粉尘螨滴剂治疗过敏性哮喘患儿效果及对白细胞介素、免疫指标等水平的影响

Effect of dermatophagoides farinae on children with allergic asthma and its effects on interleukin and immunoglobulin

目的观察粉尘螨滴剂治疗过敏性哮喘患儿的效果及对白细胞介素、免疫球蛋白水平的影响。方法选择2014年2月—2017年2月湖北省天门市第一人民医院儿科收治的过敏性哮喘患儿94例作为研究对象,随机数字表法分为对照组和观察组各47例。对照组参照GINA方案进行治疗,观察组在对照组基础上加用粉尘螨滴剂1~4号舌下含服,1~3 min后吞服,1次/d。第1周采用1号,粉尘螨总蛋白浓度1μg/ml;第2周采用2号,浓度为10μg/ml;第3周采用3号100μg/ml;剂量依次为1、2、3、4、6、8、10滴,40μg/滴;第4周含服4号滴剂,3滴/次,40μg/滴维持治疗。2组患者疗程6个月。比较2组患儿临床效果,治疗前后血清免疫指标(Ig A、Ig E、CD3^+、CD4^+、CD8^+、CD4^+/CD8^+)、血清白细胞介素(IL-2、IL-4)、肺功能(FEV1、FVC、PEF)水平,并对2组患儿安全性进行评价。结果治疗后观察组总控制率93.6%明显高于对照组80.9%(χ~2=4.374,P=0.036);治疗后,观察组Ig E、CD3^+、CD4^+、CD4^+/CD8^+明显高于对照组,Ig A显著低于对照组(t=3.371、4.699、4.915、2.633、9.609,P均<0.001),而CD8^+水平差异无统计学意义(t=0.522,P=0.302);观察组IL-2明显高于对照组,IL-4显著低于对照组(t=6.925、5.353,P均=0.000);观察组FEV1、FVC、PEF水平显著高于对照组(t=5.319、22.233、7.856,P均=0.000)。2组患儿治疗过程中发生皮肤瘙痒、食欲减退、流涕、头晕、头痛、困倦等不良反应发生率比较,差异无统计学意义(χ~2=0.319、0.234、0.319、0.255、2.272、0.781,P>0.05)。结论粉尘螨滴剂治疗过敏性哮喘患儿,可提高临床效果,改善血清白细胞介素、免疫球蛋白水平,安全可靠,值得临床推广应用。

Objective To investigate the effect of dermatophagoides farinae on children with allergic asthma and its effects on interleukin and immunoglobulin. Methods Ninety-four＂ cases of children with allergic asthma were selected, who were treated in hospital from February 2014 to February 2017, and they were divided into the observation group （47 cases） and control group （47 cases）. The patients of control group were treated with GINA program. Based on control group, the patients of observation group were treated with dermatophagoides farina drops （ No. 1 to 4 for sublingnal, containing 1-3 min then swallowing, 1 time/d. No. 1 were taken in the 1st week, the total protein concentration of dust mite 1 μg/ml; No. 2 were taken in the 2nd week, the total protein concentratioh of dust mite were 10 μg/ml; No. 3 were taken in the 3rd week, the total protein concentration of dust mite were 100 μg/ml; The dose of No. 1,2, 3 was 1,2, 3, 4, 6, 8, 10 drops/d in each day within one week, 40 μg/drop; No. 4 were taken in the 4th week, 3 drops/time, 40μg/drop）. The patients of 2 groups were all treated for 6 months. Compare the clinical efficacy, safety and changes of IgA, IgE, IL-2, IL-4, CD3 ^＋ , CD4^＋ , CD8^＋ , CD4^＋/CD8 ^＋ , FEV1, FVC, PEF levels of the two groups. Results After the appropriate treatment, the total control rate of the observation group was 93.6%, which was significantly higher than 80.9% of the control group （ χ^2=4. 374 ,P =0. 036） ; The IgE, CD3 ^＋, CD4^＋, CD4^＋/CD8^＋ in the observation group were significantly higher than those in the control group, and the IgA in the observation group were significantly lower than those in the control group （t =3. 371, t =4. 699, t =4. 915,t =2.633, t =9.609; P =0.001, P=0.000, P=0. 000, P =0.005, P =0.000）, while the CD8^＋ level did not change significantly （ t = 0. 522, P = 0. 302 ） ; The IL-2 in the observation group were significantly higher than those in the control group, and the IL-4 in the observation group were significantly lower than those in the control group （ t = 6. 925, t = 5. 353 ; P =0.000, P =0. 000） ; The FEV1 , FVC, PEF levels in the observation group were significantly higher than those in the control group （ t = 5.319, t = 22. 233, t = 7. 856, P = 0.000, P =0. 000,P= 0. 000） ; There were skin itching, loss of appetite, runny nose, dizziness, headache and other adverse reactions occurred in both two groups, but the difference between groups was not statistically significant （ χ^2 = O. 319, χ^2= 0.234,χ^2 =0. 319, χ^2 = 0. 255, χ^2 = 2.272, χ^2 = 0.781 ; P = 0. 572, P=0.628, P=0.572, P=0.613, P=0. 132,P=0.377）. Conclusion Dermatophagoides farina drops in the treatment of children with allergic asthma can improve clinicaf outcomes, improve interteukin and immunoglobulin levels, and it is also safe and effective, which makes it worthy of ctinicai application.