特异性免疫治疗与糖皮质激素对变异性鼻炎患者Th17和RORγt的影响

Effects of Specific Immunotherapy and Glucocorticoid on Th17 and RORγt of Patients with Allergic Rhinitis

目的分析特异性免疫治疗与糖皮质激素对变异性鼻炎(allergic rhinitis,AR)患者辅助性T细胞17(Th17)及转录因子孤独受体(RORγt)mRNA表达的影响。方法选取2010年6月—2014年5月收治的50例AR患者作为研究对象,依据临床治疗方案分为A、B两组,每组25例,A组采用糖皮质激素治疗,B组采用特异性免疫治疗方案,分别于治疗前后取患者外周血液,检测Th17细胞阳性率,测定RORγt mRNA表达水平,与正常健康人对照(对照组)。测定患者白介素-17(IL-17)、IL-6和IL-23炎性介质水平,同时评估患者临床症状的改善情况。结果 AR患者Th17细胞阳性率、RORγt mRNA表达、IL-6、IL-17及IL-23水平均高于对照组(P<0.05)。B组治疗后IL-6、IL-17、IL-23、Th17细胞阳性率和RORγt mRNA表达水平均低于治疗前和A组(P<0.05)。两组治疗后鼻部症状评分及鼻炎生活质量表(RQLQ)评分均低于治疗前(P<0.05)。治疗后B组鼻部症状评分及RQLQ评分低于A组(P<0.05)。结论 AR患者外周血内Th17细胞、RORγt转录因子及相关炎性因子均可能参与AR的发病过程,采用特异性免疫治疗方案,可下调AR患者相关细胞因子及转录因子水平,改善患者鼻炎症状及生活质量。

Objective To analyze effects of specific immunotherapy and glucocorticoid on helper T cell 17（ Th17） and related orphan nuclear receptor γt（ RORγt） transcription factors mRNA expressions of patients with allergic rhinitis（ AR）. Methods A total of 50 AR patients during June 2010 and May 2014 were recruited in this study,and were divided into group A and B according to treatment methods（ n = 25 for each group）. Group A was treated with glucocorticoid,while group B was treated with specific immunotherapy. Peripheral blood samples were obtained before and after the treatment to detect the positive rates of Th17 cells,and expressions of RORγt mRNA were detected and compared with those in healthy people（ control group）. Levels of interleukin-17（ IL-17）,IL-6 and IL-23 inflammatory mediators were measured,and the improvement conditions of clinical symptoms were evaluated. Results Values of positive rates of Th17,expressions of RORγt mRNA,levels of IL-6,IL-17 and IL-23 in AR patients were higher than those in control group（ P〈0. 05）. After treatment in group B,values of expressions of IL-6,IL-17 and IL-23 and positive rates of Th17 and RORγt mRNA expression were lower than those before treatment and in group A（ P〈0. 05）. In two groups after treatment,scores of nasal symptoms and rhinitis quality of life questionnaire（ RQLQ） were lower than those before treatment（ P〈0. 05）. After treatment,scores of nasal symptom and RQLQ in group B were lower than those in group A（ P〈0. 05）. Conclusion Th17 cells,RORγt transcription factors and related inflammatory factors in the peripheral blood of patients with AR may be involved in AR pathogenesis. Specific immunotherapy can be used to reduce levels of related cytokines and transcription factors and improve rhinitis symptom score and quality of life.