粉尘螨滴剂治疗螨致敏过敏性鼻炎和哮喘患儿的临床研究

发布时间：2018-06-17 18:21

本文选题：粉尘螨 + 舌下特异性免疫治疗　；参考：《南昌大学》2011年硕士论文

【摘要】：目的：通过比较舌下特异性免疫治疗(sublingual specific immunotherapy, SLIT)前后血清白介素-17(IL-17)、白介素-10(IL-10)、特异性IgE (specific IgE, SIgE)、特异性IgG4 (specific IgG4, SIgG4)的水平变化,探讨抑炎因子IL-10及促炎因子IL-17在SLIT中的作用及SLIT可能的作用机制；评价SLIT的安全性及有效性。方法：选择年满4-14周岁,对粉尘螨过敏的过敏性鼻炎和／或轻度哮喘患儿30例作为病例组,采用粉尘螨滴剂进行SLIT24周；另选取年满4-14周岁的健康儿童25例作为正常对照组。应用双抗体夹心酶联免疫吸附试验(Enzyme-linked immunosorbent assay,ELISA)分析法分别检测血清IL-17、IL-10、SIgE、SIgG4。分别比较病例组治疗前、治疗24周后及正常对照组上述各项指标的变化；同时对病例组治疗前后还进行外周血嗜酸性粒细胞(eosinophil, Eos)计数、肺功能／气道阻力的测定以及鼻炎和／或哮喘症状评分及症状总评分。结果：经过24周SLIT后,患儿血清IL-17水平较治疗前明显下降,P0.01,但较正常对照组仍高,P＜0.01；血清IL-10水平较治疗前明显升高,P0.01,但仍低于正常对照组,P0.0l；血清SIgE水平较治疗前有所下降,P＞0.05,无统计学意义;血清SIgG4水平明显升高,P＜0.01,差异有显著统计学意义；外周血嗜酸性粒细胞计数较治疗前明显下降,P＜0.01,差异有显著统计学意义；肺功能,第一秒用力呼气容积(FEV1%：实测值／预计值)较治疗前升高,气道阻力(%：实测值／预计值)则较治疗前下降,P0.05,差异有统计学意义；且所有患儿的鼻炎和／或哮喘症状评分及症状总评分较治疗前均有下降,P0.0l,差异有显著统计学意义。治疗效果：显效43.3%、有效50%、无效6.7%；病例组患儿的鼻炎和／或哮喘症状均得到显著改善。病例组在进行SLIT前及治疗24周后,血清IL-10与血清SIgG4水平均成正相关关系,且与患儿症状总评分均成负相关关系；SIgG4与症状总评分存在负相关关系。结论：(1)促炎因子IL-17是儿童呼吸道变应性疾病的一个重要致病因子。SLIT可以降低血清中促炎因子IL-17的水平,提高抑炎因子IL-10的水平。(2)证实SIgG4在儿童呼吸道变应性疾病中起保护性抗体作用。(3)SLIT是儿童呼吸道变应性疾病的一种安全、有效的治疗方法,但目前多种过敏原SLIT暂不推荐广泛应用。
[Abstract]:Objective: to compare the serum levels of interleukin-17 (IL-17), interleukin-10 (IL-10), specific IgE (Siga), specific IgG4 (SIgG4) before and after sublingual specific immunotherapy (SLITT). To investigate the role of anti-inflammatory factor IL-10 and pro-inflammatory factor IL-17 in SLIT and the possible mechanism of SLIT, to evaluate the safety and efficacy of SLIT. Methods: thirty cases of allergic rhinitis and / or mild asthma with allergic rhinitis and / or mild asthma aged 4-14 years were selected as the case group, and 25 healthy children aged 4-14 years were selected as the normal control group. Double antibody sandwich enzyme-linked immunosorbent assay (Elisa) was used to detect serum IL-17, IL-10, Siga, Siga and Siga. The changes of the above indexes were compared before treatment, 24 weeks after treatment and in the normal control group, and the eosinophilic (eosinophilic) counts of peripheral blood were also counted before and after treatment in the case group. Measurement of pulmonary function / airway resistance, as well as rhinitis and / or asthma symptom score and total symptom score. Results: after 24 weeks of SLIT, the serum IL-17 level was significantly lower than that before treatment, but still higher than that of the normal control group (P < 0.01), and the serum IL-10 level was significantly higher than that of the control group (P 0.01), but still lower than that of the normal control group (P 0.0l). The level of Siga E in serum was lower than that before treatment (P > 0.05), but the level of Siga _ 4 in serum was significantly higher than that before treatment (P < 0.01). The eosinophil count in peripheral blood was significantly lower than that before treatment (P < 0.01), and the pulmonary function, forced expiratory volume in the first second (FEV1: actual value / predicted value) was higher than that before treatment, and the number of eosinophils in peripheral blood was significantly lower than that before treatment (P < 0.01). The score of the symptoms of rhinitis and / or asthma and the total score of symptoms in all the children were significantly lower than that before treatment (P 0.0l). The results showed that the symptoms of rhinitis and / or asthma were significantly improved in the case group. There was a positive correlation between serum IL-10 and Siga _ 4 level before SLIT and 24 weeks after treatment, and there was a negative correlation between serum IL-10 and Siga _ 4, and there was a negative correlation between Siga _ 4 and total symptom score. Conclusion Interleukin-17 (IL-17) is an important pathogenic factor of respiratory allergic disease in children. SLIT can reduce the level of IL-17 in serum. It is proved that Siga _ 4 plays a protective role in children's respiratory allergic diseases. It is a safe and effective method to treat children's respiratory allergic diseases. However, currently many allergens SLIT is not recommended to be widely used.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R725.6;R765.21

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