变应性鼻炎患者皮下特异性免疫治疗剂量累加阶段免疫学指标及鼻声反射的观察

发布时间：2018-05-06 12:45

  本文选题：变应性鼻炎 + 特异性免疫治疗　； 参考：《宁波大学》2017年硕士论文

【摘要】：目的:1.观察变应性鼻炎患者皮下特异性免疫治疗(SCIT)的临床疗效。2.观察变应性鼻炎患者特异性免疫剂量累加阶段唾液sIgG4、血清免疫学指标(sIgG4、血嗜酸性粒细胞,总IgE、sIgE)、鼻声反射的变化。3.分析唾液sIgG4与血清sIgG4的相关性。方法:1.随机从2015年8月至2016年6月就诊于宁波大学附属医院以尘螨过敏为主并自愿接受SCIT治疗的患者中随机选取42例,在治疗前及剂量累加阶段完成后分别进行症状VAS评分,血清、唾液及鼻声检测,观察并记录42例患者治疗前后VAS评分、血嗜酸性粒细胞(绝对值、百分比),血总IgE、sIgE、sIgG4浓度,唾液sIgG4浓度和鼻腔总容积以及鼻腔最小截面积的变化。随访并记录患者不良反应。2.通过疗效评定公式得出患者剂量累加阶段结束后(17周)的疗效,统计分析比较治疗前后症状VAS评分,血清各指标及唾液sIgG4浓度变化及鼻声检测(鼻腔总容积、最小截面积)的变化。3.分析治疗前后唾液sIgG4与血清sIgG4的相关性。结果:1.42例AR患者共有41例完成剂量累加阶段治疗,治疗后主要症状(鼻痒、鼻塞、喷嚏、流涕)VAS评分、伴随症状(眼痒)VAS评分,疗效评定:显效21.95%(9/41),有效56.10%(23/41),无效21.95%(9/41),总有效率78.05%(32/41)。2.与治疗前比较,血清sIgG4浓度、唾液sIgG4浓度、鼻腔总容积、最小截面积均有统计学差异(p0.05)。3.与治疗前比较,治疗后血清嗜酸性粒细胞绝对值、百分比,总IgE,sIgE差异均无统计学意义(p0.05)。4.治疗前血清sIgG4与唾液sIgG4呈正相关(R=0.734,P0.05),剂量累加阶段完成后血清sIgG4与唾液sIgG4相关性不明显(R=0.304,P0.05)。结论:1.经过17W皮下特异性免疫治疗,患者鼻部及眼部伴随症状VAS评分均有降低。2.SCIT可使AR患者血清、唾液s IgG4浓度升高,s IgG4可作为客观评估免疫治疗临床疗效的一个重要的免疫学指标。3.鼻腔总容积、最小截面积与治疗前比较有明显的增大,免疫治疗在早期可以明显改善鼻通气功能。4.血清sIgG4与唾液sIgG4的相关关系需通过扩大样本量,延长随访时间等进一步深入研究。
[Abstract]:Purpose 1. To observe the clinical effect of subcutaneous specific immunotherapy in patients with allergic rhinitis. To observe the changes of salivary Siga _ 4, serum immunological index, serum eosinophil, total IgE sIgE, nasal acoustic reflex in patients with allergic rhinitis. The correlation between salivary sIgG4 and serum sIgG4 was analyzed. Method 1: 1. From August 2015 to June 2016, 42 patients with dust mite hypersensitivity were randomly selected from the affiliated Hospital of Ningbo University and accepted SCIT treatment voluntarily. The symptom VAS score and serum were evaluated before and after the dose-accumulation stage. Saliva and nasal acoustic examination were performed to observe and record the changes of VAS score, eosinophilic granulocyte (absolute value, percentage of eosinophils), total IgES IgEN sIgG4 concentration, salivary sIgG4 concentration, nasal total volume and minimal nasal area before and after treatment in 42 patients. Follow up and record adverse reactions. 2. 2. According to the formula of curative effect evaluation, the curative effect was obtained after the end of the patients' dose accumulation stage. The VAS score of symptoms, the changes of serum indexes, saliva sIgG4 concentration and nasal acoustic examination (total volume of nasal cavity) before and after treatment were statistically analyzed and compared. Minimum cross-sectional area). To analyze the correlation between salivary sIgG4 and serum sIgG4 before and after treatment. Results 41 of 41 patients with AR completed the dose-accumulation stage treatment. The main symptoms after treatment (nasal itch, nasal congestion, sneezing, snot) VAS scores, accompanying symptoms (EVAS score, curative effect evaluation: 21.95595 / 41C, effective 56.1010n23 / 41a, no effect 21.9599 / 41a), total effective rate 78.05 / 32 / 41a 路2. 5%. The total effective rate was 78.05 卤32 / 41 / 41g / L, and the total effective rate was 78.05 / 32 / 41 / 41g / L, and the total effective rate was 78.05 卤32 / 41 / 41g / L, respectively. Compared with before treatment, the serum sIgG4 concentration, saliva sIgG4 concentration, total volume of nasal cavity and minimum cross section area were all significantly different (P < 0.05). There was no significant difference in serum eosinophil absolute value, percentage and total IgE between before and after treatment. There was a positive correlation between serum sIgG4 and salivary sIgG4 before treatment, and there was no significant correlation between serum sIgG4 and salivary sIgG4 after the completion of dose-accumulation stage. Conclusion 1. After 17 W subcutaneous specific immunotherapy, the VAS scores of nasal and ocular associated symptoms were decreased. 2. SCIT could make the serum of AR patients. Saliva s IgG4 concentration increased and s IgG4 could be used as an important immunological index to objectively evaluate the clinical efficacy of immunotherapy. The total volume and minimum sectional area of nasal cavity were significantly increased compared with those before treatment. Immunotherapy could significantly improve nasal ventilation function at the early stage. The relationship between serum sIgG4 and salivary sIgG4 should be further studied by enlarging sample size and prolonging follow-up time.
【学位授予单位】：宁波大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R765.21

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