舌下含服免疫治疗联合孟鲁司特钠对变应性鼻炎患者自噬及外周血ECP、YKL-40的影响

Effects of Sublingual Immunotherapy Combined with Montelukast Sodium on Autophagy and Peripheral Blood ECP andYKL-40 in Patients with Allergic Rhinitis

目的研究舌下含服免疫治疗联合孟鲁司特钠对变应性鼻炎的治疗效果以及对患者自噬蛋白和外周血嗜酸细胞阳离子蛋白(eosinophil cationic protein,ECP)和YKL-40的影响。方法选取2019年1月至2020年12月到北京市大兴区人民医院耳鼻喉科进行治疗的变应性鼻炎患者106例。应用随机数字法将患者平均分为两组,观察组和对照组各53例。对照组患者应用和舌下含服免疫治疗疫苗性状和外包装相同的安慰剂(生理盐水和50%甘油)合用孟鲁司特钠片进行治疗,观察组患者采用舌下含服免疫治疗和孟鲁司特钠片联合治疗;对两组患者的治疗效果以及治疗前后的鼻部症状评分、生活质量评分进行评价;对治疗前后患者的血清lgE水平、Th1/Th2细胞因子(IL-2、IL-4、IL-10和INF-γ)、ECP和YKL-40水平进行检测;应用Western blot对两组患者下鼻甲黏膜自噬相关蛋白LC3-II表达进行检测。结果治疗后,两组患者的鼻结膜炎相关生活质量问卷评分均有所降低,而且观察组的评分较对照组低(P<0.05);治疗后,两组患者的鼻部症状评分均有所降低,且观察组患者的鼻部评分低于对照组(P<0.05);观察组患者的治疗总有效率(98.11%)高于对照组(83.02%)(P<0.05);经过治疗后,两组患者的IgE阳性率、YKL-40和ECP水平均有所降低(P<0.05),而且观察组患者的YKL-40和ECP水平低于对照组(P<0.05);治疗后,两组患者的IL-4和IL-10水平有所降低,IL-2和INF-γ水平有所升高(P<0.05),且治疗后观察组的IL-4和IL-10水平低于对照组,IL-2和INF-γ水平高于对照组(P<0.05);治疗后,观察组患者的LC3-II相关蛋白的表达较对照组低(P<0.05)。结论舌下含服免疫治疗联合孟鲁司特钠对变应性鼻炎治疗效果显著,能够降低患者ECP和YKL-40水平,降低患者的自噬蛋白表达。

Objective To study the therapeutic effects of sublingual immunotherapy combined with montelukast sodium on allergic rhinitis and the autophagy protein and peripheral blood Eosinophil cationic protein(ECP)and YKL-40 influence.Methods A total of 106 patients with allergic rhinitis who visited People’s Hospital of Beijing Daxing District ENT for treatment from January,2019 to December,2020 were selected for the study.These patients were equally divided into two groups by random number method,with 53 cases in the observation group and 53 cases in the control group.Patients in the control group were treated with a placebo(normal saline and 50%glycerol)with the same properties and packaging as the sublingual immunotherapy vaccine combined with Montelukast sodium tablets.Patients in the observation group were treated with sublingual immunotherapy and Mongolian immunotherapy,with the combination therapy of Rukast sodium tablets.We evaluated the treatment effect of the two groups of patients,as well as the nasal symptom scores and quality of life scores before and after treatment.Serum lgE levels,Th1/Th2 cytokines(IL-2,IL-2,and IL-2)of the patients before and after the treatment-4,IL-10 and INF-γ),ECP and YKL-40 levels were detected.Western blot was conducted to detect the expression of autophagy-related protein LC3-II in the inferior turbinate mucosa of the two groups of patients.Results After treatment,the rhinoconjunctivitis-related quality of life questionnaire scores of the two groups of patients were reduced,and the scores of the observation group were lower than those of the control group(P<0.05);After treatment,the scores of nasal symptoms of the two groups were both reduced and the observation group’s nose score was lower than that of the control group(P<0.05);The total effective rate of treatment in the observation group(98.11%)was higher than that of the control group(83.02%)(P<0.05);After treatment,the IgE positive rate,YKL-40 and ECP levels of the two groups of patients decreased(P<0.05),and the YKL-40 and ECP levels of the observation group were lower than those of the control group(P<0.05);After treatment,the levels of IL-4 and IL-10 of the patients from both groups decreased,and the levels of IL-2 and INF-γincreased(P<0.05).After treatment,the levels of IL-4 and IL-10 in the observation group were lower than those in the control group.IL-2 and INF-γlevels were higher than those in the control group(P<0.05);After treatment,the expression of LC3-II related proteins in the observation group was lower than that in the control group(P<0.05).Conclusion Sublingual immunotherapy combined with montelukast sodium has a significant effect on the treatment of allergic rhinitis,which can reduce the levels of ECP and YKL-40 in patients,and reduce the expression of autophagy protein.