皮下免疫治疗和舌下免疫治疗对哮喘患儿免疫应答功能影响的比较

A comparision of the effects of subcutaneous and sublingual immunotherapy on immunological responses in children with asthma

目的比较皮下免疫治疗何舌下免疫治疗对哮喘患儿免疫应答功能影响的差异。方法收集尘螨致敏哮喘患儿86例,分为舌下免疫治疗组(SLIT组,n=29)、皮下免疫治疗组(SCIT组,n=13)、结束皮下免疫治疗足疗程组(结束SCIT组,n=14)以及常规药物治疗组(对照组,n=30)。体外水平检测各组患儿外周血单个核细胞经螨蛋白浸液刺激后CD4+T淋巴细胞中调节性T淋巴细胞比例(Treg%)的变化;比较SCIT组和SLIT组患儿治疗前、治疗后6个月、治疗后12个月体液免疫学指标和临床疗效指标变化的差异。结果未给予抗原刺激时,SCIT组患儿CD4+T细胞中Treg%显著高于SLIT组、对照组;给予抗原刺激后的4组CD4+T细胞中Treg%均显著性降低。在免疫治疗后6个月和12个月,SCIT组患儿其血清s Ig E和s Ig G4水平与治疗前相比差异均有统计学意义,而SLIT组患儿仅血清s Ig E水平与治疗前相比差异有统计学意义,s Ig G4水平未见随时间变化而变化。结论不同免疫治疗途径在引发哮喘患儿内在免疫学应答反应上存在时间差异性,其中SCIT免疫治疗患儿免疫应答反应出现的时间更早。

Objective To compare the difference in the effects of subcutaneous immunotherapy（SCIT） and sublingual immunotherapy（SLIT） on immunological responses in children with asthma. Methods A total of 86 children with asthma caused by dust mites were enrolled and divided into a SLIT group（n=29）, a SCIT group（n=13）, a group receiving complete SCIT course（complete SCIT group; n=14）, and a group receiving conventional medication（control group, n=30）. Peripheral blood mononuclear cells were isolated and stimulated with house dust mite extract for 48 hours in vitro, and the percentage of regulatory T cells（Treg%） in CD4^＋ T cells was measured by flow cytometry. Analysis of variance with repeated measures was applied to compare the changes in humoral immunological indices and therapeutic effects in the SCIT and SLIT groups before treatment and after 6 and 12 months of treatment. Results Before antigenic stimulation, Treg% in CD4^＋ T cells in the SCIT group was significantly higher than that in the SLIT and control groups; after antigenic stimulation was given, Treg% in the four groups decreased significantly. After 6 and 12 months of immunotherapy, the SCIT group had significant changes in serum sIgE and sIgG4 levels, while the SLIT group only showed a significant change in serum sIgE level. Conclusions Temporal difference exists in different immunotherapies to cause immunological responses in children with asthma, and immunological responses induced by SCIT may occur earlier.