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МЕДИЧН1ПЕРСПЕКТИВИ / MEDICNIPERSPEKTIVI
UDC 616.441-008:616.233-026.13:613.84]-053.2
https://doi.Org/10.26641/2307-0404.2019.3.181879
N.S. Bashkirova, I.L. Vysochina
SENSITIVITY OF BRONCHIAL RECEPTORS UNDER THE EFFECT OF TOBACCO SMOKE IN THE CONDITIONS OF VARIOUS ACTIVITY OF THE THYROID GLAND IN CHILDREN
SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine»
Department of Family Medicine FPE
V. Vernadsky str., 9, Dnipro, 49044, Ukraine
ДЗ «Днтропетровська медична академiя МОЗ Украши»
кафедра ciMeüHoi медицини ФПО
(зав. -д. мед. н., доц. 1.Л. Височина)
вул. В. Вернадського, 9, Днтро, 40984, Украша
e-mail: [email protected]
Цитування: Медичт перспективы. 2019. Т. 24, № 3. С. 53-57 Cited: Medicniperspektivi. 2019;24(3):53-57
Key words: tobacco smoke, children, thyroid, bronchial hypersensitivity
Ключовi слова: тютюновий дим, dimu, щитоподiбна залоза, бронхiальна гiперчутливiсть Ключевые слова: табачный дым, дети, щитовидная железа, бронхиальная гиперчувствительность
Abstract. Sensitivity of bronchial receptors under the effect of tobacco smoke in the conditions of various activity of the thyroid gland in children. Bashkirova N.S., Vysochina I.L. The role of the initial hormonal profile disorders of the system "pituitary - thyroid" in the emergence of a bronchospasm in response to exogenic stimuli has not been finally determined. The aim of our research was to investigate the character and degree of the relationship between bronchial hypersensitivity in children exposed to smoking and the functional activity of the thyroid gland. The research involved 74 patients aged 10 to 17 years. Sixteen children were not exposed to tobacco smoke, 50 children were passive smokers, and 8 of the children surveyed smoked actively. To investigate the level of bronchial sensitivity, a bronchial provocation test with a non-specific stimulus - bronchoconstrictor acetylcholine was carried out. We assayed the functional state of the thyroid gland by the level of free triiodothyronine (FT3), free thyroxin 4 (FT4) and thyroid stimulating hormone (TSH), identified by Enzyme-linked Immunosorbent Assay (ELISA) (Alkor Bio, Russia). Indicators of hormones of a thyroid gland in most of the examined children did not differ from standard values for healthy children. Analysis of the results of the inhaled bronchial provocation test with acetylcholin showed that the state of nonspecific bronchial hypersensitivity was observed in 2 active smokers and in none of the passive smokers and non-smokers (x2=15,4>x201=9,21 або р<0,01). According to our data, in children with hypothyroidism, under the effect of tobacco smoke, changes in the functional state of sensitive bronchial receptors do not occur. Among 2 children who had an increased activity of the thyroid gland (hyperthyroidism), one child from the group of smokers had an increased bronchial sensitivity by the results of the acetylcholine test (p>0.05). According to our data, changes in the functional status of sensitive bronchial receptors (cholinergic receptors) resulting from exposure to tobacco smoke in children exposed to tobacco smoke, active or passive, do not depend on the functional state of the thyroid gland (Р/2>0,05).
