灭活卡介苗经皮接种预防毛细支气管炎患儿发生哮喘的临床研究

Clinical study on transcutaneous inoculation of inactivated bacillus calmette-guerin in preventing children with bronchiolitis from asthma

目的:评价灭活卡介苗经皮接种预防毛细支气管炎患儿哮喘的效果并探讨其作用机制.方法:将85例毛细支气管炎患儿随机分为常规治疗组(常规组)与灭活卡介苗治疗组(卡介苗组),常规组仅给予常规治疗;卡介苗组在常规治疗的基础上,加用灭活卡介苗经皮接种治疗.观察患儿治疗前及治疗半年后的IFN-γ、IL-4、IgE的变化,并随访2～2.5年,于患儿3岁时统计哮喘的患病率.另设20例健康体检者作为正常对照组.结果:①治疗前卡介苗组和常规组IL-4与IgE均高于正常对照组,IFN-γ低于正常对照组,差异有显著性(P＜0.01);卡介苗组与常规组比较差异无显著性(P＞0.05);②卡介苗组治疗后IL-4与IgE低于治疗前,IFN-γ较治疗前升高,差异有显著性(P＜0.01),且IFN-γ水平与正常对照组差异无显著性(P＞0.05).常规组治疗前、后IL-4与IgE水平差异无显著性,但IFN-γ水平治疗后有所下降,差异有显著性(P＜0.01).③患儿3岁时,卡介苗组哮喘患病率明显低于常规治疗组(8.89%vs 42.5%,P＜0.005).结论:灭活卡介苗能刺激毛细支气管炎患儿IFN-γ生成增多,下调IL-4水平,诱导Th1细胞的优势分化,调节Th1/Th2平衡,可降低毛细支气管炎后婴幼儿哮喘的患病率.

Objective:By evaluating the effects of transcutaneous inoculation of inactivated bacillus calmette-guerin (BCG) in preventing children with bronchiolitis from asthma to explore its mechanism.Methods:85 children with bronchiolitis were randomly divided into routine treatment group (routine group) and inactivated BCG group (routine therapy adjuvant inoculation of inactivated BCG). The changes of IFN-γ, IL-4 and IgE before treatment and half a year after treatment of children with bronchiolitis were observed and they were followed-up for two years to count the incidence of asthma in children aged three years old. Moreover 20 healthy children were as normal controls.Results:①IL-4 and IgE levels before treatment in BCG group and routine group were higher than those of control group, but IFN-γ levels were lower than that of control group with significant difference ( P <0.01). There was not significant difference between BCG group and routine group ( P >0.05). ②In BCG group, IL-4 and IgE levels after treatment were lower than those before treatment, but IFN-γ levels after treatment were higher than that before treatment ( P <0.01), and there was no significant difference in IFN-γ levels comparing to that of control group ( P >0.05). In routine group, there were no significant differences in IL-4 and IgE levels before and after treatment, but IFN-γ after treatment significantly decreased ( P <0.01). ③Incidence of asthma in children aged 3-year old in BCG group were significantly lower than that of routine group (8.89% vs 42.5%, P <0.005).Conclusion:Inactive BCG could stimulate the production of IFN-γ in Children with bronchiolitis, down-regulate IL-4 levels, induce the dominant differentiation of Th1/Th2 and reduce the incidence.