尘螨致敏蛋白组分sIgE和sIgG4水平变化与舌下免疫治疗疗效相关性分析  

Correlation Between Levels of sIgE and sIgG4 Against House Dust Mite Components and the Efficacy of Sublingual Immunotherapy

作　　者：魏勉 皇惠杰 姜楠楠 向莉[1] WEI Mian;HUANG Hui-jie;JIANG Nan-nan;XIANG Li(National Children's Medical Center,Department of Anaphylaxis,Beijing Children's Hospital,Capital Medical University,National Clinical Research Center for Respiratory Diseases,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院过敏反应科,国家呼吸系统疾病临床医学研究中心,北京100045

出　　处：《中国合理用药探索》2024年第9期67-74,共8页Chinese Journal of Rational Drug Use

基　　金：国家呼吸系统疾病临床医学研究中心“呼吸专项”(HXZX-20210203、HXZX-20210204、HXZX-202107);北京市研究型病房建设示范单位项目(BCRW202101);2023年北京市重大疑难疾病中西医协同攻关项目(2023BJSZDYNJBXTGG-005);北京市首批临床研究联合体儿科研联体试点单位过敏疾病分级诊疗项目;“生机计划2023”(202406170002)。

摘　　要：目的:观察舌下免疫治疗(SLIT)疗效与尘螨组分sIgE和sIgG4水平变化的相关性。方法:回顾性分析2018年4月~2021年10月就诊于某院过敏反应科并行SLIT的过敏性鼻炎患儿(n=37),根据治疗1年后症状和药物综合评分(CSMS)分为控制稳定组(n=25)和控制不稳定组(n=12),比较两组患儿9种重要尘螨致敏蛋白组分(Derp1/Derf1、Derp2/Derf2、Derp5、Derp7、Derp10、Derp21和Derp23)sIgE和sIgG4的水平变化。结果:Derp1/Derf1和Derp2/Derf2为主要致敏蛋白组分,其治疗前sIgE阳性率为86.5%~94.6%,其中Der p 2的sIgE浓度高于Derp1(P<0.0001)、Derp5(P<0.001)、Derp7(P<0.001)、Derp10(P<0.001)、Derp21(P<0.01);Derf2的sIgE浓度高于Derf1(P<0.0001)、Derp5(P<0.0001)、Derp7(P<0.0001)、Der p 10(P<0.0001)、Der p 21(P<0.0001)和Der p 23(P<0.01)。治疗前Der f 2的sIgG4浓度高于其他组分(P<0.0001),控制不稳定组中Der f 1的sIgG4阳性率(33.3%)高于控制稳定组(4.0%,P<0.05),且控制不稳定组中Derf1和Derp10的sIgG4浓度高于控制稳定组(P<0.05)。治疗1年后,控制稳定组患儿Der f 1和Der p 2的sIgG4水平高于治疗前(P<0.05)。结论:尘螨致敏过敏性鼻炎患儿应用SLIT治疗后,Der f 1和Der p 2的sIgG4浓度升高明显,提示SLIT疗效较好,为临床评估SLIT疗效提供了线索。Objective:To observe the correlation between the efficacy of sublingual immunotherapy(SLIT)and the levels of sIgE and sIgG4 against house dust mite components.Methods:A retrospective analysis was performed for children with allergic rhinitis(n=37)who visited the allergy department of a hospital and received SLIT during April 2018 to October 2021.They were assigned to a stable control group(n=25)and an unstable control group(n=12)according to the combined symptom and medication score(CSMS)at one year of treatment.The levels of sIgE and sIgG4 against 9 important house dust mite components(Der p 1/Der f 1,Der p 2/Der f 2,Der p 5,Der p 7,Der p 10,Der p 21,and Der p 23)were compared between two groups.Results:Der p 1/Der f 1 and Der p 2/Der f 2 were the main house dust mite components,and their sIgE positive rates before treatment were 86.5%~94.6%.The concentration of sIgE against Der p 2 was higher than that against Der p 1(P<0.0001),Der p 5(P<0.001),Der p 7(P<0.001),Der p 10(P<0.001),and Der p 21(P<0.01);the concentration of sIgE against Der f 2 was higher than that against Der f 1(P<0.0001),Der p 5(P<0.0001),Der p 7(P<0.0001),Der p 10(P<0.0001),Der p 21(P<0.0001),and Der p 23(P<0.01).The sIgG4 concentration against Der f 2 was higher than that against other components before treatment(P<0.0001).The positive rate of sIgG4 against Der f 1 was higher in the unstable control group(33.3%)than in the stable control group(4.0%,P<0.05),and the concentrations of sIgG4 against Der f 1 and Der p 10 were higher in the unstable control group than in the stable control group(P<0.05).After 1-year treatment,the levels of sIgG4 against Der f 1 and Der p 2 in stable control group were higher than those before treatment(P<0.05).Conclusion:After SLIT treatment for children with allergic rhinitis sensitized by dust mites,the significant increase in the sIgG4 concentrations of Der f 1 and Der p 2 may indicate that these children might have a better therapeutic effect,which provides clues for clinical evaluation of the efficacy of SLIT.

关 键 词：儿童 舌下免疫治疗 过敏性疾病 尘螨致敏蛋白组分 疗效预测标志物 

分 类 号：R725.6[医药卫生—儿科]