Povezanost nivoa citokina u nosnom sekretu sa težinom kliničke slike, komorbiditetima i kvalitetom života kod adolescenata s alergijskim rinitisom/

Abstract

Uvod: Rinitisi se klasifikuju u dve grupe sa propratnom alergijom (alergijski rinitis, AR) i bez alergije koji i dalje ispoljavaju nazalne simptome (nealergijski rinitis, NAR) bez specifične preosetljivosti posredovane imunoglobulinom E (IgE). Česte epizode nazalnih simptoma kod AR imaju značajan negativan uticaj na kvalitet života povezan sa zdravljem (eng. Health Related Quality of Life, HRQoL) kod adolescenata. Svrha ove studije bila je testiranje hipoteza da inflamatorni citokini produkovani u nosnom sekretu mogu biti povezani sa HRQoL, komorbiditetima i težinom kliničkih manifestacija kod adolescenata s AR. Metode: U studiji preseka ispitivano je 113 adolescenata podeljenih na grupe s AR, NAR i kontrolnu grupu. Kvalitet života ispitivan je Evropskim upitnikom 5 dimenzija 3 nivoa za određivanje kvaliteta života (eng. European Quality of Life 5 Dimensions 3 Level Version, EQ-5D-3L), opštim 16D upitnikom, upitnikom za procenu kvaliteta života kod adolescenata a rinokonjuktivitisom (eng. Adolescent Rhinoconjunctivitis Quality of Life Questionnaire, AdolRQLQ), mini upitnikom za kvalitet života kod astme (eng. Mini Asthma Quality of Life Questionnaire, MiniAQLQ) upitnikom pod nazivom skor ukupno četiri simptoma (eng. Total 4 Symptom Score, T4SS) za procenu kliničkih manifestacija. Iz sekreta uzorkovanih nazalnim brisevima određivano je prisustvo eozinofila i protočnom citometrijom koncentracije 13 citokina. Rezultati: AR grupa adolescenata je imala značajno niže vrednosti EQ-5D-3L ukupnog indeks skora (0,661±0,267 u odnosu na 0,943±0,088; p < 0,001) i veće ukupne vrednosti AdolRQLQ skora (2,76±1,01 naspram 1,02±0,10; p < 0,001) u poređenju sa kontrolnom grupom. AR grupa je imala veće koncentracije IL-1β (p = 0,002), IL-6 (p = 0,031), IL-8 (p < 0,001), IL17-A (p=0,013) i IL-18 (p=0,014) u poređenju sa kontrolnom grupom, a IL-1β, IL-6, IL17-A i IL-18 su bili značajno (p < 0,050) povećani sa progresijom bolesti. Citokini IL-1β, IL-6, kao i težak oblik bolesti su identifikovani kao značajni prediktori nižeg HRQoL kod adolescenata s AR. Zaključci: Adolescenti sa AR imali su značajno lošiji HRQoL u odnosu na NAR i kontrolnu grupu ispitanika. Ova studija je identifikovala IL-1β, IL-6 i težinu bolesti kao prediktore nižeg HRQoL kod adolescenata s AR.

Introduction: Rhinitis can be classified into two groups, those with accompanying allergy (allergic rhinitis, AR) and those without allergy but still exhibiting nasal symptoms (non-allergic rhinitis, NAR) and without specific hypersensitivity mediated by immunoglobulin E (IgE). Frequent episodes of nasal symptoms in AR have a significant negative impact on the health-related quality of life (HRQoL) in adolescents. The purpose of this study was to test the hypothesis that inflammatory cytokines produced in nasal secretions may be associated with HRQoL, comorbidities, and severity of clinical manifestations in adolescents with AR. Methods: In a cross-sectional study, 113 adolescents were examined, which were divided into groups with AR, NAR and a control group. Quality of life was examined with the European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-3L), the general 16D questionnaire, the Adolescent Rhinoconjunctivitis Quality of Life Questionnaire (AdolRQLQ), Mini Asthma Quality of Life Questionnaire (MiniRQLQ) and a questionnaire called Total 4 Symptom Score (T4SS) to assess severity clinical manifestations. Nasal secretions were sampled and concentrations of 13 cytokines were determined by flow cytometry, as well as the presence of eosinophils. Results: AR group of adolescents had significantly lower EQ-5D-3L total index score values (0.661±0.267 vs. 0.943±0.088; p < 0.001) and higher AdolRQLQ total scores (2.76±1.01 vs. 1 .02±0.10; p < 0.001) compared to the control group. AR group had higher concentrations of IL-1β (p = 0.002), IL-6 (p = 0.031), IL-8 (p < 0.001), IL17-A (p=0.013) and IL-18 (p=0.014) compared to the control group, and IL-1β, IL-6, IL17-A and IL-18 were significantly (p < 0.050) increased with disease progression. Cytokines IL-1β, IL-6, as well as the severe form of the disease were identified as significant predictors of lower HRQoL in adolescents with AR. Conclusion: Adolescents with AR had significantly worse HRQoL compared to NAR and control subjects. This study identified IL-1β, IL-6, as well as severe clinical manifestations as predictors of lower HRQoL in adolescents with AR.