口服卡介苗对哮喘患者Th1/Th2平衡的影响

Effects of oral Bacillus Calmette-Guerin on Th1/Th2 balance in asthmatic patients

目的探讨口服卡介苗(BCG)对哮喘患者Th1/Th2平衡的影响。方法45例哮喘患者随机分为常规治疗组、口服卡介苗组,常规组用支气管扩张剂解痉平喘治疗,卡介苗组在常规治疗基础上加用口服卡介苗,疗程3个月。20例健康成人为对照组。治疗前后测定肺功能(FEV1)、PPD、症状评分,用酶联免疫吸附试验(ELISA)方法测定血浆IL-4和IFN-γ水平,并采用三色流式细胞法测定外周血Th1/Th2细胞之比。检测药物不良反应。结果常规组、卡介苗组治疗前后FEV1相比无显著差异(P>0.05);治疗前后常规组哮喘症状评分无明显差异(P>0.05),而卡介苗组有显著差异(P<0.05);治疗后卡介苗组PPD阳转率为85.71%,与常规组比较差异有统计学意义(P<0.05);治疗前两组血浆IL-4均较正常对照组明显升高,而IFN-γ水平明显降低(P均<0.01),治疗后与常规组相比,卡介苗组血浆IL-4水平明显下降,IFN-γ水平明显升高(P均<0.05);治疗前常规组、卡介苗组Th1细胞IFN-γ表达率、Th1/Th2低于对照组,而Th2细胞IL-4表达率均高与对照组,差异有显著性(P<0.01);常规组治疗前后Th1细胞IFN-γ表达率、Th2细胞IL-4表达率无显著差异(P>0.05);卡介苗组Th1细胞IFN-γ表达率治疗后(17.48±9.78)%,较治疗前(10.79±9.79)%显著增高(P<0.05),Th2细胞IL-4表达率治疗前后分别为(8.75±8.2)%和(4.45±8.1)%,治疗前后有显著差异(P<0.05);治疗期间未见药物不良反应。结论Th1/Th2失平衡是哮喘发病的重要机理,口服卡介苗操作简单、方便、副作用小,可以纠正哮喘患者Th1/Th2失衡。

Objective To explore the effect of oral Bacillus Calmette-Guerin （BCG） on Th1/Th2 balance in asthmatic patients. Methods Forty-five asthma patients were randomly divided into common group and oral BCG group, and compared with 20 healthy controis. The oral BCG group was treated with BCG and bronchodilators, while the common group with only bronchodilators. Expiratory volume in one second （FEV1）, purified protein derivative（PPD） and skin test were measured, and serum concentrations of IL-4 and IFN-γ were detected before and after treatment. Th1/Th2 cells and Th1/Th2 rate were assayed by flow cytometry. Results There was no significant difference on FEV1 between common group and oral BCG group with before and after treatment（P〉0.05）. IFN-γ expressions of Thl cells and IL-4 of Th2 cells showed no different in the common group（P〉0.05）. In oral BCG group and common group before treatment, the IFN-γ expression of Thl cells and Th1/Th2 rate were lower and IL-4 expression of Th2 cells was higher than those in control group （P〈0.01）. The IFN-γ expression of Thl cells in the oral BCG group after treatment was 17.48±9.78%, which was higher than that before treatment（P〈0.05）. The IL-4 expression of Th2 cells in the oral BCG group after treatment was lower than that before treatment （P〈0.05）. Conclusion The disequilibrium of Th1/Th2 is a important role in asthmatic morbidity mechanism. Oral BCG is simple, convenient, little adverse reaction, it may correct the rate of Th1/Th2.