标准化屋尘螨变应原疫苗治疗的疗效评价  

Eff icacy evaluation of specif ic immunotherapy with standardization allergen vaccine of dermatophagoides pteronyssinus

作　　者：林小平[1] 高军[1] 郑岩[1] 李玉珍[1] 吕智慧[1] 冯小娟[1] 迟秀丽[1] 

机构地区：[1]沈阳军区总医院全军呼吸内科及变态反应疾病诊治中心,辽宁沈阳110016

出　　处：《中国耳鼻咽喉头颈外科》2007年第1期7-10,共4页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：科技部"十五"国家科技攻关计划基金资助项目(2004BA720A19-01)

摘　　要：目的探讨标准化屋尘螨变应原疫苗(Alutard?)特异性免疫治疗(specificimmunotherapy,SIT)变应性鼻炎伴哮喘的疗效及作用机制。方法选择对屋尘螨过敏的变应性鼻炎伴轻-中度哮喘患者37例,进行SIT3年。SIT采用以浓度、剂量逐渐递增的皮下注射方法,从100SQ-U0.2ml/次/周的初始量至100000SQ-U1.0ml/次/6周的维持剂量。应用UniCAPsystem免疫荧光法和瑞氏染色法分别测定血清特异性IgE(specificIgE,sIgE)、总IgE(totalIgE,tIgE)、IgG、嗜酸性粒细胞阳离子蛋白(Eosinophilcationicprotein,ECP)和外周血嗜酸细胞(Eosinophil,Eos)计数;应用ELISA法检测血清白细胞介素4(interleukin-4,IL-4)、白细胞介素5(interleukin-5,IL-5)和干扰素γ(interferon-gamma,IFN-γ)。分别比较治疗前和治疗3年后上述各种参数、肺功能指标、症状评分和皮肤反应指数(skinindex,SI)的变化。结果经过3年SIT后,患者血清ECP水平和血Eos计数明显降低,与治疗前相比P<0.01,与正常对照组相比P>0.01。SIT后IL-4和IL-5降至正常水平,而IgG和IFN-γ分泌增加;血清tIgE水平降至正常,sIgE有所下降,但无明显统计学意义。临床完全控制率64.86%,良好控制率35.14%;所有患者肺功能指标和症状评分均得到明显改善或恢复正常。62.12%的患者不用任何药物,78.4%的患者SI明显降低。3年SIT后无新的过敏症状的发生。结论坚持长期SIT能明显缓解变应性鼻炎和哮喘的临床症状,改善肺功能,抑制Eos的聚集,降低血清ECP水平,增强对变应原的耐受性,从而达到调节免疫细胞Th1和Th2分泌的平衡,以维持长期、稳定的临床疗效。OBJECTIVE To explore the effectiveness and mechanisms of allergen specific immunotherapy （SIT） with standardization allergen vaccine of Dermatophagoides pteronyssinus （house dust mite） in the patients of allergic rhinitis combining with asthma. METHODS A total of 37 patients of allergic rhinitis combining with mUd-moderate asthma were recruited into the study.The course of SIT was treated by standardization allergen vaccine for 3 years. Subcutaneous immunotherapy were performed depending on concentration and dosage （from initial 100 SQ-U O.2mlltimelweek to maintenance dosage 100 000 SQ-U1.0ml/time/6weeks）.The levels of serum total IgE（tlgE）, specific IgE（slgE）, IgG and EosinophU cationic protein（ECP） were determined with Uni CAP system, and Eosinophil numbers were counted. The serum IL-4, IL-5, IFN-γ were detected by ELISA. The above-mentioned indices, lung function test, symptomatic score and skin test results were compared before and after treatment. RESULTS The elevated levels of serum tlgE, ECP and eosinophil counts in peripheral blood of the patients were significantly reduced compared to before SIT and the healthy control respectively（P〈0.01, and P〉0.01）. The levels of IL-4 and IL-5 were decreased to normal, but IgG and IFN-Y were increased. Although the level of serum slgE was decreased, no statistic differences were found after 3 years＇ treatment. 64.86 %of the patients were clinically cured, 35.14 %of them were effective; the lung function test and symptomatic score were achieved normal or improved significantly. 62.12 % of patients were not treated by any medicine, skin test index were decreased in 78.4 % of them significantly. There is no new sensitized symptoms developed after 3 years SIT. CONCLUSION SIT was able to improve the clinical symptoms and lung function,inhibit the recruitment of Eosinophil and increase the ability of immune tolerance. The balance between Thl and Th2 was well regulated and was kept a long-stable clinical efficacy in patients with allergic r

关 键 词：抗原 尘螨属 脱敏法 免疫 鼻炎 变应性 常年性 哮喘免疫球蛋白E 

分 类 号：R765.21[医药卫生—耳鼻咽喉科] R562.25[医药卫生—临床医学]