雷公藤联合氯雷他定治疗轻度变应性鼻炎的临床疗效以及对血清Th1/Th2、Treg/Th17的影响

Clinical efficacy of tripterygium glycosides combined with loratadine in the treatment of mild allergic rhinitis and its effect on serum Th1/Th2 and Treg/Th17 levels

目的:探讨雷公藤联合氯雷他定治疗轻度变应性鼻炎的临床疗效以及对血清辅助性T细胞1(Th1)/辅助性T细胞2(Th2)与调节性T细胞(Treg)/辅助性T细胞17(Th17)的影响。方法:选取2018年1月-2019年5月于武汉大学中南医院耳鼻喉科诊断为变应性鼻炎患者113例,随机分为对照组(56例)和雷公藤组(57例)。对照组患者口服氯雷他定片,10 mg/次,1片/d;雷公藤组患者在对照组的基础上加服雷公藤多甙片,每天用药总剂量l mg/kg体质量,均分为3等份,于饭后口服。两组患者均治疗21 d。观察两组患者临床疗效,比较治疗前后两组患者、鼻部症状体征评分和气道黏膜与血液中Th1/Th2和Treg/Th17免疫平衡情况。结果:治疗后对照组、雷公藤组的总有效率分别为71.43%和89.47%,雷公藤组明显优于对照组(P<0.05)。与治疗前比较,两组患者治疗后鼻塞、鼻痒、喷嚏、流涕评分均降低(P<0.05),血清干扰素(IFN-γ)、白细胞介素(IL-35)、转化生长因子-β(TGF-β)水平升高,IL-4、IL-5、IL-17降低(P<0.05),叉头翼状螺旋转录因子(Foxp3)mRNA表达升高,维甲酸依赖性孤核受体γ(RORγt)mRNA表达减少(P<0.05);且治疗后雷公藤组上述指标改善情况明显优于对照组(P<0.05)。结论:雷公藤多甙片联合氯雷他定治疗轻度变应性鼻炎临床疗效较好,可控制患者鼻部症状,其机制可能与调节Th1/Th2与Treg/Th17免疫平衡有关。

Objective:To investigate the clinical efficacy of tripterygium glycosides combined with lorata-dine in the treatment of mild allergic rhinitis and its effects on serum helper T(Th)cell 1(Th1)/Th2 and regulatory T cell(Treg)/Th17.Methods:A total of 113 patients with allergic rhinitis diagnosed in Otolaryngology Department of Zhongnan Hospital of Wuhan University from January 2018 to May2019 were randomly divided into control group(56 cases)and tripterygium group(57 cases).The pa-tients in the tripterygium group were given loratadine tablets 10 mg/time,1 tablet per day.The pa-tients in the tripterygium group were given tripterygium glycosides on the basis of the tripterygium group.The total daily dose(1 mg per kg body weight)of tripterygium was divided into three equal parts and taken orally after meals.Both groups were treated for 21 days.The clinical efficacy of the two groups was observed.Nasal symptoms and signs score,Th1/Th2 and Treg/Th17 immune bal-ance in airway mucosa and blood were compared before and after treatment.Results:After treatment,the total effective rates of control group and tripterygium group were 71.43%and 89.47%,respec-tively,with significant difference(P<0.05).Both groups showed significant improvements in symp-tom scores fior nasal obstruction,nasal itching,sneezing,and runny nose(P<0.05).Serum IFN-γ,IL-35,TGF-βlevels increased,while IL-4,IL-5,and IL-17 decreased(all P<0.05).Fox p3 gene expression increased,and RORγT gene expression decreased(both P<0.05).After treatment,the improvement of the above indexes in tripterygium group was significantly better than that in control group(all P<0.05).Conclusion:Tripterygium glycosides combined with loratadine is effective in the treatment of mild allergic rhinitis.It can control nasal symptoms.Its mechanism may be related to the regulation of Th1/Th2 and Treg/Th17 immune balance.