Реферат. Чутливкть бронза. ii>iiii\ pe^rnopiB пщ впливом тютюнового диму в умовах pi3HOi активност щитоподiбноT залози в д^ей. Башкчрова Н.С., Височина 1.Л. Остаточно не визначена роль вихiдних порушень гормонального профтю системи «гiпофiз - щитоподiбна залоза» у виникненш бронхоспазму у вiдповiдь на екзогенш стимули. Метою нашого до^дження було вивчення характеру i вираженостi взаемозв'язку мiж бронхiальною гiперчутливiстю в дтей, як зазнають впливу куртня, i функцiональною активтстю щиmоподiбноi залози. У дослiдженнi взяли участь 74 дитини у вiцi вiд 10 до 17 роюв. Серед обстежених дтей було 16 дтей, як не зазнавали впливу тютюнового диму, 50 дiтей були пасивними курцями, i 8 обстежених дiтей активно курили. Для до^дження рiвня бронхiальноi чутливостi проводилися iнгаляцiйнi бронхопровокацшш тести з неспецифiчним подразником - бронхоконстрикторами з ацетилхолiном. Функцю-нальний стан щитоподiбноi залози оцтювали за рiвнем у сироватцi кровi тиреотропного гормона (ТТГ), тироксину (Т4) i трийодтиротну (Т3). Для бiльшосmi обстежених дтей типовими були показники гормотв щиmоподiбноi залози, яю не вiдрiзняюmься вiд нормативних показниюв для здорових дтей. Аналiз резульmаmiв iнгаляцiйного бронхопровокацшного тесту з ацеmилхолiном показав, що стан неспецифiчноi бронхiальноi гiперчуmливосmi мав мiсце в 2 активних курщв, в одного пасивного курця i в одного, який не палить (х2=15,4> Х201=9,21 або р<0,01) у гр^ дimей з еутирео'1'дним станом. У дтей з гтотирео'1'дизмом пiд впливом тютюнового диму змт у функцiональному сmанi чутливих рецепmорiв бронхiв не вiдбуваеmься. Серед 2 дтей, ят мали пiдвищену активтсть щиmоподiбноi залози (пертирео'1'дизм•), одна дитина з групи курщв мала
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пгдвищену бронхгальну чутливгсть за результатами тесту з ацетилхолгном (р>0,05). Зг1дно з нашими даними, змши у функцюнальному стан чутливих рецепторгв бронх1в (холторецепторов) у дтей, яК зазнають впливу тютюнового диму, активно або пасивно, не залежать вгд функцюнального стану щитопод1бно1 залози (Ру2>0,05).
Tobacco smoking remains the most common harmful habit of humanity. Smoking is comparable with epidemic, as according to data of the World Health Organization (WHO) 87% of annually deaths from lung cancer are associated with smoking, 82% of deaths - from chronic pulmonary obstruction (bronchitis, emphysema), and 21% of deaths - from cardiovascular diseases [2].
In literature there are many data that not only active smoking, but also air pollution of rooms with tobacco smoke is a risk factor for development of various diseases [8, 9, 11, 12]. Especially tobacco smoke has negative effect on children and teenagers [1]. In childhood passive smoking causes respiratory tract infections, asthma attacks in babies and children, increases the risk of developing asthma and chronic obstructive lung disease, bronchitis and other diseases of respiratory system in adults [3]. The risk of the development of acute respiratory infections increases by 42% in smoking households as compared with non-smoking [10].
In our previous work it was shown that in childhood, tobacco smoke impairs the functional condition of cholinergic receptors, which play the main role in regulating the patency of the airway tree, increasing bronchial hypersensitivity [7].
Today it is known that bronchial hypersensitivity is the main component of the pathogenetic mechanism of bronchial asthma development. Tobacco smoke, combined with an increase in bronchial hypersensitivity is a stress factor that induces the development of a complex of metabolic changes in the body, including the hypothalamic-pituitary-thyroid system [5]. Taking this into accountit it is possible to suppose existence of functional changes of the thyroid status in the presence of bronchial hypersensitivity under the effect of tobacco smoke. Scientific publications about a thyroid function condition in the effect of a stressful factor of smoking in children are limited. The role of the initial hormonal profile disorders of the system "pituitary - thyroid" in the emergence of a bronchospasm in response to exogenic stimuli has not been finally determined.
The aim of our research was to investigate the character and degree of the relationship between bronchial hypersensitivity in children exposed to smoking and the functional activity of the thyroid gland.
MATERIALS AND METHODS OF RESEARCH
The research involved 74 patients aged 10 to 17 years, including 32 boys and 42 girls. Sixteen
children were not exposed to tobacco smoke, 50 children were passive smokers, and 8 of the children surveyed smoked actively. In carrying out functional methods of a research children did not have anamnestic and clinical manifestations of acute, recurrent or chronic diseases of a respiratory system, it made possibile to determine basal levels of bronchial sensitivity.
To investigate the level of bronchial sensitivity, a bronchial provocation test with a non-specific stimulus - bronchoconstrictor acetylcholine was carried out. For the test such solutions were used: 0.004%, 0.012%, 0.036%, 0.11%, 0.33%, 1%, 3%, 9% starting from the lowest concentration. Measurement procedure provided control of condition of patency of airways under the effect of increasing concentrations of the irritant.
Respirable concentration of acetylcholine after which levels of FVC, FEV1, FEV1/FVC decreased by 20% was considered as a threshold of the increased nonspecific bronchial sensitivity (threshold concentration - PK20).
If, after inhalation of a 1% acetylcholine solution, the patency of airways was not reduced by a specified percentage, the nonspecific sensitivity of the bronchi was considered as low [4, 6].
