尘螨变应性鼻炎特异性免疫治疗的疗效预测指标探讨

发布时间：2018-11-11 10:03

【摘要】：目的观察变应性鼻炎(AR)患者接受变应原特异性免疫治疗1年后血清总Ig E(tIgE)和特异性Ig E(sIgE)水平的变化,探讨皮下免疫治疗(SCIT)和舌下免疫治疗(SLIT)的疗效预测指标。方法以尘螨致敏的中-重度持续性AR患者完成免疫治疗1年的病例作为研究对象,采用患者自评的方式对治疗效果进行主观评价,比较治疗前后血清tIgE、屋尘螨(Dp)和粉尘螨(Df)sIgE水平的变化,并依据治疗有效与否进行分层分析。对免疫治疗前患者的基线血清Ig E抗体水平与治疗效果的关系进行分析,应用ROC曲线获得具有最佳预测效果的血清指标及其最佳临界值(cut-off值)。结果完成1年免疫治疗的SCIT组(50例)和SLIT组(58例)患者中,有效率分别为64.0%和65.5%,两组治疗效果的差异无统计学意义(P0.05)。免疫治疗1年后与治疗前相比较,两组血清tIgE、Dp-sIgE和Df-sIgE水平的变化均无统计学意义(P0.05),仅SCIT组有效患者血清Dp-sIgE水平的下降有统计学意义(P0.05)。基线血清Dp-sIgE/tIgE比值对SCIT疗效具有最佳预测效果,其最佳cut-off值为11.95%,敏感性为71.9%,特异性为83.3%。而基线血清Df-sIgE水平对SLIT疗效具有最佳预测效果,其最佳cut-off值为27.95 IU/ml(4级),敏感性为52.6%,特异性为85.0%。结论免疫治疗前患者的血清sIgE水平可在一定程度上对治疗效果进行预测,sIgE水平较高或sIgE/tIgE比值较大的患者更容易取得满意疗效。
[Abstract]:Objective to observe the changes of serum total Ig E (tIgE) and specific Ig E (sIgE) levels in patients with allergic rhinitis (AR) after one year of allergen specific immunotherapy. Objective: to investigate the predictors of subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT). Methods the patients with moderate to severe persistent AR sensitized by dust mite for one year after immunotherapy were used to evaluate the therapeutic effect subjectively. The serum tIgE, was compared before and after treatment. The changes of (Dp) and (Df) sIgE levels in house dust mites were analyzed according to the efficacy of treatment. The relationship between the baseline serum Ig E antibody level and the therapeutic effect was analyzed. The best predictive serum index and the best critical value (cut-off value) were obtained by using the ROC curve. Results the effective rates of SCIT group (50 cases) and SLIT group (58 cases) were 64.0% and 65.5%, respectively. There was no significant difference between the two groups (P0.05). After one year of immunotherapy, the changes of serum tIgE,Dp-sIgE and Df-sIgE levels in the two groups were not statistically significant (P0.05), but only the decrease of serum Dp-sIgE level in the SCIT group was statistically significant (P0.05). The baseline serum Dp-sIgE/tIgE ratio was the best predictor of the efficacy of SCIT. The best cut-off value was 11.95. The sensitivity was 71.9 and the specificity was 83.3. The baseline serum Df-sIgE level was the best predictor of the efficacy of SLIT. The best cut-off value was 27.95 IU/ml (grade 4), the sensitivity was 52.6, and the specificity was 85.0. Conclusion the serum sIgE level of patients before immunotherapy can predict the therapeutic effect to some extent, and patients with higher sIgE level or higher sIgE/tIgE ratio are more likely to obtain satisfactory results.
【作者单位】：南京医科大学第一附属医院江苏省人民医院耳鼻咽喉科;
【基金】：国家卫生计生委公益性行业科研专项(201502012) 江苏高校优势学科建设工程(JX10231801) 江苏省科教兴卫工程医学重点人才(RC2011071)
【分类号】：R765.21

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