舌下特异性免疫治疗过敏性鼻炎/过敏性哮喘患儿IL-17和IL-35水平的变化及临床疗效

Effects of sublingual immunotherapy on serum IL-17 and IL-35 levels in children with allergic rhinitis or asthma

目的 探讨舌下特异性免疫治疗（SLIT）的机制,并评价SLIT的临床疗效。方法 随机选取2011年1~12月行SLIT治疗的粉尘螨过敏性鼻炎（AR）和/或过敏性哮喘（AS）患儿30例为病例组,另随机选取行体检的30例健康儿童为对照组。检测病例组行SLIT治疗前及治疗1、2年时的1秒钟用力呼气容积（FEV1）或气道阻力与预计值之比、嗜酸性粒细胞（Eos）计数及血清细胞因子IL-17和IL-35水平,与对照组进行比较分析;同时对病例组患儿的鼻炎/哮喘症状进行评分并监测哮喘控制水平。结果 病例组SLIT治疗前、治疗1年时IL-17水平均明显高于对照组（P〈0.01）;且IL-17水平在治疗前、治疗后1年及治疗后2年呈逐年下降趋势（P〈0.01）,至治疗2年时与对照组比较差异无统计学意义（P〉0.05）。血清IL-35水平在治疗前后的变化趋势与IL-17的变化趋势刚好相反。FEV1与预计值之比在治疗前、治疗后1年及治疗后2年呈逐年上升趋势（P〈0.01）;而气道阻力与预计值之比、Eos计数则呈逐年下降趋势（P〈0.01）。病例组SLIT治疗2年时的鼻炎症状总评分和哮喘症状总评分改善百分率均较治疗1年时明显增高（P〈0.01）;SLIT治疗AR 1年时显效率85%,2年时达100%;SLIT治疗AS 1年时控制率为76%,2年时控制率达92%。结论 SLIT是一种有效治疗儿童AR和AS的方法,可能是通过抑制IL-17并促进IL-35的表达水平从而达到治疗目的,且治疗2年的效果较1年更好。

Objective To study the clinical effect and mechanisms of specific sublingual immunotherapy （SLIT） for the treatment of allergic rhinitis or asthma in children. Methods Thirty children suffering from Dermatophagoides farinae-allergic rhinitis or asthma （case group） and 30 healthy children （control group） were enrolled in this study. The case group accepted SLIT between January and December 2011. The ratio of forced expiratory volume in one second （FEV1） and its expected value, the ratio of airway resistance and its expected value, peripheral blood eosinophil （Eos） count and serum levels of IL-17 and IL-35 were measured before treatment and one and two years after treatment. The rhinitis or asthma symptom scores were rated and the level of asthma control was monitored. Results Serum IL-17 level in the case group was significantly higher than in the control group before treatment and one year after treatment （P〈0.01）. Furthermore, serum IL-17 level in the case group gradually decreased from before treatment to 1 year to 2 years after treatment （P〈0.01）. By two years of treatment, there was no significant difference in serum IL-17 level between the case and control groups （P〉0.05）. The changes of serum IL-35 level after treatment were opposite to serum IL-17 in the case group. The ratio of FEV1 and its expected value gradually increased from before treatment to 1 year to 2 years after treatment （P〈0.01） in the case group. In contrast, the change of the ratio of airway resistance and its expected value and Eos count gradually decreased from before treatment to 1 year to 2 years after treatment （P〈0.01） in the case group. More patients achieved improved rhinitis or asthma symptom scores two years after treatment than one year after treatment in the case group （P〈0.01）. SLIT was effective in 85% of children with allergic rhinitis one after treatment vs 100% two years after treatment. Asthma control was observed in 76% of the asthmatic patients one after treatment vs 92% two years after treatment. Conclusions SLIT is effective for allergic rhinitis and asthma in children, and the treatment period of two years seems to be superior to one year. The mechanism of action of SLIT for the treatment of allergic rhinitis and asttmaa may be associated with inhibition of IL-17 expression and promotion of IL- 35 expression.