow(MEF25),50% vital capacity maximum expiratory flow(MEF50) and 25% vital capacity maximal expiratory flow(MEF75) were all improved.The differences were statistically significant(P < 0.05).(4)The vitamin D levels in the study group and the control group were correlated with PEF%,FEV1/FVC%,EFE25%,EFE50% and EFE75%(P < 0.05).There was no correlation between vitamin D and pulmonary function FVC(P > 0.05). Conclusion 25-OH-vitamin D_3 level may affect humoral immunity by affecting the expression of cytokines in children with asthma.Insufficient or lack of vitamin D levels may affect lung ventilation in children with asthma,and increasing vitamin D levels may be helpful in improving pulmonary function.
Objective To explore the correlation between serum 25-OH-vitamin D_3(25-OH-VD_3) levels and CD4~+T lymphocyte cytokines in children with bronchial asthma. Methods Children over 5 years old who had good clinical control and were able to receive management and standardized treatment were selected.During the study,all the children did not have acute attacks,and the serum 25-OH-vitamin D_3 level was detected.82 children with asthma who could receive standardized management were selected as research objects.Among whom,42 children with serum 25-OH-vitamin D_3 lower than 30 ng/mL were included in the study group while 40 children with serum 25-OHvitamin D_3 greater than 30 ng/L were included in the control group.When Children were tested for vitamin D level,their blood was taken to detect serum interferon-gamma(IFN-γ) and interleukin-4(IL-4) levels.Pulmonary Functions of children were monitored.All children were treated in accordance with the 2016 edition of the guidelines for the prevention and treatment of asthma in children.The study group was treated with oral vitamin D400 U daily.After 3 months,children in the study group were given hemospasia to respectively detect serum 25-OH-vitamin D_3 level and serum IFN-γ and(IL-4) levels. Results(1)There were statistically significant differences in vitamin D levels between the study group and the control group(P < 0.05).The study group was treated with oral vitamin D400 U daily.After 3 months,there was no difference in vitamin D levels between the study group and the control group(P > 0.05).(2)There were significant differences in serum IL-4,IFN-γ and IL-4/IFN-γ between the study group and the control group before treatment(P < 0.05).After 3 months of vitamin D intervention,there was no statistically significant difference in IL-4,IFN-γ and IL-4/IFN-γ between the study group and the control group(P > 0.05).After vitamin D intervention,the IL-4 and IFN-γ levels of the study group were both decreased,but IL-4/IFN-γ level were increased.The differences were statistically significant(P < 0.05).(3)The pulmonary function before treatment and that after 3 months of vitamin D intervention in the study group were compared.After intervention with vitamin D,pulmonary function peak expiratory flow(PEF) and 1 second rate(FEV1/FVC),75% vital capacity maximal expiratory flow(MEF25),50% vital capacity maximum expiratory flow(MEF50) and 25% vital capacity maximal expiratory flow(MEF75) were all improved.The differences were statistically significant(P < 0.05).(4)The vitamin D levels in the study group and the control group were correlated with PEF%,FEV1/FVC%,EFE25%,EFE50% and EFE75%(P < 0.05).There was no correlation between vitamin D and pulmonary function FVC(P > 0.05). Conclusion 25-OH-vitamin D_3 level may affect humoral immunity by affecting the expression of cytokines in children with asthma.Insufficient or lack of vitamin D levels may affect lung ventilation in children with asthma,and increasing vitamin D levels may be helpful in improving pulmonary function.
引文
[1]中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.儿童支气管哮喘诊断与防治指南[J].中华儿科杂志,2016,54(3):167-181.
[2]中华医学会骨质疏松和骨矿盐疾病分会.维生素D及其类似物的临床应用共识[J].中华内分泌代谢杂志,2018,34(3):187-201.
[3]Brehm JM,Schuemann B,Fuhlbrigge AL,et al.Serum vitamin D levels and severe asthma exacerbations in the Childhood Asthma Management Program study[J].J Allergy Clin Immunol,2010,126(1):52-58.
[4]Brehm JM,Celedón JC,Soto-Quiros ME,et al.Serum vitamin D levels and markers of severity of childhood asthma in Costa Rica[J].Am J Respir Crit Care Med,2009,179(9):765-771.
[5]Esfandiar N,Alaei F,Fallah S.Vitamin D deficiency and its impact on asthma severity in asthmatic children[J].Ital JPediatr,2016,17;42(1):108.
