奥马珠单抗联合布地奈德喷雾剂治疗变应性鼻炎的疗效及对鼻腔分泌物神经肽和血清免疫炎症指标水平的影响  

Efficacy of omalizumab combined with budesonide spray in the treatment of allergic rhinitis and its effect on the levels of neuropeptide in nasal secretions and serum immune inflammatory indexes

作　　者：常永军[1,2] 张晓林 毛涌[1] 程雨珊[2] CHANG Yong-jun;ZHANG Xiao-lin;MAO Yong(Department of Otorhinolaryngology Head and Neck Surgery,Shanghai Tongji Hospital,Shanghai 200065,China;Department of Otolaryngology,Karamay Central Hospital,Karamay Xinjiang 834000,China)

机构地区：[1]上海市同济医院耳鼻喉头颈外科,上海200065 [2]克拉玛依市中心医院耳鼻喉科,新疆克拉玛依834000

出　　处：《临床和实验医学杂志》2024年第5期539-543,共5页Journal of Clinical and Experimental Medicine

基　　金：上海市科学技术委员会项目(编号:22015832300)。

摘　　要：目的探讨奥马珠单抗联合布地奈德喷雾剂治疗变应性鼻炎的疗效及对鼻腔分泌物神经肽和血清免疫炎症指标水平的影响。方法将2020年1月至2022年12月在上海市同济医院治疗的AR患者90例作为研究对象,按照随机数字表法分为对照组与试验组,每组45例。对照组予以布地奈德喷雾剂治疗,试验组在使用布地奈德喷雾剂基础上予以奥马珠单抗治疗,两组均连续治疗8周。于治疗前和治疗8周后,对患者进行鼻症状[鼻炎患者症状量表(TNSS)]评估和生活质量[生活质量调查表(RQLQ)]的评定,对鼻腔分泌物神经肽Y、P物质水平进行检测,并进行血清免疫炎症指标[嗜酸性粒细胞(EOS)、IgE、干扰素γ(IFN-γ)、白细胞介素-4(IL-4)]的测定,比较两组疗效和不良反应。结果试验组治疗总有效率为95.56%,显著高于对照组(80.00%),差异有统计学意义(P<0.05)。试验组治疗8周后的TNSS评分和RQLQ评分分别为(4.12±1.17)、(33.78±6.41)分,均低于对照组[(5.58±1.42)、(51.42±9.29)分],差异均有统计学意义(P<0.05)。试验组治疗8周后的神经肽Y水平为(312.78±40.64)ng/L,高于对照组[(274.89±39.17)ng/L],P物质水平为(192.67±36.47)ng/L,低于对照组[(263.79±40.68)ng/L],差异均有统计学意义(P<0.05)。且试验组治疗8周后的EOS、IgE、IL-4水平分别为(0.21±0.06)mg/L、(162.74±33.58)U/L、(1.24±0.31)pg/mL,均低于对照组[(0.34±0.09)mg/L、(223.68±37.14)U/L、(1.53±0.36)pg/mL],IFN-γ水平为(26.07±4.31)ng/L,高于对照组[(23.41±3.95)ng/L],差异均有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论布地奈德喷雾剂基础上使用奥马珠单抗治疗AR可提高疗效,能更有效地调节神经肽释放和免疫炎症指标,从而改善鼻部症状。Objective To investigate the efficacy of omalizumab combined with budesonide spray in the treatment of allergic rhinitis and its effects on neuropeptide and serum immune and inflammatory indexes in nasal secretions.Methods A total of 90 AR patients treated in Shanghai Tongji Hospital from January 2020 to December 2022 were divided into the control group and the experimental group according to the random number table method,with 45 cases in each group.The control group was treated with budesonide spray,and the experimental group was treated with omalizumab on the basis of budesonide spray.Both groups were treated continuously for 8 weeks.Before and after 8 weeks of treatment,the nasal symptoms[total rhinitis symptom scalee(TNSS)]and quality of life[rhinitis quality of life questionnaire(RQLQ)]were evaluated,the levels of neuropeptide Y and substance P in nasal secretions were detected,and the serum immune inflammatory indexes[eosinophil(EOS),IgE,interferonγ(IFN-γ),interleukin-4(IL-4)]were measured.The efficacy and adverse reactions of the two groups were compared.Results The total effective rate of the experimental group was 95.56%,which was significantly higher than that of the control group(80.00%),and the difference was statistically significant(P<0.05).After 8 weeks of treatment,the TNSS score and RQLQ score of the experimental group were(4.12±1.17)and(33.78±6.41)points,respectively,which were lower than those of the control group[(5.58±1.42)and(51.42±9.29)points],and the differences were statistically significant(P<0.05).After 8 weeks of treatment,the neuropeptide Y level in the experimental group was(312.78±40.64)ng/L,which was higher than that in the control group[274.89±39.17)ng/L],and the level of substance P was(192.67±36.47)ng/L,which was lower than that in the control group[263.79±40.68)ng/L],and the differences were statistically significant(P<0.05).After 8 weeks of treatment,the levels of EOS,IgE,and IL-4 in the experimental group were(0.21±0.06)mg/L,(162.74±33.58)U/L,and(1.24±0.31)pg/mL

关 键 词：变应性鼻炎 布地奈德 奥马珠单抗 神经肽 免疫炎症反应 

分 类 号：R765.21[医药卫生—耳鼻咽喉科]