CAJ | 학술논문

目的分析标准化屋尘螨变应原疫苗特异性免疫治疗(specific immunotherapy,SIT)变应性鼻炎(allergic rhinitis,AR)的疗效及其可能机制.方法选择南通大学附属医院耳鼻咽喉头颈外科2011年1-12月的90例中-重度持续性AR患者根据患者意愿分为标准化屋尘螨变应原疫苗特异性免疫治疗+药物治疗组(SIT组)及单纯药物治疗(药物治疗组).采用症状视觉模拟量表评分(visual analoguescale,VAS)、用药评分评定疗效.采用流式细胞技术检测治疗前、治疗1年后外周血调节性T细胞(regulatory T cell,Treg)、辅助性T细胞17(T help 17cell,Th17)的细胞比例.所获资料用SPSS 21.0统计软件进行统计学分析.结果 SIT组AR患者免疫治疗后VAS评分及用药评分分别为(14.25 ±6.40)、(1.00±0.84)分,较治疗前的(32.18 ±7.78)、(3.12±1.54)分明显下降,差异有统计学意义(t值分别为19.65、10.71,P值均＜0.05);药物治疗组仅VAS评分由(30.30 ±5.97)分下降为(20.30 ±5.79)分,差异有统计学意义(t=10.09,P＜0.05),用药评分无明显变化(P＞0.05).SIT组患者治疗1年后外周血Th17细胞比例降低、Treg细胞比例显著升高,差异有统计学意义(x2值分别为2.81、2.80,P值均＜0.05),而药物治疗组治疗前后上述各指标差异无统计学意义(P值均＞0.05).结论 SIT及药物治疗均能改善AR患者症状,而SIT能减少患者用药,其疗效优于药物治疗.SIT能明显降低患者外周血中Th17细胞比例,提高Treg细胞比例.
목적 분석표준화옥진만변응원역묘특이성면역치료(specific immunotherapy,SIT)변응성비염(allergic rhinitis,AR)적료효급기가능궤제.방법 선택남통대학부속의원이비인후두경외과2011년1-12월적90례중-중도지속성AR환자근거환자의원분위표준화옥진만변응원역묘특이성면역치료+약물치료조(SIT조)급단순약물치료(약물치료조).채용증상시각모의량표평분(visual analoguescale,VAS)、용약평분평정료효.채용류식세포기술검측치료전、치료1년후외주혈조절성T세포(regulatory T cell,Treg)、보조성T세포17(T help 17cell,Th17)적세포비례.소획자료용SPSS 21.0통계연건진행통계학분석.결과 SIT조AR환자면역치료후VAS평분급용약평분분별위(14.25 ±6.40)、(1.00±0.84)분,교치료전적(32.18 ±7.78)、(3.12±1.54)분명현하강,차이유통계학의의(t치분별위19.65、10.71,P치균＜0.05);약물치료조부VAS평분유(30.30 ±5.97)분하강위(20.30 ±5.79)분,차이유통계학의의(t=10.09,P＜0.05),용약평분무명현변화(P＞0.05).SIT조환자치료1년후외주혈Th17세포비례강저、Treg세포비례현저승고,차이유통계학의의(x2치분별위2.81、2.80,P치균＜0.05),이약물치료조치료전후상술각지표차이무통계학의의(P치균＞0.05).결론 SIT급약물치료균능개선AR환자증상,이SIT능감소환자용약,기료효우우약물치료.SIT능명현강저환자외주혈중Th17세포비례,제고Treg세포비례.
Objective The study was designed to analyze the efficacy of standardized house dust mite allergen vaccine to allergic rhinitis by subcutaneous injection and investigate the possible mechanism of specific immunotherapy(SIT).Methods From January 2011 to December 2011 a prospective study was performed in the Department of Otorhinolaryngology Head and Neck Surgery,the Affiliated Hospital of Nantong University,involving 90 patients with perennial AR,of whom 60 patients received Der p-SIT +pharmacotherapy after their approval and 30 received only pharmacotherapy.All patients were allergic to house dust mites.Symptom and medication scores were recorded three times:before the treatment,at the middle of treatment and at the end of treatment.Over a period of 1 yr.prior to and at the end of treatment,CD4 + CD25 + Foxp3 + Treg cells and Th17 cells were measured by flow cytometry.SPSS 21.0 software was used to analyze the data.Results The symptom scores using VAS and medication scores in AR patients treated with SIT and medication were reduced,the differences were significant (14.25 ± 6.40,1.00 ± 0.84 vs.32.18 ± 7.78,3.12 ± 1.54,t value was 19.65,10.71,both P ＜ 0.05).The symptom of VAS score in medication group was reduced after treatment (30.30 ±5.97 vs.20.30 ±5.79,t =10.09,P ＜0.05),but the medication score had not significant difference (P ＞ 0.05).The frequency of Thl7 cells in peripheral blood mononuclear cells were decreased in patients treated with SIT,whereas the frequency of Treg cells were increased (x2 value was 2.81,2.80,both P ＜ 0.05),but not in medication group.Conclusions Both SIT and pharmacotherapy can improve symptoms of allergic rhinitis,but SIT can also reduce medication use.The effect of immunotherapy is better than drug treatment alone.The frequency of blood Th17 cells in peripheral blood mononuclear cells were decreased in patients treated with SIT,whereas the frequency of Treg cells were increased.