特异益生菌株对变应性鼻炎患者的免疫调节作用

Immunomodulation effect of specific probiotics in allergic rhinitis patients

目的探讨特异益生菌干预是否可以减少常年性变应性鼻炎(perennial allergic rhinitis,PAR)发作次数,减轻PAR症状;益生菌抑制PAR发病是否与肠道或全身免疫有关。方法 2013年春季和2014年春季(2-4月),我院收治PAR患者50例进入研究序列,每例患者允许获得独立编码的胶囊药物,每天确保口服胶囊1粒,连续3个月。益生菌组药物为益生菌胶囊,每粒含5×109CFU(25%嗜酸乳杆菌和75%乳双歧杆菌)。对照组为纤维素胶囊。2组PAR患者均口服氯雷他定10 mg/d,治疗1个月。分别于治疗后1、3个月进行随访,完成以下指标检测:症状VAS评分、鼻腔分泌物及全血嗜酸性粒细胞测定,血清s Ig E、细胞因子IL-4及IFN-γ浓度测定,粪便Ig A浓度测定。结果 2组治疗前检测的上述指标差异无统计学意义(P>0.05)。2组症状VAS评分在治疗后1个月均降低;治疗后3个月益生菌组评分低于对照组(P<0.05)。治疗后1、3个月,益生菌组鼻腔分泌物嗜酸性粒细胞检出率较对照组明显降低(P<0.05,P<0.01)。治疗后1、3个月,2组血清s Ig E出现先上升后下降的现象,组间差异均有统计学意义(P<0.05)。治疗后1个月,2组IL-4均上升,组间差异有统计学意义(P<0.05);治疗后3个月IL-4升高被益生菌干预阻断,而对照组IL-4继续升高,组间差异有统计学意义(P<0.01)。2组全血嗜酸性粒细胞计数和血清IFN-γ水平在治疗后1、3个月无明显变化(P>0.05)。治疗后1、3个月,益生菌组粪便中Ig A持续降低,而对照组Ig A水平持续升高,组间差异有统计学意义(P<0.01)。结论口服特异益生菌组合能够减少PAR的发病,减轻鼻腔黏膜的变应性炎症。益生菌可能通过调节肠道或全身免疫状态,抑制PAR的发病。

Objective To study whether probiotic intervention can prevent perennial allergic rhinitis （PAR） and alleviate PAR symptoms, and to investigate whether probiotics prevent PAR by modulating gut or systematic immunity. Methods Fifty PAR patients were randomized to receive either probiotic capsules （probiotic group ） containing 25% Lactobacillus acidophilus and 75% Bifidobacterium lactis or placebo cellulose capsules （control group） in a double-blind manner every day for one month. Loratadine （10 rag/d） was administered to all PAR patients for a month. The follow-up was done during the 1st month and 3rd month after treatment, and the symptom VAS scores, eosinophils of nasal swabs and whole blood, serum immunoglobulin E （IgE）, serum interleukin-4 （IL-4）, serum interferon-γ/ （IFN-γ）, and fecal immunoglobulin A （IgA） were detected. Results There was no significant difference in all the parameters between the two groups before treatment （P 〉 0.05 ）. The symptom VAS scores were reduced in both groups during the 1 st month, and the scores of the probiotic group were lower than those of the control group during the 3rd month （P 〈0. 05）. After treatment, the eosinophils of nasal swabs in the probiotic group were lower than those of the control group during the 1 st and 3rd months （P 〈 0. 05, P 〈 0. 01 ）. The serum IgE firstly increased and then decreased, with statistical difference between the 2 group （P 〈 0. 05 ）. During the 1 st and 3rd months, there was no significant difference in blood eosinophils and serum IFN-γ between the 2 groups （P 〉 0. 05 ）. Serum level of IL-4 was increased during the 1 st month, and the increase was prevented by probiotics during the 3rd month （P 〈 0. 01 ）. Fecal IgA was increased in control group, whereas it was decreased in the probiotic group during the 1st and 3rd months （ P 〈 O. 01 ）. Conclusion The specific combination of probiotics can reduce the incidence of PAR and alleviate allergic inflammation in nasal mucosa by modulating gut or systematic