鼻用糖皮质激素治疗变应性鼻炎的临床疗效:白介素-17A的影响

Efficacy of intranasal steroid on allergic rhinitis and effect of interleukin-17A

目的探讨鼻用糖皮质激素治疗变应性鼻炎的临床疗效及鼻腔分泌物中白介素(interleukin,IL)-17A浓度对鼻用糖皮质激素疗效的影响。方法总共纳入29例中-重度持续性变应性鼻炎患者,采用酶联免疫吸附试验(ELISA)检测鼻腔灌洗液中IL-17A的浓度,评估IL-17A浓度与鼻部症状总计分(total nasal symptom score,TNSS)之间的关联性;比较鼻用糖皮质激素(丙酸氟替卡松,每天1次,每次每鼻孔2喷)治疗2周前后TNSS的差异及与鼻腔不同IL-17A浓度之间的关系。结果变应性鼻炎患者鼻腔灌洗液中IL-17A的浓度明显高于正常对照组。其中,21例患者鼻腔灌洗液中IL-17A检测阳性(均数为56.4pg/mL),8例患者IL-17A阴性(低于检测下限)。IL-17A浓度与TNSS之间存在显著关联性(P<0.05)。IL-17A^+和IL-17A^+的两组患者经鼻用糖皮质激素治疗后TNSS相对基线值的改善幅度分别为-2.69和-4.52,差异有统计学意义(P<0.05)。结论 IL-17A能够加重变应性鼻炎患者的临床严重程度并且降低鼻用糖皮质激素治疗变应性鼻炎的临床疗效。

Objective To evaluate the efficacy of intranasal steroid on allergic rhinitis and effect of IL-17A in nasal secretion. Method Twenty nine patients with moderate to severe allergic rhinitis were enrolled. The association of clinical severity determined by total nasal symptom score （TNSS） and level of IL-17A in nasal lavage examined by enzyme-linked immunosorbent assay （ELISA） were evaluated. The clinical efficacy determined by mean change of TNSS after 2 weeks＇ treatment of fluticasone propionate aqueous nasal spray （FPANS） and different level of IL-17A in nasal lavage was compared. Results We found that the IL-17A levels in nasal lavage were positive in 21 of 29 patients with an average of 56.4 pg/mL,and the IL-17A levels in 8 of 29 patients were below the detection limit. The IL-17A levels in nasal lavage were significantly higher in patients with allergic rhinitis than those in normal controls （P〈0.05）. And the IL- 17A levels were found to be positively associated with clinical severity of allergic rhinitis （P〈0.05）. After treatment with FPANS, the mean changes of TNSS to baseline in IL-17A＋ group and IL-17A- group were -2.69 and -4.22, respectively （P〈0.05）. Conclusion IL-17A is associated with clinical severity of allergic rhinitis and with relative corticosteroid insensitivity.