儿童变应性鼻炎免疫治疗的基础与临床研究

发布时间：2018-06-28 14:26

本文选题：变应性鼻炎 + 免疫治疗　；参考：《昆明医科大学》2013年硕士论文

【摘要】：目的：研究尘螨变应原疫苗皮下免疫疗法(subcutaneous immunotherapy,SCIT)和舌下免疫疗法(sublingual immunotherapy,SLIT)治疗儿童中-重度持续性变应性鼻炎(allergic rhinitis,AR)的血清IL-2、IL-4、IL-6、IL-10、TNF和IFN-y的变化情况和临床疗效。方法：50例确诊为中-重度持续性AR的患儿纳入本项开放性对照研究。所有患儿均对屋尘螨和(或)粉尘螨过敏,年龄为5-14周岁,病程1-6年。患儿随机分为2组,每组25例,分别采用SCIT或SLIT治疗方案并长期随访。治疗前和治疗1年后抽取静脉血行流式细胞术(Flow Cytometry,FCM)测定Th1/Th2细胞因子(IL-2、IL-4、IL-6、IL-10、TNF和IFN-y)的值。并同时应用视觉模拟量表(visual analogue scale,VAS)进行鼻部症状(打喷嚏、流清涕、鼻塞和鼻痒)和总体症状评分。结果：1.免疫治疗1年后与治疗前相比,SCIT组和SLIT组患儿血清中IL-2、IL-10和IFN-γ值明显上升,IL-4和IL-6值下降,差异有统计学意义(t值分别为7.183、4.084、10.115、-8.662、-3.343；7.226、4.016、10.095、-11.015、-2.170,P值均0.05)：两组的TNF值也有所下降,SCIT组下降差异有统计学意义(t值=-2.195,P值0.05),但SLIT组差异无统计学意义(t值=-1.859,P值0.05)。 2.两组患儿治疗前后各细胞因子的差值行组间比较,仅IFN-y差值SLIT组高于SCIT组(t值=2.508,P值0.05),其余组间比较差异均无统计学意义(t值分别为1.347、-1.949、0.025、0.130、-0.026,P值均0.05)。 3.免疫治疗1年后,SCIT组和SLIT组患儿的流清涕、打喷嚏、鼻塞、鼻痒症状和总体症状评分均明显下降,差异有统计学意义(t值分别为-18.667、-15.267、-15.544、-11.830、-19.822;-25.103、-22.992、-14.288.-140343、-22.093,P值均0.01)。 4.两组患儿治疗前后的各症状评分差值进行比较,组间差异无统计学意义(t值分别为0.147、0.522、1.327、0.695、0.112,P值均0.05)。 5.SCIT组和SLIT组患儿治疗前与治疗1年后的血清细胞因子(IL-2、IL-4、IL-6、IL-10、TNF和IFN-γ)值与总体症状VAS评分均没有相关性(P值均0.05)。结论：1.特异性免疫治疗能显著提高患儿外周血中IL-2和IFN-γ (Th1类细胞因子)的表达水平,降低IL-4和IL-6(Th2类细胞因子)的表达,调节Th1和Th2细胞的平衡,达到治疗目的。 2.尘螨变应原免疫治疗能够有效改善儿童变应性鼻炎的症状,舌下免疫治疗与皮下免疫治疗有相同的临床疗效。舌下免疫治疗给药方便,无疼痛,有望替代皮下免疫治疗在儿童中推广。
[Abstract]:Objective: to study the changes and clinical efficacy of subcutaneous immunotherapy and sublingual immunotherapy in the treatment of moderate to severe persistent allergic rhinitis in children with moderate to severe persistent allergic rhinitis (allergic rhinitis AR). Methods 50 children with moderate-severe persistent AR were included in this open controlled study. All the children were allergic to house dust mites and / or dust mites aged 5-14 years and the course of disease was 1-6 years. The children were randomly divided into two groups, 25 cases in each group, treated with SCIT or SLIT respectively and followed up for a long time. Flow Cytometry (FCM) was used to measure the levels of Th1 / Th2 cytokines (IL-2 / IL-4, IL-6, IL-10, TNF and IFN-y) before and one year after treatment. At the same time, the nasal symptoms (sneezing, runny, nasal congestion and itching) and the overall symptoms were evaluated by visual analogue scale (visual analogue scale VAS). The result is 1: 1. After one year of immunotherapy, the serum levels of IL-2, IL-10 and IFN- 纬 in the SCIT group and the SLIT group were significantly increased, and the levels of IL-4 and IL-6 were decreased significantly (t = 7.1834.084 卤10.115- 8.662U -3.343respectively). The serum levels of IL-2, IL-10 and IFN- 纬 in the SCIT group and the SLIT group were significantly higher than those in the control group (t = 7.1834.084). The TNF values of the two groups were also decreased (t value was 2.195 P 0.05), but there was no significant difference in the SLIT group (t value -1.859P value 0.05), but there was no significant difference between the two groups (t = -1.859P = 0.05), but there was no significant difference between the two groups (t = -1.859P = 0.05), but there was a significant difference between the two groups (t = -2.195, P = 0.05), but there was no significant difference in the SLIT group (t = -1.859P = 0.05). Only IFN-y difference was higher in SLIT group than that in SCIT group (t = 2.508, P = 0.05), but there was no significant difference between other groups (t = 1.347- 1.949U 0.0250.130- 0.026P, respectively). After one year of immunotherapy, the scores of snot, sneezing, nasal congestion, nasal itching and total symptoms in SCIT group and SLIT group were significantly decreased (t values were -18.667- 15.267- 15.544- 11.830U -19.822U -25.103- 22.992- 14.288.-140343- 22.093n, P < 0.01), and the difference was statistically significant (t = -18.667- 15.267- 15.544- 11.830U -19.822- 25.103- 22.992- 14.288.-140343- 22.093P). The difference of symptom scores before and after treatment was compared between the two groups. There was no significant difference between the two groups (t = 0.147) (t = 0.147, 0.522, 1.327, 0.6950.12, P = 0.05). 5. There was no correlation between serum cytokines (IL-2IL-4, IL-6, IL-10, TNF and IFN- 纬) and total symptom VAS score in SCIT group and SLIT group before and 1 year after treatment (P all 0.05). Conclusion 1. Specific immunotherapy can significantly increase the expression of IL-2 and IFN- 纬 (Th1 cytokines) in children's peripheral blood, decrease the expression of IL-4 and IL-6 (Th2 cytokines), regulate the balance of Th1 and Th2 cells, and achieve the therapeutic purpose. 2. Dust mite allergen immunotherapy can effectively improve the symptoms of allergic rhinitis in children. Sublingual immunotherapy has the same clinical effect as subcutaneous immunotherapy. Sublingual immunotherapy is convenient and painless. It is expected to replace subcutaneous immunotherapy in children.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R765.21

【引证文献】