Журнал «Здоровье ребенка» 7 (58) 2014

Topics of allergic and neurogenic inflammation in the pathogenesis of bronchial asthma (BA) devoted a lot of research work. But most of the literature covering sided plane pathogenesis of asthma, determine or cytokine activity (leukocyte) level, or neurogenic. Today the lack of comprehensive research indicated both links that do not allow these components to balance the body and integrally assess their impact on the patient's with asthma. Still no information on the concentration in the blood serum of these mediators, depending on the degree of control of asthma is not known, whether there are gender differences mentioned indicators and so on. All the above listed research gaps cause asthma complexity of the problem and the urgency of further research of allergic and neurogenic mechanisms of inflammation in children with asthma, which in turn is the key to the effectiveness of treatment of asthma.

The purpose of the study. Determine the level of neuropeptides VIP, Subst. P and interleukins IL-2, IL-4, IL-5, IFN-gamma in children with asthma with controlled and uncontrolled disease course; establish the existence of gender differences in this contingent of children; identify the impact of the duration of the disease at the level of these indicators; determine the possibility of using the specified parameters as diagnostic criteria for controllability of the disease.

Materials and methods. Concentration levels of neuropeptides VIP, Subst. P and interleukins IL-2, IL-4, IL-5, IFN-gamma was determined in serum by ELISA in 34 children with asthma aged 10-17 years. The children were examined twice - at uncontrolled and controlled of asthma. The survey results were presented in the form of statistical averages - arithmetic mean, median and average error to determine the reliability of the differences used Mann-Whitney test. No reliable difference was considered at p ≤ 0, 05.

Results. Levels of neuropeptide Subst. P and interleukins IL-2, IL-4, IFN-gamma had no statistically significant gender differences. Also, they did not change statistically during anti-inflammatory therapy of asthma. The analysis established the presence of gender differences in VIP and IL-5, namely VIP level was statistically lower in boys with uncontrolled of asthma compared with healthy boys - respectively 0,03 ± 0,003 pg/ml and 0,07 ± 0 , 01 pg/ml (p = 0.002) and the level of IL-5 in boys with uncontrolled of asthma almost 8 times increased compared with a group of healthy boys - respectively 1,46 ± 0,27 pg/ml vs. 0.18 ± 0,12 pg/ml (p = 0.02). Gender susceptibility to boys with asthma may be associated with a decrease in serum levels of endogenous VIP as a bronchodilator and an increase in the level of IL-5 as interleukin allergic inflammation. After a course of anti-inflammatory therapy and transition process to a controlled form, regardless of the duration of illness, increased levels of VIP and IL-5 - reduced to the corresponding parameters of healthy children, namely at a controlled flow of asthma as 5 years, and over 5 years VIP level increases - according to 0,05 ± 0,005 pg/ml and 0,05 ± 0,004 pg/ml; IL-5 - falling under 0,46 ± 0,14 pg/ml and 0,74 ± 0,13 pg/ml. Patients girls statistically significant fluctuations in VIP and IL-5 in the transition to a controlled form of the disease is not established.

Conclusions

1. Neuropeptide levels Subst. P and interleukins IL-2, IL-4, IFN-gamma had no statistically significant differences between patients with asthma and healthy children is also not established gender differences statistically significant fluctuations in concentration depending on the degree of asthma control and duration of disease.

2. Analysis of the levels of VIP and IL-5 set of gender-dependent fluctuations: VIP level was statistically lower and the level of IL-5 - boys higher in patients with uncontrolled form of asthma compared with healthy boys.

3. Possible to assume that a predisposition to asthma and a higher incidence of asthma in boys is associated with decreased levels of VIP as a bronchodilator and increased levels of IL-5 as interleukin allergic inflammation.

4. Upon reaching the control of asthma, regardless of the duration of the disease there was an increase of VIP and decrease of IL-5 levels according to the performance of healthy children.

5. May suggest the use levels of VIP and IL-5 as diagnostic markers of treatment efficacy and controllability exponent of asthma.