| 摘要: | 氣喘兒童常有睡眠的困擾,不管是因氣喘症狀或是所使用藥物而引起。氣喘的症狀(如咳嗽、喘鳴)常在夜間或清晨時更易惡化,所以病童常有半夜醒來或清晨提早醒來的情形。許多研究都已證實細胞激素在氣喘的病因扮演重要角色。近年來細胞激素在人類睡眠的調控功能也漸被重視,文獻上則少有氣喘兒童的睡眠品質、細胞激素和疾病控制狀況的相關性研究。
研究目的:
本研究針對門診氣喘兒童進行有關睡眠品質、氣喘控制程度及血中細胞激素的相關研究。
研究方法:
本研究從2007年七月到十二月,在小兒過敏科門診,共收案90位年齡從6歲到12歲,患有氣喘病史超過6個月以上的兒童參加本研究。每位參加者均填寫一份氣喘控制測驗(Asthma Control Test)和一份氣喘兒童睡眠品質問卷。同時採集血液做細胞激素interleukin(IL)-4、IL-6、IL-10、IL-12, prolactin和免疫球蛋白E(IgE)的定量。
研究結果:
氣喘控制測驗得分20或20分以上者歸為控制良好組(well-controlled group,68人), 19分或19分以下者則歸為控制不佳組(inadequately- controlled group,22人),比較兩組的睡眠困擾得分顯示兩者沒有明顯的差異存在(8.14 ± 7.193 vs. 4.91 ± 4.203, P = 0.063)。主觀睡眠感受在控制良好組則明顯比控制不佳組為好(4.59 ± 1.149 vs.3.95 ± 1.090, p = 0.028),在這兩組的IgE和IL-6、IL-10、IL-12則無統計學上有意義的差別。進一步分析控制良好組,發現睡眠品質好的兒童(11人)較睡眠品質不好的兒童(57人)血中IL-10濃度較低(1.78 ± 1.05 pg/mLvs.3.92 ± 3.81 pg/mL,p = 0.026), 泌乳激素(prolactin) 濃度較高(10.03 ± 7.15 ng/mL vs. 7.73 ± 4.63 ng/mL, p = 0.037) 。IL-12/ IL-10比值在睡眠品質好的兒童則明顯較睡眠品質不好者高(0.93 ± 1.17 vs.0.41 ± 0.26,p = 0.03)。IL-6、IL-12、IgE在這兩組中則沒有明顯差異。
研究結論:
此研究結果顯示良好的氣喘控制可明顯改善兒童的睡眠品質,同時好的睡眠品質則有較低的IL-10濃度及較高的TH1/TH2的比值,這有利於氣喘的控制。泌乳激素在這免疫的轉變中扮演一個重要的角色。
Background: According to the International Study of Asthma and Allergies in Childhood study phase Ⅲ, there has been an increasing trend of asthma prevalence in Taiwan during the last 30 years. Recently, a national survey in Taiwan demonstrated the general hospitalization rate of asthma in the children group (<18 yr old) increased significantly from 1996 to 2002.Asthmatic children have been reported to complain about poor sleep quality. Recent research has demonstrated the relationship between sleep and circulating cytokines. There are few studies delineating the relationship between immune mediators and sleep quality in asthmatic children. This cross-sectional study aims to assess the relationship of serum cytokine level and sleep quality in asthmatic children.
Methods and materials: After an initial screening phase at allergic clinic visits, 90 asthmatic children aged 6 through 12 years were enrolled to complete one Chinese version of the (Childhood) Asthma Control Test. A specially-design questionnaire concerning sleep quality of asthmatic children was administered to all subjects and parents. We assessed the serum level of certain immunological parameters, including interleukin (IL)-4, IL-6, IL-10, IL-12, total immunoglobulin (Ig) E, and prolactin at enrollment.
Results: Subjects with an ACT score of 20 or more were assigned as the well-controlled group (N = 68) and those with a score of 19 or less were assigned as the inadequately-controlled group (N = 22). Mean scores for level of sleep disturbance did not have a significant difference between the well-controlled group and inadequately-controlled group (8.14 ± 7.193 vs. 4.91 ± 4.203, respectively; p = 0.063). Mean scores for the subjective sleep perception showed a significant difference between the well-controlled group and inadequately-controlled group (4.59 ± 1.149 vs. 3.95 ± 1.090, respectively; p = 0.028). Mean levels of assessed cytokines IL-6, IL-10, IL-12 and total IgE did not show a significant difference in relation to the level of asthma control. In the well-controlled group, the good sleepers had a significantly lower mean level of IL-10 (1.78 ± 1.05 pg/mL vs. 3.92 ± 3.81 pg/mL, respectively, p = 0.026) and higher mean ratio of IL-12/IL-10 (0.93 ± 1.17 vs. 0.41 ± 0.26, respectively, p = 0.03) compared to the poor sleepers. Additionally, there was a significantly enhanced serum prolactin level in the good sleeper subgroup, in comparison with the poor sleeper subgroup (10.03 ± 7.15 ng/mL vs. 7.73 ± 4.63 ng/mL, respectively, p = 0.037). Of both subgroups, the concentrations of IL-6, IL-12 and total IgE did not reach a significant difference.
Conclusion: These results suggested an improvement in asthma control would promote better sleep quality. Good sleep is associated with a lower IL-10 level, a higher prolactin concentration, and a higher TH1/TH2 ratio. Prolactin may have a potential role in this immunity shift. Furthermore, this pattern of immune profile may have therapeutic benefits on asthma management. Thus, it can be anticipated that further insight into the functional role of cytokines on sleep quality of asthmatic sufferers will result in novel therapeutic perspectives. Nonetheless, more research is warranted to see whether the reduced IL-10 level and elevated IL-12/IL-10 ratio in the good sleepers is of therapeutic benefit. Clinicians should make an effort and do more to shift the spiral to a positive direction by helping asthmatic children to gain well-control of their asthma and get the sleep they need. |
