皮下免疫治疗在变应性鼻炎伴咳嗽变异型哮喘患儿中的二级预防作用及对血清sIgG4、IL-27和IL-33水平的影响  

The secondary prevention effect and influence on serum sIgG4,IL-27 and IL-33 levels of subcutaneous immunotherapy in children with allergic rhinitis and cough variant asthma

作　　者：汪在华[1] 彭惠兰 饶凯成 WANG Zaihua;PENG Huilan;RAO Kaicheng(Department of Otolaryngology,Wuhan Children’s Hospital(Wuhan Maternal and Child Healthcare Hospital),Tongji Medical College,Huazhong University of Science&Technology,Wuhan,430016,China)

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院,武汉市妇幼保健院耳鼻咽喉科,武汉430016

出　　处：《临床耳鼻咽喉头颈外科杂志》2020年第9期793-798,共6页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:评估皮下免疫治疗(SCIT)在变应性鼻炎(AR)伴咳嗽变异型哮喘(CVA)中的二级预防作用及对血清sIgG4、IL-27和IL-33水平的影响。方法:回顾性分析112例5~12岁AR伴CVA患儿的临床资料,分为对照组(52例)和SCIT组(60例),并随访3年。对照组采用单纯的对症治疗,SCIT组在对照组基础上进行SCIT。分析2组患儿在治疗3年期间产生新致敏原和发展为典型哮喘(CA)的例数,分析2组患儿治疗前后的血清sIgG4、IL-27、IL-33水平变化以及鼻炎症状评分(TNSS)、日间咳嗽症状评分(DCSS)、夜间咳嗽症状评分(NCSS)、鼻炎药物评分(TRMS)、咳嗽药物评分(TCMS)、视觉模拟量表(VAS)评分和第1秒用力呼气容积/用力肺活量(FEV1%)。结果:治疗期间SCIT组有4例(6.67%)产生了新致敏原,对照组有20例(38.46%)产生了新致敏原,组间比较差异有统计学意义(P<0.05);SCIT组3例(5.00%)发展为CA,对照组15例(28.85%)发展为CA,组间比较差异有统计学意义(P<0.05)。与基线比较,2组血清sIgG4和IL-27水平在治疗3年后均明显升高(P<0.05),而血清IL-33水平明显降低(P<0.05)。治疗3年后,SCIT组的血清sIgG4和IL-27水平明显高于对照组,血清IL-33水平明显低于对照组(P<0.05)。与基线相比,2组患儿的TNSS、DCSS、NCSS、TRMS、TCMS、VAS和FEV1%在治疗1、2、3年时均明显改善(P<0.05)。2组间的TNSS、DCSS、NCSS、TRMS、TCMS、VAS和FEV1%在基线时比较差异无统计学意义(P>0.05),而治疗1、2、3年后,SCIT组的以上指标均明显优于对照组(P<0.05)。结论:SCIT治疗能够预防AR伴CVA患儿产生新致敏原和发展为CA,同时SCIT治疗能够改善血清sIgG4、IL-27和IL-33水平。Objective:To observe the secondary prevention efficacy of subcutaneous immunotherapy in children with allergic rhinitis(AR)and cough variant asthma(CVA)and to analyze its effect on the levels of serum sIgG4,IL-27 and IL-33.Method:The clinical data of 112 children aged 5-12 years with AR and CVA were retrospectively analyzed and divided into control group(52 cases)and SCIT group(60 cases).The patients were followed up for 3 years.The control group was received symptomatic treatment only,and the SCIT group was received SCIT on the basis of the control group.The numbers of cases of the two groups of children who produced new allergens and developed CA were analyze during the 3-year treatment.Changes in serum sIgG4,IL-27,IL-33 levels,TNSS,DCSS,NCSS,TRMS,TCMS,VAS score,and FEV1%before and after treatment were analyzed.Result:During the treatment,4 patients(6.67%)in the SCIT group produced the new allergen,and 20 patients(38.46%)in the control group(χ~2=16.73,P<0.05).There were only 3 cases(5.00%)in the SCIT group,which developed into CA,while 15 cases(28.85%)in the control group.The difference between the groups was statistically significant(χ~2=11.74,P<0.05).Compared with baseline,serum levels of sIgG4 and IL-27 in both groups were significantly increased after 3 years of treatment(P<0.05),while serum levels of IL-33 were significantly decreased(P<0.05).After 3 years of treatment,serum levels of sIgG4 and IL-27 in the SCIT group were significantly higher than those in the control group,and serum levels of IL-33 were significantly lower than those in the control group(P<0.05).Compared with baseline,TNSS,DCSS,NCSS,TRMS,TCMS,VAS,and FEV1%in both groups were significantly improved at 1,2,and 3 years of treatment(P<0.05).There was no significant difference in TNSS,DCSS,NCSS,TRMS,TCMS,VAS and FEV1%between the two groups at baseline(P>0.05),while after 1,2 and 3 years of treatment the above indicators in the SCIT group were significantly better than those in the control group(P<0.05).Conclusion:SCIT treatment can prevent

关 键 词：皮下免疫治疗 鼻炎 变应性 咳嗽变异型哮喘 sIgG4 IL-27 IL-33 

分 类 号：R765.21[医药卫生—耳鼻咽喉科]