Клінічні особливості персистування бронхіальної астми в дітей за альтернативного вмісту маркерів ремоделінгу в дихальних шляхах

Abstract

The research of bronchial remodeling and the role of angiogenesis processes in it are currently relevant for the study of the phenotypic features of the course of bronchial asthma in children and require further study in order to develop preventive and therapeutic measures. Purpose - to optimize treatment and prevention measures for persistent bronchial asthma (pBA) in children, to determine the clinical and anamnestic features of its phenotype, taking into account the accumulation of mediators of neoangiogenesis (фактора росту ендотелію судин - VEGF, матрична металопротеїназа-9 - MMP-9) in the respiratory tract as markers of bronchial remodeling. Materials and methods. A comprehensive examination of 116 children with pBA aged from 6 to 17 years (average age 11.6±0.29 years) and disease duration of 4.9±0.38 years was conducted. Three clinical groups were formed: the Group 1 was formed by 37 children with pBA with VEGF >80.0 ng/ml and MMP-9 >5.2 ng/ml in the sputum supernatant; the Group 2 included 41 children with an excess of one of these markers; and the control group consisted of 38 patients with values of these biomarkers below the median (VEGF<80.0 ng/ml and MMP-9 <5.2 ng/ml). The main clinical characteristics of the observation groups were comparable. Results. The article shows that uncontrolled pBA (sum of points >20) during the 4-year follow-up occurred most often in children of еру Group 1 and the Group 2, and indications of insufficient control of asthma indicated a probable risk of developing structural changes in the bronchi: OR - 2.23 (95% CI: 1.2-4.1), RR - 1.5 (95% CI: 1.0-2.2) and RR - 22%. The severe course of pBA was also associated with the risk of bronchial remodeling with the accumulation of angiogenesis mediators in their lumen as follows: OR - 2.2 (95% CI: 1.1-4.52), RR - 1.42 (95% CI: 1.0-2.5) and AR - 19%. Accumulation of remodeling markers in airways in patients with asthma in the Group 1 and the Group 2 is associated with a predominantly eosinophilic phenotype of the disease. At the same time, patients with a low content of markers of bronchial remodeling in sputum (control group) have better chances of achieving complete control over the symptoms of pBA compared to children with a high content (total absolute risk - 19.0%, total relative risk - 45.1%, the minimum number of patients who need to be treated to obtain a positive result - 2.2) and average (total absolute risk - 10.2%, total relative risk - 30.6%, the minimum number of patients who need to be treated to obtain a positive result - 3.2) content of angiogenesis factors in sputum. Conclusions. In patients with pBA, the accumulation of markers of bronchial remodeling in the lumen of the airways was associated with a severe uncontrolled course of asthma and worse chances of achieving disease control. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.