特异性脱敏治疗对变应性鼻炎血中Th1/Th2细胞比例调节的影响

The effect of specific immunotherapy on the regulation of Th1/Th2 cell ratio of the patients with allergic rhinitis in serum

目的:探讨经鼻内和(或)舌下特异性脱敏治疗常年性变应性鼻炎(PAR)的效果及对患者血清Th1/Th2细胞因子平衡的调节及总IgE(tIgE)水平表达的影响。方法:选择36例PAR患者经鼻特异性脱敏治疗(鼻喷组)和36例PAR舌下特异性脱敏治疗(舌下组),并进行疗效比较,以32例健康成年人作为正常对照组。同时用免疫放射平衡法和双抗夹心法检测鼻喷组及舌下组治疗前后血清IL-2、IL-4、IL-8及tIgE水平;用酶联免疫吸附法检测IFN-γ;鼻分泌物涂片观察局部嗜酸粒细胞的浸润与变化。结果:变应性鼻炎(AR)患者在经鼻和舌下特异性免疫治疗(SIT)前两组血清Th1细胞因子IL-2及IFN-γ含量显著减少,而Th2细胞因子IL-4、IL-8和tIgE含量显著增高,鼻喷组及舌下组与正常对照组比较差异有统计学意义(P<0.01);SIT至维持量后,AR患者血清中IL-2及IFN-γ含量较治疗前明显增高,而IL-4、IL-8及tIgE含量则明显降低(P<0.01或P<0.05)。SIT后鼻喷组和舌下组临床总有效率分别为97.22%和94.44%,两组疗效比较差异无统计学意义(P>0.05)。结论:AR患者体内存在Th1/Th2细胞比例和细胞因子平衡失调,表现为Th2细胞功能亢进。经鼻黏膜和舌下脱敏治疗能通过对AR血中Th1/Th2细胞因子比例平衡和细胞因子水平表达的调控及对血tIgE水平的调节来改善和纠正Th1/Th2细胞失平衡,能明显改善AR的临床症状。

Objective：To explore the effects of specific immunotherapy by the nasal spray and/or sublingual contain on the regulation the balance of serumTh1/Th2 cell ratio,and the expression of total IgE（tIgE） level in perennial allergic rhinitis patients.Method：Thirty-six cases of allergic rhinitis of perennial（PAR） patients with nasal specific immunotherapy（nasal spray group） were chosen as the object of study,36 PAR patients with sublingual specific immunotherapy（sublingual group） were chosen for the efficacy comparison group,and 32 cases of healthy adults as control（normal control group）.The levels of serum IL-2,IL-4,IL-8 and tIgE in PAR nasal spray group and sublingual group were examined by IRMA and double-antibody sandwich assay before and after the treatment of specific immunotherapy（SIT）;The content of IFN-r was determined by enzyme-linked immunosorbent assay;The infiltration and changes of eosinophilic granulocyte were observed by the smear of nasal secretions.Result：In nasal spray group and sublingual group,the contents of serum Th1 cytokines IL-2 and IFN-γ were reduced levels significantly,while the contents of Th2 cytokines IL-4,IL-8 and tIgE were significantly increased before the treatment of SIT.After the SIT to the maintenance dose,the levels of IL-2 and IFN-γ in serum were significantly higher than that before treatment,while IL-4,IL-8 and tIgE content were significantly lower in AR patients（P0.01 or P0.05）.The clinical efficacy of nasal spray group and sublingual group were 97.22% and 94.44%,while the two groups was no statistical difference in efficacy（P0.05）.Conclusion：With the presence of Th1/Th2 cell ratio and cytokine imbalance,the AR patients manifested as Th2 cell function in accentuation.Nasal mucosa and/or sublingual in the local SIT can have changed no-balance Th1/Th2 cell of by regulating the balance of serum Th1/Th2 cell ratio,the expression level of cytokine expression and the level of tIgE.