尘螨舌下特异性免疫治疗对儿童支气管哮喘效果的观察

Observation of efficacy of sublingual specific immunotherapy on child with dust mite allergic asthma

目的观察尘螨舌下特异性免疫治疗(sublingual specific immunotherapy,SLIT)对儿童支气管哮喘内型的效果。方法回顾性分析2012年3月至2018年12月首都医科大学附属北京儿童医院收治的支气管哮喘行SLIT的59例患儿的临床资料,根据治疗1、2、3年时哮喘控制治疗反应性分为控制稳定组和控制不稳定组,比较两组细胞因子水平的差异。结果59例患儿治疗达1年,40例达2年,26例达3年。治疗1年时,控制稳定组31例,占53%,控制不稳定组28例,占47%;控制稳定组IL-33、IL-23水平均低于控制不稳定组[(21.25±22.06)pg/ml比(31.61±30.48)pg/ml,P=0.017;(4.10±5.26)ng/ml比(5.01±4.97)ng/ml,P=0.023]。治疗2年时,控制稳定组IFN-γ水平显著低于控制不稳定组[(23.00±13.04)pg/ml比(26.69±8.11)pg/ml,P=0.020],控制稳定组IL-17A水平显著高于控制不稳定组[(15.03±17.44)pg/ml比(14.68±5.13)pg/ml,P=0.020]。治疗3年时,两组间细胞因子水平比较,差异无统计学意义(P>0.05)。结论尘螨致敏的支气管哮喘患儿经SLIT后临床疗效显著,IL-33、IL-23、IFN-γ、IL-17A可作为特异性免疫治疗早期临床疗效的生物标志物。

Objective To observe sublingual specific immunotherapy(SLIT)on child with bronchial asthma sensitized by dust mite.Methods The clinical data of 59 children with bronchial asthma who underwent SLIT in the Department of Allergology,Beijing Children’s Hospital from March 2012 to December 2018,were collected.The stability of disease control was evaluated after one year,two years and three years of treatment,and the children were divided into stable control group and unstable group according to the treatment response of the children during the whole course of treatment.The correlation between the endotype of the baseline period and the clinical efficacy of specific immunotherapy was also analyzed.Results Fifty-nine cases received basic asthma control treatment for more than one year,40 patients had SLIT for two years and 26 patients for three years.It was found that the stable group after one year of management IL-33[(21.25±22.06)pg/ml vs.(31.61±30.48)pg/ml,P=0.017]and IL-23[(4.10±5.26)ng/ml vs.(5.01±4.97)ng/ml,P=0.023]were significantly lower than those of the unstable group.In stable group after two years of management,it was found that the stable group had lower IFN-γthan that of the unstable group[(23.00±13.04)pg/ml vs.(26.69±8.11)pg/ml,P=0.020],while the stable group had higher IL-17 A than that of the unstable group,the difference was statistically significant[(15.03±17.44)pg/ml vs.(14.68±5.13)pg/ml,P=0.020].Patients who completed three years of management were grouped and cytokines level were not statistically significant between stable control group and unstable group(P>0.05).Conclusions Dust mites-sensitized asthma patients have significant effects after SLIT.Cytokines,such as IL-33,IL-23,IFN-γ,IL-17 A,can be used as biomarkers for early clinical efficacy of specific immunotherapy.