免疫球蛋白游离轻链在变应性及非变应性鼻炎中的表达水平及意义探讨

Analysis of the level and significance of immunoglobniin free light chain in nasal secretion and in serum of patients with allergic rhinitis and non-allergic rhinitis

目的检测变应性鼻炎（allergicrhinitis，AR）、非变应性鼻炎（non．allergicrhinitis，NAR）患者和健康对照组在鼻分泌物及血清中的免疫球蛋白游离轻链（freelightchain，FLC）的表达水平，初步探讨FLC可能参与AR及NAR发病的免疫学机制。方法选取2009年9—12月就诊的AR及NAR患者各30例以及健康对照组30例，所有入组病例均进行过敏原皮肤点刺试验（skinpricktests，SPT）及血清特异性IgE检测（specificIgE，sIgE）。对入组的所有患者进行鼻部症状的视觉模拟量表评分（visualanaloguescale，VAS），包括阵发性喷嚏、鼻涕、鼻塞及鼻痒，采集患者外周血及鼻腔分泌物，检测其中的总IgE、嗜酸粒细胞阳离子蛋白（eosinophilcationicprotein，ECP）、肥大细胞类胰蛋白酶（mastcelltryptase，MCT）、KFLC、kFLC蛋白表达水平。结果AR及NAR组患者喷嚏、鼻涕、鼻塞、鼻痒的VAS评分差异无统计学意义（t值分别为1．189、0．741、0．758、0．797，P值均〉0．05）。血清中KFLC、kFLC、ECP、MCT蛋白表达水平在NAR组均高于健康对照组（P值均〈0．05）；kFLC蛋白表达水平在NAR组高于AR组，差异有统计学意义（P〈0．05）；KFLC、总IgE及ECP蛋白表达水平在AR组高于健康对照组（P值均〈0．05）。AR组及NAR组鼻分泌物中KFLC、kFLC、ECP及MCT的蛋白表达水平均较健康对照组明显升高（P值均〈0．05）；ECP和总IgE蛋白表达水平在AR组较NAR组明显升高（P值均〈0．05）。鼻分泌物中KFLC、kFLC分别与MCT呈正相关趋势（r值分别为0．518、0．484，P值均〈0．05）。血清中KFLC、kFLC分别与ECP呈正相关趋势（r值分别为0．343、0．342，P值均〈0．05）。结论FLC可能参与了AR及NAR的发病，其在AR及NAR的发病过程中可能通过肥大细胞及嗜酸粒细胞参与并发挥一定的免疫学作用。

Objective To test the immunoglobulin free light chain （FLC） from nasal secretion and serum of patients with allergic rhinitis（AR） and non-allergic rhinitis（NAR） for the purpose of exploring the possible immunological mechanism. Methods Sixty consecutive patients were selected between September and December in 2009, involving 30 patients with AR and 30 patients with NAR diagnosed by symptoms, signs, skin prick tests （SPT） and specific IgE （slgE）. Thirty volunteers were chosen as healthy control （HC）. According to the visual analogue scale （VAS） scores, the nasal symptoms of AR and NAR, including sneeze, nasal discharge, nasal obstruction and nasal itching were compared. ELISA was used to detect the total IgE, eosinophil cationic protein （ ECP ）, mast cell tryptase （ MCT）, KFLC, hFLC in nasal secretion and serum. The data was analyzed by SPSS 17.0 software. Results There was no statistical difference between AR and NAR group in nasal symptoms （ t value was 1. 189,0. 741,0. 758,0. 797, respectively, all P 〉 O. 5） ; In serum, KFLC, hFLC, ECP, MCT increased in NAR group compared to HC group （all P 〈0. 05） ; hFLC increased in NAR group compared to AR group（P 〈0.05）, KFLC , total IgE and ECP was increased in AR group compared to HC group. In nasal secretion, KFLC, hFLC, ECP and MCT increased in AR and NAR groups compared to HC group, and the ECP and total IgE were significantly increased in AR group compared to NAR group （ all P 〈 0. 05 ）. In nasal secretion, the FLC revealed a significantly higher correlation trend with MCT （r value was O. 518 and 0. 484, all P 〈0. 05） , and in serum revealed a significant correlation trend with ECP （ r value was O. 343 and O. 342, all P 〈 O. 05）. Conclusion Immunoglobulin FLC takes part in the path of physiological process of AR and NAR with the immunological mechanism.