We assayed the functional state of the thyroid gland by the level of the free triiodothyronine (FT3), free thyroxin 4 (FT4) and thyroid stimulating hormone (TSH), identified by Enzyme-linked Immuno-sorbent Assay (ELISA) (Alkor Bio, Russia). The obtained data were compared to standard indicators depending on the child's age.
The study was carried out in accordance with the principles of bioethics.
The analysis of data was carried out using the following statistical methods of the chi-square test to compare qualitative variables between groups; unpaired t-tests - to compare two groups.
RESULTS AND DISCUSSION
Findings of thyroid gland hormones in most of the examined children did not differ from standard values for healthy children.
At the same time thyroxine findings (T4) lower than norm in normal findings of triiodothyronine (T3), thyroid-stimulating hormone( TSH) were registered in 40% of children.
The average values of the content of the main thyroid hormones in the blood serum in the examined children did not differ from the standard values (Table).
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MEffHHHI nEPCnEKTHBH / MEDICNIPERSPEKTIVI
Average findings of thyroid hormones in blood serum in children depending on the status of the smoker
Indexes TSH FТ4 FТ3
uIU/mL nmol/1 nmol/l
Non-smokers 1,24±0,5 90,43±46,3 2,067±0,7
Passive smokers 1,13±0,6 67,32±43,5 2,46±1,4
Active smokers 1,24±0,5 86,69±88,9 1,72±0,7
Note: There was no significant difference in TSH, FT, FT between patient groups and normative indices (p>0.05).
In children smokers there was no significant dif- diagnosis of hypothyroidism or hyperthyroidism, or
ference between the indices of the content of individual a subclinical state. However, in some children
hormones in the blood depending on the sex (Fig. 1). deviations of thyroid parameters from the norm give
None of the children had sufficient clinical and possibility to suppose the beginning of the
laboratory criteria that correspond to the level of development of the pathological condition.
TSH (uIU/mL)
Fig. 1. Findings of thyroid hormone levels in blood, depending on sex in children who smoke
Given this, to achieve the aim - to determine the change in the functional state of sensitive bronchial receptors under the effect of tobacco smoke in the context of different functional activity of the thyroid gland, the statistical analysis was performed in groups with different endocrine profile.
The results of the distribution of children into groups depending on the status of the smoker and endocrine profile are shown in figures 2, 3.
In the group of children with euthyroid status, 29 children were smokers (5 active and 24 passive), 13 children were not exposed to tobacco smoke.
Analysis of the results of the inhaled bronchial provocation test with acetylcholin showed that the state of non-specific bronchial hypersensitivity was observed in 2 active smokers and in none of the passive smokers and non-smokers (x2=15,4>%201=9,21 a6o p<0,01). Thus, the obtained data show that in children who are in the euthyroid state of the thyroid gland under the effect of tobacco smoke, the functional state of bronchial cholinergic receptors worsens, as evidenced by an increase in bronchial sensitivity to acetylcholine in active smokers.
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Fig. 2, 3 Distribution of children by functional activity of the thyroid gland and the status of a smoker
According to our data, in children with hypothyroidism under the effect of tobacco smoke, changes in the functional state of sensitive bronchial receptors do not occur. Thus, the analysis of the results of the bronchial provocation test with acetylcholine showed that out of 30 children who form a group of children with hypothyroidism, cases of nonspecific bronchial hypersensitivity were observed in 2 out of 24 passive smokers and none of the 3 active smokers and non-smokers (x2=0,53<%2os=5,99 a6o p>0,05).
Among 2 children with an increased activity of the thyroid gland (hyperthyroidism), one child from the group of smokers had an increased bronchial sensitivity according to the results of the acetylcholine test (p> 0.05).
An attempt to compare the average levels of thyroxine, triiodothyronine, thyroid-stimulating hormone in the blood serum of children smokers between groups with different levels of bronchial sensitivity to acetylcholine showed that there is no direct correlation between these indicators.
Therefore, the presented results of the study showed that in children exposed to tobacco smoke, actively or passively, changes in the functional state of the bronchial receptors of cholinergic receptors do not depend on the functional activity of the thyroid gland. The difference between the formation of impairments of the bronchial receptor apparatus that occurs under the effect of tobacco smoke in children with different levels of tyretropic hormone, thyroxine, triiodothyronine in serum was not detected (p>0.05).
Ambiguity of the obtained data requires further research and dynamic monitoring as well.
CONCLUSION
According to our data, changes in the functional status of sensitive bronchial receptors (cholinergic receptors) resulting from exposure to tobacco smoke in children exposed to tobacco smoke, active or passive, do not depend on the functional state of the thyroid gland (P%2>0,05).
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Стаття надшшла до редакцп 01.07.2019
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