早期免疫干预防治毛细支气管炎后婴幼儿哮喘的研究

BCG-polysaccharide nucleic acid and bacillus calmette-guerin decreased the incidence of asthma following infantile acute bronchiolitis

目的:评价卡介菌多糖核酸、卡介苗经皮接种治疗对毛细支气管炎患儿日后发生哮喘的预防效果并探讨其作用机制。方法:将128例毛细支气管炎患儿随机分为常规治疗组(常规组)、卡介菌多糖核酸治疗组(A治疗组)与卡介苗治疗组(B治疗组),常规组仅给予常规治疗,而A治疗组与B治疗组在常规治疗的其础上,分别加用卡介菌多糖核酸治疗与卡介苗经皮接种治疗。观察患儿在治疗前、治疗半年后、3岁时的IFN-γ、IL-2、IL-4、IL-10、IgE的变化,并随访2～2.5年,于患儿3岁时统计各组哮喘的患病率。另设20例健康体检者作为正常对照组。结果:(1)治疗前A治疗组、B治疗组和常规组IL-4、IL-10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);A治疗组、B治疗组与常规组比较差异无显著性(P>0.05);(2)A治疗组与B治疗组治疗半年后IL-4,IL-10与IgE低于治疗前,IFN-γ较治疗前有升高,其差异有显著性(P<0.01);两组患儿3岁时IFN-γ、IL-10水平与正常对照组无明显差异(P>0.05),IL-4和IgE水平虽较治疗半年后明显降低,但仍高于正常对照组(P<0.05)。(3)患儿3岁时,A治疗组、B治疗组哮喘患病率明显低于常规组(P<0.005)。结论:卡介菌多糖核酸和卡介苗能刺激毛细支气管炎患儿IFN-γ生成增多,下调IL-4、IL-10水平,诱导Th1细胞的优势分化,调节Th1/Th2平衡,降低毛细支气管炎后婴幼儿哮喘的患病率。

Objective To evaluate the effects of intervention by polysaccharide nucleic acid fraction of BCG （BCG-PSN）, bacillus calmette-guerin （BCG） inoculation in preventing infants with acute bronchiolitis from asthma and explore its mechanism . Methods One hundred and twenty-eight infants with acute bronchiolitis were randomly divided into 3 groups：treated group A, treated group B and control group. BCG-PSN was administered to 43 patients in treated group A, BCG inoculation was administered to 45 patients in treated group B and the routine therapy was given to 40 patients in control group. Twenty healthy infants were used as the normal controls. The concentration of IFN-γ, IL-2, IL-4 and IL-10 from peripheral blood mononuclear cells, and the level of serum IgE were measured by using ELISA before treatment, 6 months after treatment and the patients aged 3 years old . The patients were followed-up for 2 - 2. 5 years to count the incidence of asthma in children aged 3 years old. Results （1） IL-4, IL-10 and IgE levels before treatment in treated group A, treated group B and control group were higher than those of the normal controls, but IFN-γ levels were lower than those of the normal controls with significant difference （P 〈 0.01）. （2）Mter 6 months of intervention both treated group A and treated group B, the levels of IL-4, IL-10 and IgE decreased significantly compared with those of before intervention; the levels of IFN-3t were significantly higher than those of before intervention. When the patients were 3 years old in treated group A and treated group B, there were no differences in the IFN-3t, IL-10 levels and higher levels of IL-4 and IgE compared with those of normal controls. （3）The incidence of asthma in children aged 3 years old in the treated group A and treated group B were significantly lower than those of the control group （P 〈 0. 005）. Conclusion BCC,-PSN and BCG may stimulate the production of IFN-γ in infants with acute bronchiolitis, down-regulate IL-4 and IL-10 levels, induce the dominant differentiation of Th1, and regulate Th1/Th2 balance. They can reduce the incidence of asthma after acute bronchiolitis.