摘要：
目的 观察β-内酰胺类抗生素接触工人血清骨膜蛋白(periostin)、嗜酸粒细胞阳离子蛋白(ECP)、免疫球蛋白E(IgE)水平,探讨其在过敏性炎症发生发展中的作用.方法 选取90名接触7-氨基头孢烷酸(7-ACA)、6-氨基青霉烷酸(6-APA)粉尘哮喘或过敏性鼻炎患者为病例组(哮喘亚组32人,鼻炎亚组58人),选取117名接触7-ACA、6-APA粉尘无哮喘或鼻炎等过敏性疾病工人为接触组,选择192名不接触粉尘体检健康者作为对照组.通过问卷调查基本情况,便携式肺功能仪测定肺功能,ELISA法测定血清骨膜蛋白、ECP和IgE水平.结果 接触组和病例组工人用力肺活量(FVC)、第1秒用力呼气容积(FEV1.0)及FEV1.0/FVC均低于对照组,差异有统计学意义(P＜0.05).病例组嗜酸粒细胞计数明显高于对照组,差异有统计学意义(P＜0.05).接触组、病例组、哮喘亚组、鼻炎亚组血清骨膜蛋白、IgE水平均高于对照组,哮喘亚组血清ECP水平高于对照组,差异有统计学意义(P＜0.05).血清骨膜蛋白与IgE、ECP均呈正相关(P＜0.01),血清骨膜蛋白与FEV1.0呈负相关(P＜0.05).多元logistic回归分析发现,接触7-ACA或6-APA(OR =3.09,95％CI:1.83～5.21)、年龄＞47岁(OR=2.53,95％CI:1.22～5.26)、ECP增高(OR=1.04,95％CI:1.01～1.06)为血清骨膜蛋白升高的危险因素.结论 职业接触7-ACA、6-APA可导致血清骨膜蛋白表达水平升高,接触7-ACA或6-APA、年龄＞47岁、ECP增高可作为骨膜蛋白升高的危险因素.%Objective To observe serum levels of periostin,ECP,IgE in the antibiotic enterprise workers,and study the role of periostin,ECP,IgE in the development of allergic inflammation.Methods 90 cases with asthma or rhinitis were enrolled as disease group,another 117 workers exposed to 7-ACA 、6-APA dust without suffering from allergic illness,are chosen as group of dust exposed,and 192 healthy workers who didn't contact dust were chosen as control group.Questionnaires were used to learn their basic information.Lung function was determined with a portable spirometer.The expression levels of periostin、ECP and IgE in serum were measured by enzyme-linked immuno sorbent assay.Results The exposure group and disease group had significantly lower forced vital capacity (FVC),forced expiratory volume in 1 second (FEV1.0),and FEV1.0/FVC ratio than the control group (P＜0.05).The disease group had significantly higher eosinophil than the control group (P＜0.05).Compared with the control group,the exposure group,the disease group,asthma subgroup,rhinitis subgroup of serum periostin and IgE increased,the differences are statistically significant (P＜0.05).Serum levels of ECP in the workers of asthma subgroup were significantly higher than that in control group (P＜0.05).Serum expression levels of periostin were positively correlated with IgE,ECP in workers (P＜0.001),serum levels of periostin were ncgatively correlated with FEV1.0 in workers (P＜0.05).Muhiple logistics regression analysis found that exposure to 7-ACA or 6-APA (OR=3.09,95％CI:1.83-5.21),age＞47years (OR=2.53,95％CI:1.22-5.26),higher ECP (OR =1.04,95％ CI:1.01-1.06) were risk factors for increased serum periostin level.Conclusion Occupational exposure to 7-ACA or 6-APA can result in higher serum periostin level,exposure to 7-ACA or 6-APA,age＞47 years,higher ECP are risk factors for increased serum periostin level.
