儿童变应性鼻炎舌下免疫治疗的临床疗效及免疫因子IL-10水平检测

Clinical efficacy and IL-10 level in children with allergic rhinitis receiving specific immunotherapy

目的评价标准化尘螨变应原疫苗舌下免疫治疗儿童变应性鼻炎的临床疗效并初步探讨其免疫学机制。方法尘螨过敏的变应性鼻炎儿童60例,随机分为免疫治疗组(31例)和药物治疗组(29例)。通过症状评分和药物评分评价临床疗效,并检测治疗前后血清中总LgE、螨特异性LgE、免疫因子IL-10的水平。结果经过1年的治疗,免疫治疗组患儿的症状评分[(4±0.50)分]和药物评分[(0.35±0.04)分]较治疗前症状评分[(10±1.0)分]及药物评分[(0.76±0.08)分]均明显减少且差异具有统计学意义(Z值分别为-4.65、-4.43,P值均<0.01);与药物治疗组症状评分[(7±0.5 0)分]和药物评分[(0.7 2±0.0 5)分]比较,差异具有统计学意义(U值分别为1 4 3.0 0、1 3 8.5 0,P值均<0.0 1)。总LgE无明显变化,螨特异性LgE水平明显下降,免疫治疗组患儿血清中IL-1 0的水平明显升高(U=5.00,P<0.01)。结论标准化尘螨变应原疫苗舌下免疫治疗能够有效改善变应性鼻炎患儿的症状,减少药物使用,细胞因子IL-10的增高可作为预测舌下免疫治疗疗效的免疫学参考指标。

Objective To evaluate the efficacy and immunological changes in children with allergic rhinitis who received subcutaneous immunotherapy with Dermatophagoides pteronyssius.60 children with allergic rhinitis to Dermatophagoides pteronyssinus were randomly allocated to receive either specific immunotherapy（n=31） or medical treatment（n=29）.Symptom and medication scores were assessed for evaluating the clinical efficacy in the baseline and after two years treatment.Total IgE,Der p-specific IgE,and specific IL-10 were measured.Symptom score in immunotherapy group of children（4±0.50） and drug group（0.35±0.04） were significantly reduced compared with before treatment.After 1 year of therapy,and the difference was statistically significant（Z values were-4.65,-4.43,respectively,P0.01）.And compared to the drug treatment group（7±0.50、0.72±0.05） the immunotherapy group has the statistically significant difference（U value were 155.00 and 139.50,respectively,P0.01）.There were no differences in levels of sernm total lgE,mite-specific LgE level were significantly decreased.but the level of serum specific IL-10 increased significantly（U=5.00,P0.01）.There is still no definite immunological treatment of reference in sublingual immunotherapy.Children with allergic rhinitis who accept sublingual immunotherapy,were carefully recorded and analyzed（followed up for 1 year）.Symptom score,medication score and serological antibody detection were assessed to evaluate the clinical efficacy in the baseline and after one year treatment.There is still no definite immunological treatment of reference in sublingual immunotherapy.Immunotherapy with standardized extract is efficacious to treat children sensitive to Der P.Elevation of allergen-specific IL-10 is significant immunological marker to predict efficacy of immunotherapy.