[6]Bener A,Ehlayel MS,Tulic MK,et al.Vitamin Ddeficiency as a strong predictor of asthma in children[J].Int Arch Allergy Immunol,2012,157(2):168-175.
[7]Fei Li,Min Peng,Lei Jiang,et al.Vitamin D Deficiency Is Associated with Decreased Lung Function in Chinese Adults with Asthma[J].Respiration,2011,81:469-475.
[8]Man L,Zhang Z,Zhang M,et al.Association between vitamin D deficiency and insufficiency and the risk of childhood asthma:evidence from a meta-analysis[J].eCollection,2015,8(4):5699-5706.
[9]Bener A,Ehlayel MS,Tulic MK,et al.Vitamin Ddeficiency as a strong predictor of asthma in children[J].Int Arch Allergy Immunol,2012,157(2):168-175.
[10]Sutherland ER,Goleva E,Jackson LP,et al.Vitamin D Levels,Lung Function,and Steroid Response in Adult Asthma[J].Am JRespir Crit Care Med,2010,181(7):699-704.
[11]Clin Ther.Vitamin D and Bronchial Asthma:An Overview of Data From the Past 5 Years[J].Epub,2017,39(5):917-929.
[12]丁冬胜,余健.维生素D3与支气管哮喘[J],国际儿科学杂志,2011,38(1):15-17.
[13]Kang JW,Kim JH,Kim HJ,Association of serum 25-hydroxyvitamin D with serum IgE levels in Korean adults[J].Auris Nasus Larynx.2016,43(1):84-88.
[14]Borges MC,Martini LA,Rogero MM.Current perspectives on vitamin D,immune system,and chronic diseases[J].Nutrition.2011,27(4):399-404.
[15]王白,乔红梅.维生素D缺乏与小儿毛细支气管炎[J],国际儿科学杂志,2018,45(3):228-230.
[2]中华医学会骨质疏松和骨矿盐疾病分会.维生素D及其类似物的临床应用共识[J].中华内分泌代谢杂志,2018,34(3):187-201.
[3]Brehm JM,Schuemann B,Fuhlbrigge AL,et al.Serum vitamin D levels and severe asthma exacerbations in the Childhood Asthma Management Program study[J].J Allergy Clin Immunol,2010,126(1):52-58.
[4]Brehm JM,Celedón JC,Soto-Quiros ME,et al.Serum vitamin D levels and markers of severity of childhood asthma in Costa Rica[J].Am J Respir Crit Care Med,2009,179(9):765-771.
[5]Esfandiar N,Alaei F,Fallah S.Vitamin D deficiency and its impact on asthma severity in asthmatic children[J].Ital JPediatr,2016,17;42(1):108.
[6]Bener A,Ehlayel MS,Tulic MK,et al.Vitamin Ddeficiency as a strong predictor of asthma in children[J].Int Arch Allergy Immunol,2012,157(2):168-175.
[7]Fei Li,Min Peng,Lei Jiang,et al.Vitamin D Deficiency Is Associated with Decreased Lung Function in Chinese Adults with Asthma[J].Respiration,2011,81:469-475.
[8]Man L,Zhang Z,Zhang M,et al.Association between vitamin D deficiency and insufficiency and the risk of childhood asthma:evidence from a meta-analysis[J].eCollection,2015,8(4):5699-5706.
[9]Bener A,Ehlayel MS,Tulic MK,et al.Vitamin Ddeficiency as a strong predictor of asthma in children[J].Int Arch Allergy Immunol,2012,157(2):168-175.
[10]Sutherland ER,Goleva E,Jackson LP,et al.Vitamin D Levels,Lung Function,and Steroid Response in Adult Asthma[J].Am JRespir Crit Care Med,2010,181(7):699-704.
[11]Clin Ther.Vitamin D and Bronchial Asthma:An Overview of Data From the Past 5 Years[J].Epub,2017,39(5):917-929.
[12]丁冬胜,余健.维生素D3与支气管哮喘[J],国际儿科学杂志,2011,38(1):15-17.
[13]Kang JW,Kim JH,Kim HJ,Association of serum 25-hydroxyvitamin D with serum IgE levels in Korean adults[J].Auris Nasus Larynx.2016,43(1):84-88.
[14]Borges MC,Martini LA,Rogero MM.Current perspectives on vitamin D,immune system,and chronic diseases[J].Nutrition.2011,27(4):399-404.
[15]王白,乔红梅.维生素D缺乏与小儿毛细支气管炎[J],国际儿科学杂志,2018,45(3):228-230.