吸入性变应原和口服糖皮质激素对过敏性哮喘患者血清可溶性CTLA-4的影响

The clinical significance of soluble CTLA-4 in sera of patients with allergic asthma

目的探讨吸入变应原与口服糖皮质激素对过敏性哮喘患者血清可溶性细胞毒T淋巴细胞相关抗原-4(sCTLA-4)浓度的影响。方法采用随机、双盲、安慰剂对照,平行分组,第一组为单相哮喘反应和双相哮喘反应组给予患者吸入变应原,第二组为口服强的松或安慰剂组,1次/d,共2周。吸入性变应原或强的松前后抽静脉血检验血清,用酶链免疫吸附分析法测定血清中sCTLA-4浓度。结果在吸入变应原后24h,双相哮喘反应组血清sCTLA-4浓度(中位数)从29.0μg/L上升到44.0μg/L,而单相哮喘反应组sCTLA-4浓度与基础值相比无显著提高。强的松治疗2周后血清sCTAL-4与基础值相比显著下降,从37.0μg/L下降至22.0μg/L。而安慰剂组则没有显著下降。结论过敏性哮喘患者血清sCTLA-4浓度在吸入变应原后升高,而用强的松治疗后其浓度则下降。

Objective To investigate effects of allergen inhalation and oral glucocorticoid on concentration of serum sCTLA-4 in patients with allergic asthma. Methods Allergen inhalation challenge was conducted in allergic asthmatics with isolated early asthma response and those with dual asthma response. In a randomized, double-blind, placebo-controUed, parallel group fashion, prednisolone or placebo was give orally once a day for 2 weeks. Venous blood samples were collected before and afterallergen inhalation or prednisolone administration for obtaining sera. The serum sCTLA-4 concentrations were determined using enzyme-linked immunosorbent assay. Results The serum sCTLA-4 concentrations in the dual responder group increased from 29.0 （ 14, 5～43.7）/zg/L [median （25～75 percentiles） ] before allergen inhalation to 44.0 （24.3～61, 3）μg/L 24 h after allergen inhalation. In the isolated early responders, there were no significant increase in serum sCTLA-4 concentrations after allergen inhalation compared with baseine levels. There was a significant decrease in serum sCTLA-4 concentrations after 2 weeks of glucocorticoid therapy [22.0（15. 5～31.0）p,g/L] compared with base- line values [37.0（19.5～53.0）μg/L], whereas there was no significant difference in the placebo group. Conclusion This study has demonstrated that serum sCTLA-4 concentrations increase after allergen inhalation in sensitized asthmatic subjects, and that serum sCTLA-4 conceratrations can be downregulated by prednisolone therapy.