变应性鼻炎患者变应原特异性免疫治疗引起免疫耐受的机制研究

Immunological changes in patients with allergic rhinitis receiving specific immunotherapy with standardized house dust mite vaccine

目的探讨变应原特异性免疫治疗引起变应性鼻炎(AR)患者免疫耐受形成的机制。方法螨过敏AR患者50例,分为免疫治疗组30例和药物治疗组20例,设正常对照组20例。免疫治疗组于治疗前及治疗后3个月、1年、2年采集血清标本。药物治疗组于治疗前和治疗后3个月采集血清标本;正常对照组入组后采集血清标本。采用酶联免疫吸附(ELISA)法检测血清细胞间黏附分子-1(intercellular adhesion molecule-1,ICAM-1)、白细胞介素-5(Interleukin-5,IL-5)水平。结果免疫治疗组、药物治疗组及正常对照组在治疗前血清ICAM-1水平有显著性差异。随着免疫治疗的进行,ICAM-1水平逐渐减低,并接近正常对照组;免疫治疗3个月后,免疫治疗组与正常对照组无显著性差异;免疫治疗组、药物治疗组及正常对照组在治疗前血清IL-5水平有显著性差异。随着免疫治疗的进行,IL-5水平逐渐减低,免疫治疗1年后免疫治疗组与正常对照组无显著性差异;血清ICAM-1与IL-5呈正的直线关系。结论血清ICAM-1、IL-5水平监测可作为判断AR免疫治疗疗效的免疫学参考指标。

OBJECTIVE To investigate the mechanism of immune tolerance in patients of allergic rhinitis（AR）with specific immunotherapy.METHODS Fifty patients with allergic rhinitis who were allergic to Dermatophagoides pteronyssinas were randomly allocated to receive either specific immunotherapy（n=30）or medical treatment（n=20）.Control group included 20 healthy persons.The samples of serum of immunotherapy group were collected in the baseline and 3 months,1 year and 2 years after treatment.The samples of serum of medical treatment group were collected in the baseline and 3 months after treatment.And the samples of serum of control group were collected in the baseline.The concentration of ICAM-l and IL-5 in the sera was measured by double antibody ELISA methods.RESULTS The level of ICAM-1 and IL-5 in the two therapy group were significantly different from that of the control group before treatment（P〈0.05）.And the level of ICAM-1 and IL-5 decreased gradually in every studied group after treatment.Three mouths after immunotherapy,there was no significant difference in the level of ICAM-1 between the control group and the immunotherapy group.Moreover one year after immunotherapy,the level of IL-5 in the serum of immunotherapy group showed no obvious difference from the control group.A positive straight line relationship was discovered between ICAM-l and IL-5.CONCLUSION It could be an immunological index to detect the level of ICAM-1 and IL-5 to predict the efficacy of immunotherapy on AR.