舌下含服标准化尘螨滴剂治疗儿童变应性鼻炎的疗效及机制研究  

Research on the efficacy and mechanism of sublingual standardized dust mite drops allergen vaccine to allergic rhinitis in children

作　　者：王佳蓉[1] 邱连升[1] 陈翊民[1] 陈敏云 WANG Jiarong;QIU Liansheng;CHEN Yimin;CHEN Minyun(Department of Otorhinolaryngology,the Second Affiliated hospital of Fujian Medical University,Quanzhou,Fujian 362000,China)

机构地区：[1]福建医科大学附属第二医院耳鼻咽喉科,泉州362000

出　　处：《福建医药杂志》2020年第1期19-22,共4页Fujian Medical Journal

基　　金：福建省自然科学基金资助项目(2016J01521)。

摘　　要：目的探讨舌下含服标准化尘螨滴剂特异性免疫(SLIT)治疗儿童变应性鼻炎(AR)的疗效和可能机制。方法选取我院确诊为持续性变应性鼻炎的患儿80例,根据患儿家属意愿分为标准化尘螨滴剂舌下含服特异性免疫治疗组(观察组)与常规药物治疗(对照组),每组40例。采用症状视觉模拟量表评分(VAS)、用药评分法评定疗效,比较治疗前与治疗1年后的VAS评分与用药评分。采用流体细胞技术检测治疗前、治疗1年后外周血辅助性T细胞17(Th17)、调节性T细胞(Treg)的细胞比例。结果观察组治疗1年后VAS评分及用药评分分别为(2.70±1.08)、(1.05±0.81),较治疗前的(7.65±1.23)、(3.58±0.96)明显下降,差异均有统计学意义(t=31.35,t=13.83;均P<0.05)。对照组治疗1年后VAS评分为(3.34±1.22),较治疗前的(7.35±1.03)下降,差异有统计学意义(t=14.64,P<0.05);对照组治疗前后用药评分差异无统计学意义(t=0.80,P=0.43)。观察组治疗1年后外周血Treg细胞比例显著增高,Th17细胞比例降低,差异有统计学意义(tTreg=20.28,tTh17=9.41,均P<0.05),而对照组治疗前后Treg和Th17细胞比例差异无统计学意义(均P>0.05)。结论两组均能改善AR患者症状,而SLIT能减少患儿药物用量,其疗效优于常规药物治疗。SLIT治疗AR的机制可能是能够诱导Treg细胞的产生,抑制Th17细胞增殖,上调Treg/Th17比例,使Treg和Th17细胞亚群比例和功能的平衡复位,最终达到免疫耐受。Objective The study was designed to analyze the efficacy and investigate the possible mechanism of sublingual standardized dust mite drops allergen vaccine to allergic rhinitis(AR)in children.Methods The study was performed in the Second Affiliated hospital of Fujian Medical University,involving 80children patients with persistent AR,of whom 40children patients received sublingual immunotherapy(SLIT)and pharmacotherapy(observation group)after their guardians,approval and 40children patients received only pharmacotherapy(control group).All patients were allergic to dust mites.Symptom and medication scores were recorded before treatment and after treatment one year.Treg cells and Thl7cells were measured by flow cytometry.Results VAS score and medication score in the observation group after one year of treatment were(2.70±1.08)and(1.05±0.81),respectively,which were significantly lower than those before treatment(7.65±1.23)and(3.58±0.96),with statistically significant differences(t=31.35,t=13.83).All P<0.05).The VAS score in the control group was(3.34±1.22)after one year of treatment,which was lower than that before treatment(7.35±1.03),and the difference was statistically significant(t=14.64,P<0.05),and there was no significant difference in medication scores before and after treatment(t=0.80,P=0.43).The proportion of Thl7cells in peripheral blood mononuclear cells decreased in the observation group,whereas the proportion of Treg cells increased(tTreg=20.28,tTh17=9.41;both P<0.05),but not in the control group.Conclusion Both SLIT and pharmacotherapy can improve symptoms of AR,but SLIT can also reduce medication use.The effect of immunotherapy is better than drug treatment alone.The proportion of blood Thl7cells in peripheral blood mononuclear cells decreases in patients treated with SLIT,whereas the proportion of Treg cells increases,the proportion of Treg/Thl7is upregulated to restore the balance of the proportion and function of Treg and Thl7cell subsets and finally achieves immune tolerance.

关 键 词：鼻炎 变应性 持续性 脱敏法 免疫 T淋巴细胞 调节性 THL7细胞 

分 类 号：R765[医药卫生—耳鼻咽喉科]