| Abstract | UVOD: Obzirom na manjkavosti tradicionalnih parametara kontrole i težine astme, zadnjih
15-tak godina istraživanja su usmjerena k pronalaženju neinvazivnih biomarkera (BM-a)
upale u dišnim putovima. ----- CILJEVI: 1. usporediti različite upalne BM-e u djece s kontroliranom i nekontroliranom
astmom, 2. ispitati povezanost BM-a upale međusobno i s drugim pokazateljima aktivnosti
bolesti (simptomi, plućna funkcija, potreba za salbutamolom, egzacerbacije, upitnik o kontroli
astme [ACT], kvaliteta života [AQLQ]). ----- MATERIJALI I METODE: Opservacijska usporedna studija kohorte paralelnih skupina
uključila je 103 djece (dob 6-18 godina) s kontroliranom ([KA], n=50) i nekontroliranom
([NA], n=53) astmom. Mjerena je plućna funkcija i slijedeći BM-i: eozinofilni kationski
protein (ECP), C-reaktivni protein velike osjetljivosti (hs-CRP), kompletna krvna slika,
izdahnuti NO (FENO), pH i urati u kondenzatu izdaha (KI) i temperatura izdaha (TI). ----- REZULTATI: Koncentracija urata u KI, pH vrijednost KI i TI su se statistički značajno
razlikovale između skupina (NA vs. KA: urati u KI, medijan [IQR], μmol/L; 0 [3] vs 37,9
[26], p≤0,0001; pH u KI, srednja vrijednost [SD], 7,2 [0,17] vs. 7,33 [0,16], p=0,002; TI
srednja vrijednost [SD], °C; 34,26 [0,83], vs 33,90 [0,60], p=0,014). Diskriminantna analiza
je pokazala da su urati u KI najbolji samostalni parametar u razlikovanju kontrolirane od
nekontrolirane astme (F=57,899; p≤0,0001) uz dijagnostičku točnost 79,6%. Serumski hs-
CRP je bio značajno proporcionalno povezan sa zbirom simptoma potrebom za
salbutamolom, TI (r=0,395, p=0,003; r=0,240, p=0,014; r=0,445, p≤0,0001) i obrnuto
proporcionalno s FEV1 (r=-0,366, p=0,007). Urati u KI su bili statistički značajno
proporcionalno povezani s vremenskom udaljenošću zadnje egzacerbacije (PZE) i FENO-om
(r=0,558, p≤0,0001; r=0,3839; p=0,005) u NA, i pH u KI (r=0,379; p≤0,0001), TI (r=-0,220;
p=0,025), FEV1 (r=0,225, p=0,022), ACT-om (r=0,665; p≤0,0001), AQLQ (r=0,703,
p≤0,0001), potrebom za salbutamolom (r=-0,538; p≤0,0001) i zbirom simptoma (r=-0,722;
p≤0,0001) u svih astmatičara. ----- ZAKLJUČAK: Urati u KI su najbolji samostalni parametar u predviđanju kontrole astme.
Rezultati ukazuju na moguću vrijednost neinvazivnih BM-a lokalne i sistemske upale kao
dodatnih parametara u praćenju kontrole dječje astme. |
| Abstract (english) | BACKGROUND: Over last 15 years there has been increasing interest in the non-invasive
assessment of airway inflammation in addition to traditional parameters of asthma control and
severity. ----- AIMS: 1) to compare different inflammatory biomarkers (BMs) in children with controlled
and uncontrolled asthma, 2) to investigate their relationship with each other and with other clinical
indices of asthma control (symptoms, lung function, prn salbutamol use, exacerbations, asthma control
test [ACT], quality of life [AQLQ]). ----- MATERIALS AND METHODS: This prospective, observational, parallel-cohort study
comprised 103 consecutive patients (age 6-18 years) with controlled ([CA], n=50) and
uncontrolled ([UA], n=53) asthma. Measured lung function and BMs included: spirometry,
eosinophilic cationic protein (ECP), high-sensitivity C-reactive protein (hs-CRP), blood
counts with differentials, exhaled NO (FENO), pH and urates in EBC, and exhaled breath
temperature (EBT). ----- RESULTS: EBC urates, EBC pH and EBT showed statistically significant differences
between groups (UA vs. CA: EBC urates, median [IQR], μmol/L; 0 [3] vs 37,9 [26],
p≤0,0001; EBC pH, mean [SD], 7,2 [0,17] vs. 7,33 [0,16], p=0,002; EBT mean [SD], °C;
34,26 [0,83], vs 33,90 [0,60], p=0,014). Discriminant analysis depicted EBC urates as the best
single significant predictor of asthma control (F=57,899; p≤0,0001) with a 79,6% diagnostic
accuracy. Serum hs-CRP significantly positively correlated with symptom score, prn
salbutamol use, and EBT (r=0,395, p=0,003; r=0,240, p=0,014; r=0,445, p≤0,0001;
respectively) and inversely with FEV1 (r=-0,366, p=0,007). EBC urates showed significant
association with time from last exacerbation (TLE) and FENO (r=0,558, p≤0,0001; r=0,3839;
p=0,005, respectively) in UA, and EBC pH (r=0,379; p≤0,0001), EBT (r=-0,220; p=0,025),
FEV1 (as % predicted) (r=0,225, p=0,022), ACT (r=0,665; p≤0,0001), AQLQ (r=0,703,
p≤0,0001), prn salbutamol use (r=-0,538; p≤0,0001), and symptom score (r=-0,722;
p≤0,0001) in all asthmatics. ----- CONCLUSION: EBC urates were the best single predictor of asthma control. Our results
provide the evidence supporting the potential utility of a panel of non-invasive BMs of local
and systemic inflammation, as additional tools for monitoring childhood asthma. |
