皮下特异性免疫治疗早期对尘螨变应原特异性抗体及多元不饱和脂肪酸代谢水平的影响分析  

Analysis of the effect of early subcutaneous specific immunotherapy on the levels of dust mite allergen-specific antibodies and polyunsaturated fatty acid metabolism

作　　者：李诗韵[1] 郑佩燕[1] 翟莺莺[2] 张毅达 甘辉 黄惠敏[1] 罗文婷[1] 蒋满云 张桂珍 钟瑞芬 程章恺 孙世学 孙宝清[1] Li Shiyun;Zheng Peiyan;Zhai Yingying;Zhang Yida;Gan Hui;Huang Huimin;Luo Wenting;Jiang Manyun;Zhang Guizhen;Zhong Ruifen;Cheng Zhangkai;Sun Shixue;Sun Baoqing(Department of Clinical Laboratory of the First Affiliated Hospital of Guangzhou Medical University,State Key Laboratory of Respiratory Disease,National Center for Respiratory Medicine,National Clinical Research Center for Respiratory Disease,Guangzhou Institute of Respiratory Health,Guangzhou 510120,China;Department of Pediatrics,The First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China;Department of Laboratory Medicine,Dongguan Eighth People′s Hospital,Dongguan 523003,China;School of Pharmacy,Guangzhou Medical University,Guangzhou 511436,China)

机构地区：[1]广州医科大学附属第一医院临床检验中心,呼吸疾病全国重点实验室,国家呼吸医学中心,国家呼吸系统疾病临床研究中心,广州呼吸健康研究院,广州510120 [2]广州医科大学附属第一医院儿科,广州510120 [3]东莞市第八人民医院检验科,东莞523003 [4]广州医科大学药学院,广州511436

出　　处：《中华预防医学杂志》2024年第6期778-790,共13页Chinese Journal of Preventive Medicine

基　　金：国家自然科学基金项目(81871736);广东省医学科研基金(B2021375);东莞市社会发展科技重点项目(20211800904882)。

摘　　要：目的探讨过敏原皮下特异性免疫治疗(subcutaneous immunotherapy,SCIT)在治疗早期对患者免疫指标和代谢水平的影响,深入了解SCIT治疗在调节免疫反应和代谢水平方面的作用,为进一步发现潜在生物标志物提供参考数据。方法采用纵向研究方法,纳入2017年11月至2022年2月期间于广州医科大学附属第一医院儿科接受尘螨过敏原SCIT的受试者40例,其中单螨制剂治疗(single mite subcutaneous immunotherapy,SM-SCIT)和双螨制剂(double mite subcutaneous immunotherapy,DM-SCIT)治疗受试者各20例。本研究检测了受试者治疗前和治疗12个月后的尘螨过敏原特异性抗体和多元不饱和脂肪酸代谢水平,同时进行了肺功能检查,并通过症状视觉模拟量表(visual analogue scale,VAS)、哮喘控制测试问卷(asthma control test,ACT)和用药总评分(total medication scores,TMS)对患者的疗效进行随访,采用t检验、Mann-Whitney U检验等方法进行结果统计分析。结果经SCIT治疗12个月后,两组的VAS总分(SM-SCIT:Z=-2.298,P<0.05;DM-SCIT:Z=-3.411,P<0.001)显著下降;ACT总分(SM-SCIT:Z=-2.054,P<0.05;DM-SCIT:Z=-2.014,P<0.05)和总用药评分(SM-SCIT:Z=-3.799,P<0.0001;DM-SCIT:Z=-3.474,P<0.001)显著升高,此外,双螨治疗组MMEF75/25值显著升高(t=-2.253,P<0.05)。单螨治疗组的sIgE无明显变化(P>0.05),Der p、Der f、p 1、p 2、f 2和p 21组分sIgG4水平均显著升高(Z分别为-2.651、-3.771、-2.949、-2.912、-2.725、-2.128、-3.285,P均<0.05);双螨治疗组的Der p 2、f 2、p 7和p 23组分sIgE(Z分别为-1.965、-2.028、-2.406、-2.134,P均<0.05)和Der p、Der f、p 1、p 2、f 1、f 2、p 10、p 21和p 23组分sIgG4水平均显著升高(Z分别为-3.808、-3.845、-3.061、-2.688、-2.464、-3.211、-2.371、-2.091、-2.427,P均<0.05)。代谢组学分析显示,在治疗初期,SM-SCIT治疗后花生四烯酸、二十二碳六烯酸、二十二碳五烯酸、二十碳五烯酸、5,9,12-十八碳三烯酸、5(S)-羟化二十烷四烯酸、二�Objective To investigate the effects of subcutaneous immunotherapy(SCIT)on patients′immune markers and metabolic levels in the early stage of allergen treatment,and to gain insight into the role of SCIT in regulating immune responses and metabolic levels,so as to provide reference data for the further discovery of potential biomarkers.Methods A longitudinal study was used to include 40 subjects who underwent SCIT with dust mite allergens in the Department of Pediatrics of the First Affiliated Hospital of Guangzhou Medical University between November 2017 and February 2022,including 20 subjects each of single mite subcutaneous immunotherapy(SM-SCIT)and double mite subcutaneous immunotherapy(DM-SCIT).In this study,levels of dust mite allergen-specific antibodies and polyunsaturated fatty acid metabolism were measured before and 12 months after treatment,while pulmonary function tests were performed.The therapeutic effects of the patients were followed up by visual analogue scale(VAS),asthma control test(ACT)and total medication scores(TMS).The results were statistically analyzed using t-test and Mann-Whitney U-test.Results After 12 months of treatment with SCIT,both groups showed a significant decrease in total VAS score(SM-SCIT:Z=-2.298,P<0.05;DM-SCIT:Z=-3.411,P<0.001);total ACT score(SM-SCIT:Z=-2.054,P<0.05;DM-SCIT:Z=-2.014,P<0.05)and total medication scores(SM-SCIT:Z=-3.799,P<0.0001;DM-SCIT:Z=-3.474,P<0.001)were significantly higher,in addition to significantly higher MMEF75/25 values in the DM-SCIT group(t=-2.253,P<0.05).There was no significant change in sIgE in the SM-SCIT group(P>0.05),and the sIgG4 levels of the Der p,Der f,p 1,p 2,f 2,and p 21 fractions were significantly elevated(Z=-2.651,-3.771,-2.949,-2.912,-2.725,-2.128,and-3.285,respectively,all P<0.05);The sIgE of Der p 2,f 2,p 7 and p 23 fractions(Z=-2.651,-3.771,-2.949,-2.912,-2.725,-2.128,-3.285,all P<0.05)and the sIgG4 levels of the Der p,Der f,p 1,p 2,f 1,f 2,p 10,p 21 and p 23 fractions(Z=-3.808,-3.845,-3.061,-2.688,-2.464,-3.211,-2.371,-2.09

关 键 词：过敏性哮喘 尘螨组分 代谢组学 羟基二十碳四烯酸 皮下特异性免疫治疗 

分 类 号：R593.1[医药卫生—内科学]