氯雷他定、布地奈德联合皮下特异性免疫对变应性鼻炎的临床疗效研究

Therapeutic effects of loratadine and budesonide combined with subcutaneous specific immunotherapy on allergic rhinitis

目的观察药物联合皮下特异性免疫对变应性鼻炎的免疫调节作用,并评估其临床疗效。方法收集治疗的变应性鼻炎患者84例,随机分为氯雷他定、布地奈德鼻喷雾剂常规药物治疗(对照组)和氯雷他定、布地奈德鼻喷雾剂联合特异性免疫治疗(观察组),每组42例。Th17和Treg细胞细胞使用流式细胞仪检测,IgE、IL-17、IL-10因子表达使用ELISA法检测。结果治疗前2组Th17和Treg细胞差异无统计学意义(P>0.05),治疗后2组Th17细胞比例均出现显著减低(P<0.05),Treg细胞比例均出现显著升高(P<0.05),但观察组对Th17和Treg细胞比例的调节作用优于观察组(P<0.05)。治疗前2组IgE、IL-17和IL-10表达差异无统计学意义(P>0.05),治疗后2组IgE和IL-17表达均出现显著减低(P<0.05),IL-10表达均出现显著升高(P<0.05),但观察组对IgE、IL-17和IL-10表达的调节作用优于观察组(P<0.05)。IgE表达与IL-17呈显著正相关(r=0.412,P<0.05),与IL-10呈显著负相关(r=-0.354,P<0.05)。治疗前2组症状评分和用药评分差异无统计学意义(P>0.05),治疗后2组症状评分均出现显著减低(P<0.05),但观察组的改善作用优于观察组(P<0.05),治疗后对照组用药评分与治疗前差异无统计学意义(P>0.05),而对照组用药评分则出现显著减低(P<0.05)。结论特异性免疫治疗可以调节变应性鼻炎患者Th17/Treg细胞失衡,临床疗效显著,且可以减少对症治疗抗组胺以及局部激素药物的用量。

Objective To observe the immunomodulatory effects of loratadine and budesonide combined with subcutaneous specific immunotherapy on allergic rhinitis , and to evaluate its clinical efficacy .Methods Eighty-four patients with allergic rhinitis who were treated in our hospital were randomly divided into conventional therapy group （ n =42） and observation group （ n =42）.The patients in conventional therapy group were treated by loratadine and budesonide nasal spray,however, the patiens in observation group were treated by loratadine and budesonide nasal spray combined with subcutaneous specific immunotherapy.of the levels of Th17 and Treg cells were detected by flow cytometry,and the expression levels of of IgE, IL-17, and IL-10 was detected by ELISA assay.Results Before treatment, there were no significant differences in the levels of Th17,Treg cells IgE,IL-17 and IL-10 between two groups （ P 〉0.05）.After treatment,the levels of Th17 cells were significantly decreased in both groups （ P 〈0.05）,however, the levels of Treg cells were significantly increased （ P 〈0.05）.However the regulatory effects on Th17 and Treg cells in observation group were superior to those in control group （ P 〈0.05）.After treatment,the expression levels of IgE and IL-17 were significantly decreased in both groups （ P 〈0.05）,however, the levels of IL-10 were significantly increased （ P 〈0.05）.Moreover the regulatory effects on the expressions of IgE,IL-17,IL-10 in observation group were superior to those in control group （ P 〈0.05）.The expression of IgE was positively correlated to that of IL -17 （ r =0.412, P 〈0.05）,however,which was negatively correlated with that of IL-10 （ r =0.354, P 〈0.05）.Before treatment,there were no significant differences in symptom scores and medication scores between two groups （ P 〉0.05）,however, after treatment,the symptom scores were significantly decreased in both groups （ P 〈0.05）.Furthermore the improvement effects in observation group were superior to those in control group （ P 〈0.05）.After treatment,medication scores in control group were not changed obviously ,as compared with those before treatment （ P 〉0.05）,but the medication scores in observation group were significantly decreased after treatment （ P 〈0.05）. Conclusion The specific immunotherapy can regulate the imbalance of Treg /Th17 cells in patients with allergic rhinitis ,and can reduce the dosage of anti histamine and local hormone drugs ,with obvious therapeutic effects .