The Clinical Significance Of Determination Of IL-17 And ECP Of Recurrent Wheezing Children Under Five Years Old With Different Clinical Phenotypic

Wheezing is a common symptom of infant and early childhood. Epidemiological survey showed that 50% of children had wheezing more than once, indicating the prevalence of wheezing in children. Wheezing is due to small airway stenosis caused by airway wall edema, smooth muscle contraction and mucus plug. At present, most scholars believe that the majority of wheezing infants and young children with the virus infection belong to the early transient wheezing, do not occur in the school-age period, only part of them develop to asthma. Diagnosis and Treatment of bronchial asthma of Chinese Children's Guide (2008 revision) in accordance with the breathing causes and prognosis of wheezing,wheezing children under 5 years of age will be divided into three clinical phenotypes namely (1) a transient early wheezing, (2) early-onset persistent wheezing (defined as onset before the age of 3), (3) late-onset wheezing/asthma. Therefore, discriminating from the wheezing children under five years old who may develop into persistent asthma and adopting early effective intervention are very necessary. At present, at home and abroad for study of the pathogenesis and treatment of children with asthma and bronchiolitis has a lot,but for recurrent wheezing in very young children, the study is relatively small.PurposeThis clinical study attempts to detect nasopharyngeal secretions(NPS) and peripheral blood of interleukin-17 (IL-17),eosinophil cationic protein (ECP) and eosinophil count and compare the correlation between them to explore the non-invasive and effective detection of indicators to distinguish late-onset wheezing/ asthma frome recurrent wheezing children under 5 years old.After correctly diagnosing, effective intervention and treatment will be applied.Materials and methodsThe experiment is divided into wheezing group and the control group. Subjects in wheezing group are all from Respiratory out-patient clinc and hospitalized patients from the September 2008 year-April 2009, the numbers of wheezing≥2 times/six months or≥3 times/1 year was called recurrent wheezing.wheezing group were divided into wheezing group I (with one risk factor), and wheezing group II (no risk factors for persons),according if they have a doctor's diagnosis of allergic diseases (including eczema, allergic dermatitis, allergic rhinitis, food allergy), or either of their parents have a history of asthma risk factors for atopic quality standards.And the random sample of preoperative 20 cases are chosed as a control group from children who has kidney stones and other non-infectious diseases over the same period in the hospital and surgical hernia, all inrolled children Ruling out congenital, caused by foreign body aspiration breathing and immune diseases, were full-term births, aged 4 months to 5 years of age, in two weeks they all had no history of systemic and local hormone application.There was no significant difference in ageand gender (P> 0.05)between twogroups.Wheezing and control groups, respectively,gathering 3ml blood in early morning after one day admitted to hospital or at the moment of visiting out-patient department,37℃water bath 1 hour,3000 revolutions/minute centrifugation for 15 minutes, separation of serum, set-70℃refrigerator to save. One mil nasopharyngeal secretions was obtained by Sterile suction tube into the nasopharynx to5～6cm deep, adding four times the volume of 0.1% dithiothreitol solution, after mixing 37℃for 15min, the supernatant collection were saved at -70℃refrigerator to detect IL-17 and ECP. Cell sediment smear, Wright's stained, in the oil-mirror high-powered microscope, counting 300 nucleated cells other than epithelial cells, then calculating EOS, PMN cells, possession of nuclear cells (except for squamous epithelial cells) in percentage(Specimens of squamous cell smears＜20% were eligible nasopharyngeal secretions). IL-17 levels of serum and nasopharyngeal secretions were detected by double-antibody sandwich enzyme-linked immunosorbent assay (ELISA). ECP levels of Nasopharyngeal secretions and serum were detected by UniCAP automatic analysis of detector test.All test data are showed by mean±standard deviation, using single factor analysis of variance and Pearson linear correlation analysis to analyze the result with statistical software SPSS 13.0,LSD test was used to compare between the two groups. Correlation analysis using Pearson linear correlation analysis,P value less than 0.05 indicated significant difference.Results1 levels of IL-17 in nasopharyngeal secretions and serum of wheezing group was significantly higher (P all＜0.01), in which wheezing groupⅠ, IL-17 levels was higher than those of wheezingⅡgroup, the difference was statistically significant (P＜0.05).2 IN wheezing group I the ECP levels of serum and nasopharyngeal secretions were significantly higher than those wheezing groupⅡand the control group (P all＜0.05), while no significant difference between wheezinggroupⅡand the control group (P＞0.05).3 Eosinophils (EOS) counts of wheezing groupⅠNPS and peripheral blood were significantly higher than wheezing groupⅡand the control group(P＜0.05, P＜0.01), while between wheezing groupⅡand the control group there was no significant difference (P＞0.05); neutrophil (PMN) count of wheezing group was significantly highe the control group, the difference was significant (P＜0.01).4 Correlation Analysis(1) There was a positive correlation in the expression of IL-17 and EOS counts in serum and NPS (r value respectively was 0.933,0.62, P＜0.05), the IL-17 levels and PMN counts of two wheezing groups in NPS was positively correlated (r value respectively was 0.56,0.66, P＜0.05), and other cells no correlation. the levels of ECP and EOS counts in serum and NPS had a positive correlation (r value respectively was 0.786,0.89, P＜0.05)(2) There was a positive correlation in the expression of ECP in nasopharyngeal secretions and serum(r=0.813, P＜0.01); the expression of IL-17 in nasopharyngeal secretions and serum had a positive correlation too. (r=0.313, P＜0.05)Conclusions1 IL-17,ECP and EOS plays a key role in wheezing children with high risk factor,the airway inflammation was dominated by EOS; but the wheezing of children without high risk factor is always associated with virus infection, the airway inflammation of which is dominated by PMN.2 ECP,IL-17 in Nasopharyngeal secretions and serum were respectively significantly related, suggesting that nasopharyngeal secretions could affect the airway inflammation...