变应性鼻炎冲击免疫治疗的疗效及相关因素研究
发布时间:2018-02-26 18:15
本文关键词: 变应性鼻炎 变应原特异性免疫治疗 皮下注射特异性免疫治疗 冲击免疫治疗 嗜酸性粒细胞 免疫球蛋白E 免疫球蛋白G 白介素-10 白介素-12 γ干扰素 出处:《南昌大学》2016年硕士论文 论文类型:学位论文
【摘要】:目的:变应性鼻炎作为耳鼻喉科常见病、多发病之一,其发病机制尚未完全阐明,但其发病率呈逐年增长,尤其是在发展中国家。AR虽然没有明显的生命危险,但其严重影响患者的日常生活、学习和工作,造成个人和社会的经济负担(药物控制)。特异性免疫治疗是治疗变应性鼻炎的有效治疗措施,临床上常用的2种给药方式分别是:皮下注射免疫治疗(SCIT)和舌下含服免疫治疗(SLIT)。本文着重探讨冲击免疫治疗方案对变应性鼻炎的疗效及其相关影响因素。方法:回顾性分析2013年2月至2015年7月于我院诊断为变应性鼻炎,同时采用冲击免疫治疗方法完成剂量累加阶段的62例患者的临床资料,采用病例自身对照方法研究,统计学上采用配对设计的t检验方法进行统计分析。1、对比完成1周冲击免疫治疗前后患者症状评分、体征评分以及VAS评分的改变,评价其疗效;2、全自动血液分析仪测定患者完成冲击免疫治疗前后外周血嗜酸性粒细胞计数的变化,评价其疗效;3、Beekman特定蛋白检测仪检测血清总免疫球蛋白E(Ig E)和免疫球蛋白G(Ig G)的浓度在冲击免疫治疗前后的变化,评价其疗效;4、ELISA法测定患者冲击免疫治疗前后血清中IFN-γ、IL-12、IL-10、Ig G1、Ig G4的浓度变化,评价冲击免疫治疗的相关影响因素;5、观察治疗过程中患者发生的不良反应事件,简要评价其安全性。结果:1、患者完成冲击免疫治疗后症状评分较治疗前有所降低,差异具有统计学意义。2、完成冲击免疫治疗后患者外周血中嗜酸性粒细胞计数较前降低,其中单纯尘螨过敏组的变化具有统计学意义。3、完成冲击免疫治疗后患者血清总Ig E、Ig G的浓度较前有所升高,单纯尘螨过敏组血清Ig G浓度变化具有统计学意义。4、完成冲击免疫治疗后患者血清IFN-γ、IL-12、IL-10的浓度均升高,其中合并多种变应原组在治疗前后IL-12和IFN-γ的浓度变化无统计学意义;其余各组的变化均有统计学意义。5、完成冲击免疫治疗后患者血清Ig G1、Ig G4的浓度均升高,其中单纯尘螨过敏组血清Ig G4的浓度变化具有统计学意义,血清Ig G1浓度变化无明显统计学意义。6、治疗过程中无明显全身过敏反应,仅出现注射部位红斑、硬结、肿胀、肿胀等局部不良反应。结论:1、冲击免疫治疗能有效改善患者的TNSS评分、体征评分、VAS评分,对AR的治疗具有良好的疗效;2、冲击免疫治疗可通过产生Ig G抗体发挥作用,还可通过调整Th1/Th2的动态平衡发挥作用。3、冲击免疫治疗是一种安全的剂量累加阶段给药方式。
[Abstract]:Objective: allergic rhinitis is one of the most common diseases in otolaryngology. The pathogenesis of allergic rhinitis has not been fully elucidated, but the incidence of allergic rhinitis is increasing year by year, especially in developing countries. However, it seriously affects the daily life, study and work of the patients, resulting in a personal and social economic burden. (drug control and specific immunotherapy is an effective treatment for allergic rhinitis. The two commonly used methods of administration in clinic are subcutaneous immunotherapy (SCITT) and sublingual immunotherapy (SLITT). The therapeutic effect of shock immunotherapy on allergic rhinitis and its related influencing factors were discussed in this paper. The diagnosis of allergic rhinitis in our hospital from February 2013 to July 2015 was retrospectively analyzed. At the same time, the clinical data of 62 patients in the dose-accumulation stage were completed by means of shock immunotherapy, and the case-control study was used. T test was used to analyze the symptoms, signs and VAS scores of patients before and after 1 week of shock immunotherapy. To evaluate its curative effect, the changes of eosinophil count in peripheral blood were measured by automatic blood analyzer before and after shock immunotherapy. To evaluate the efficacy of Beekman specific protein detection instrument, the changes of serum total immunoglobulin (IgE) and immunoglobulin G (GG) concentrations before and after shock immunotherapy were evaluated. To evaluate the effect of shock immunotherapy, to determine the concentration of IFN- 纬 -12 IL-12, IL-10, Ig, Ig, and IgG4 in serum before and after shock immunotherapy, and to evaluate the related influencing factors of shock immunotherapy, and to observe the adverse events in the course of treatment. Results the symptom score of the patients after shock immunotherapy was lower than that before treatment, and the difference was statistically significant. The eosinophil count in peripheral blood of patients with shock immunotherapy was lower than that before. The changes of the allergic group of dust mite were statistically significant. The serum concentration of IgE Ig was increased after Impulse immunotherapy. The changes of serum IgG concentration were statistically significant in simple dust mite allergy group. The serum levels of IFN- 纬 IL-12 IL-10 were increased after shock immunotherapy, but the concentrations of IL-12 and IFN- 纬 in patients with multiple allergens were not significantly changed before and after treatment. The changes of the other groups were statistically significant. The serum levels of IgG4 in the patients with pneumoconidia hypersensitivity group were significantly higher than those in the control group after Ig G1 + Ig G4 treatment, and there was a significant difference in the concentration of IgG4 in the patients with simple dust mite allergy group. There was no significant change in serum Ig G 1 concentration. 6. There was no obvious systemic allergic reaction during the treatment, only erythema, sclerotia and swelling occurred at the injection site. Conclusion impact immunotherapy can effectively improve the TNSS score and physical sign score of patients, and has a good curative effect on AR treatment. Shock immunotherapy can play an important role by producing IgG antibody. By adjusting the dynamic balance of Th1/Th2, impulse immunotherapy is a safe dose-accumulation method.
【学位授予单位】:南昌大学
【学位级别】:硕士
【学位授予年份】:2016
【分类号】:R765.21
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