基于T-bet和GATA-3表达研究特异性免疫治疗对过敏性哮喘患者治疗机制

Analysis on the mechanism of immunotherapy for allergic asthma patients based on expressions of T-bet and GATA-3

目的探讨屋尘螨特异性免疫治疗（SIT）过程中，转录因子T-bet和GATA-3在外周血单个核细胞（PBMCs）中的表达变化，分析该治疗方案的作用机制。方法纳入2015年1月至12月我院收治的过敏性哮喘患者89例，进行回顾性分析，根据治疗方案及转归划分为4组：接受SIT治疗，且显效患者纳为观察A组，共22例；接受SIT治疗，且未达显效标准者纳为观察B组，共12例；未接受SIT治疗，且显效患者纳为对照A组，共15例；未接受SIT治疗，且未达显效标准者纳为对照B组，共40例。检测对比4组治疗前、治疗12个月时PBMCs中T-bet和GATA-3mRNA表达水平、外周血Thl和Th2细胞比率。结果观察A组、对照A组在治疗后GATA-3mRNA、Th2细胞比率明显下降，T-betmRNA／GATA-3mRNA、Thl／Th2明显上升，观察A组在治疗后T-betmRNA、Thl细胞比率明显升高。观察B组在治疗后T-betmRNA、GATA-3mRNA、Thl细胞比率、Th2细胞比率明显升高，上述差异均有统计学意义（P〈0．05）。②各时点所有患者T-betmRNA／GATm3mRNA与Thl／Th2均呈显著正相关（治疗前r=0．811，P=0．004；治疗后r=0．801，P=0．000）。检测对比4组治疗前、治疗12个月时PBMCs中T-bet和GATA-3mRNA表达水平、外周血Thl和Th2细胞比率。结论仅采用常规疗法，有助于抑制哮喘患者GATA-3mRNA过表达，协同采用特异性免疫治疗则能同时促进T-betmRNA表达，发挥双向治疗作用，从而提升疗效。

Objective To investigate the changes of T-bet mRNA and GATA-3 mRNA during house dust mite specific immunotherapy （SIT） in peripheral blood mononuclear cells （PBMCs） of allergic asthma patients, and to analyze the mechanism of the treatment. Methods Eighty-nine patients with allergic asthma treated in our hospital from January to December in 2015 were analyzed retrospectively. According to the therapy and prognosis, they were divided into four groups. Twenty-two patients who were treated with SIT and achieved good prognosis were included into the observation group A, 12 patients who were treated with SIT and did not achieve good prognosis were included into the observation group B, 15 patients who were not treated with SIT but achieved good prognosis were included into the control group A, 40 patients who were not treated with SIT and did not achieve good prognosis were included into the control group B. The expressions of T-bet mRNA and GATA-3 mRNA in PBMCs, and the ratio of Thl and Th2 in peripheral blood of 4 groups before and after treatment were detected and compared, Results In the observation group A and the control group A, expressions of GATA-3 mRNA and ratio of Th2 decreased significantly, T-bet mRNA/GATA-3 mRNA and Thl/Th2 increased significantly. In the observation group A, expressions of T-bet mRNA and ratio of Thl increased significantly. In the observation group B, expressions of T-bet mRNA and GATA-3 mRNA, ratio of Thl and Th2 increased significantly. Differences above all were statistically significant （ P 〈 0.05）. T-bet mRNA/GATA-3 mRNA were positively correlated with Thl/Th2 （Before treatment, r = 0.811, P = 0.004. After treatment, r=0. 801, P=0. 000）. Conclusions It is helpful to inhibit the excessive expression of GATA- 3 mRNA in patients with asthma by using conventional therapy, and the use of SIT can promote the expression of T-bet mRNA at the same time, thus to improve the clinical efficacy.