粉尘螨滴剂特异性免疫治疗对哮喘患儿血清IgE、FeNO及嗜酸性粒细胞的影响及机制分析

Study on effect and mechanism of Dermatophagoides farinae drops as specific immunotherapy for asthmatic children on serum IgE,FeNO and eosinophils

目的观察粉尘螨滴剂特异性免疫治疗对哮喘患儿临床症状和体征的影响,评估血清Ig E、呼气一氧化氮(Fe NO)及嗜酸性粒细胞的变化,并分析其作用机制。方法前瞻性选择在襄阳市中心医院诊治的哮喘患儿206例,随机分为治疗组和对照组,两组各103例。对照组进行常规治疗;治疗组在常规治疗基础上给予粉尘螨滴剂进行特异性治疗。评估患儿治疗后临床症状改善状况,检测患儿治疗前后血清Ig E、Fe NO及嗜酸性粒细胞水平,观察患儿哮喘再次发作率及不良反应发生情况。结果治疗组患儿治疗后初期呼吸阻力(Rrsc)和日、夜间症状评分分别为(2.11±0.35)分、(0.56±0.31)分和(0.62±0.38)分,均低于对照组(2.79±0.38)分、(1.07±0.35)分和(1.14±0.36)分,差异具有统计学意义(P<0.05)。治疗组治疗后莱斯特咳嗽问卷(LCQ)评分为(19.78±1.29)分,高于对照组(18.10±1.35)分,差异具有统计学意义(P<0.05);治疗组治疗后血清Ig E,Fe NO及嗜酸性粒细胞水平分别为(76.59±10.80)IU/ml(14.61±2.09)ppb和(1.17±0.49)×109/L,均低于对照组(85.46±10.78)IU/ml、(19.56±2.14)ppb和(2.28±0.51)×109/L,差异均有统计学意义(P<0.05)。治疗组哮喘再次发作率13.59%(14/103),低于对照组24.27%(25/103),治疗组哮喘再次发作间隔时间为(22.54±1.33)周,长于对照组为(19.47±1.16)周,差异均有统计学意义(P<0.05)。两组患儿均未出现严重不良反应。结论应用粉尘螨滴剂特异性免疫治疗哮喘患儿,患儿哮喘临床症状、体征显著得到改善,血清Ig E,Fe NO及嗜酸性粒细胞显著下降,患儿哮喘再次发生率显著下降,再次发作间隔时间延长。

Objective To observe the application of Dermatophagoides farinae drops as specific immunotherapy for pediatric patients with asthma,and to evaluate the efficacy on clinical symptoms and signs of asthma,levels of Ig E,expiratory nitric oxide（ Fe NO） and eosinophil changes,and to analyze its mechanism. Methods By using prospective study methods,a total of 206 pediatri patients with asthma in this hospital were randomly divided into trial group and control group,103 cases in each group. Patients in control group were given with routine treatment. Patients in trial group were treated with Dermatophagoides farinae drops on the basis of routine treatment. The clinical symptoms,blood levels of Ig E,Fe NO and eosinophils in pediatric patients were observed before and after treatment. The incidence of recurrence of asthma and adverse reactions in patients of these 2 groups had been observed. Results Initial respiratory resistance（ Rrsc） scores and scores of daytime and nighttime in trial group were（ 2. 11 ± 0. 35） points,（ 0. 56 ± 0. 31） points and（ 0. 62 ± 0. 38） points respectively,which were lower than those of control group（ 2. 79 ± 0. 38） points,（ 1. 07 ± 0. 35） points and（ 1. 14 ± 0. 36） points respectively,the difference was statistically significant（ P〈0. 05）.Leicester Cough Questionnaire（ LCQ） scores of patients in trial group after treatment were（ 19. 78 ± 1. 29） points,which were higher than those of control group（ 18. 10 ± 1. 35） points,and the difference was statistically significant（ P〈0. 05）. The levels of serum Ig E,Fe NO and eosinophils in trial group were（ 76. 59 ± 10. 80） IU/ml,（ 14. 61 ± 2. 09） ppb and（ 1. 17 ± 0. 49） × 109/L respectively,which were lower than those of control group（ 85. 46 ± 10. 78） IU/ml,（ 19. 56 ± 2. 14） ppb and（ 2. 28 ± 0. 51） × 109/L respectively,and the difference was statistically significant（ P〈0. 05）. The reccurrence rate of asthma in trial group was 13. 59%（ 14/103）,it was lower than that（ 24. 27%）（ 25/103） of control group,the interval for reccurrence of asthma in trial group was（ 22. 54 ± 1. 33） weeks,which were longer than（ 19. 47 ± 1. 16） weeks of control group,and the difference was statistically significant（ P〈0. 05）. There was no serious adverse reaction occurred in pediatric patients of these 2 groups. Conclusion After the application of Dermatophagoides farinae drops for specific immunotherapy of pediatric patients with asthma,their clinical symptoms and signs of asthma are significantly improved,serum levels of Ig E,Fe NO and blood eosinophils are significantly decreased,and the reccurrence rate of asthma in these pediatric patients is significantly decreased,and the interval for reccurence of asthma is prolonged.