INFLAMATOMETRIC FEATURES OF BRONCHIAL ASTHMA WITH DIFFERENT ACTIVITY DEGREE OF EOSINOPHILIC AIRWAY INFLAMMATION

Abstract

The aim of the study – to investigate the clinical signifi cance of eosinophilic cationic proteinconcentration in sputum and its diagnostic role in the disease management for optimizationof the personalized anti-infl ammatory therapy of patients with bronchial asthma.
 Materials and methods. There have been examined 66 school-aged children with persistentbronchial asthma who had been under anti-infl ammatory control therapy for at least thelast three months, but still needed treatment correction. Sputum has been collected in allpatients during post-attack period of disease by the method of sputum induction usingan inhalation of hypertonic solutions (3%,5%,7%) of sodium chloride. Quantitative andqualitative cytological composition of the sputum precipitate has been determined, inthe supernatant liquid fraction, obtained after sputum centrifugation, the concentrationsof eosinophilic cationic protein (ECP) and endothelial vascular growth factor (VEGF)have been studied by ELISA method. In the general cohort of examined patients, theaverage ECP concentration was 2.28±2.2 ng/ml (minimum value 0, maximum – 9.2 ng/ml). Depending on the ECP content in the sputum, children have been divided into 2clinical groups: The fi rst (I) clinical group was formed by 29 children with a content ofECP in the sputum greater than the average cohort value, and the second (II) clinicalgroup included remaining 47 patients with the level of ECP<2 ng/ml). According to themain clinical characteristics (age, gender, place of residence, duration of the disease)the clinical groups have been comparable. All patients underwent a biochemical studyof exhaled breath condensate (EBC), which involved the content determination of totalprotein, catalase activity; concentrations of nitrogen monoxide metabolites and markers
 of proteolytic activity. The results of the study were analyzed by parametric and non-parametric calculation methods, and estimation of the tests’ diagnostic value were carried
 out from the position of clinical epidemiology taking into account their sensitivity (Se)and specifi city (Sp), as well as attributive (AR) and relative (RR) risks, and the odd ratio(OR) of the event, taking into consideration their 95% confi dence intervals (95% CI).Results. The analysis of the obtained data has showed that in the comparison groups theclinical level of asthma control (18.3 ± 1.5 vs. 18.6 ± 1.3 points, P> 0.05), and sputumcell composition (in particular by the number of eosinophilic granulocytes: 9,24±2.3vs. 9,28±2.2%, P> 0.05) did not diff er much. In addition to that, VEGF concentrationin sputum, which refl ects the bronchial remodeling processes, was 1.25 times higherin representatives of the I group (145.43 ± 19.71 pg/ml) compared with patients of theII group (115.93 ± 15, 7 pg/ml; P> 0.05). In EBC, the content of nitrogen monoxidemetabolites was higher in patients of the II group: 44.4 ± 5.74 μmol/l in comparison withrepresenatives of I group (55.8 ± 9.8 μmol/l; P> 0.05). At the same time, in patients ofclinical I group in EBC higher proteolytic activity of azocol, as well as a higher catalaseactivity was noted (68.4 ± 22.6 μmol/min x mg of protein compared to 49.6 ± 10.3 μmol/min x mg of protein in the II group of comparison; P> 0, 05). In contrast, in the II group,the infl ammatory process has been associated with the lysis of low molecular weightproteins.Conclusion. In children with bronchial asthma, increased degranulation of sputumeosinophils (according to the ECP concentration) is associated with a more pronouncedairway infl ammation, as evidenced by the increased intensity of oxidative modifi cation ofproteins (OR=3,6) and proteolytic activity of high molecular weight proteins; togetherwith high catalase activity and elevated concentration of such marker of bronchialremodeling as VEGF, along with decreased content of nitrogen monoxide metabolites inthe exhaled breath condensate.