变应原特异性免疫疗法治疗儿童过敏性鼻炎合并哮喘的效果及机制研究

Study on the effect and mechanism of allergen specific immunotherapy for allergic rhinitis in children with asthma

目的探讨变应原特异性免疫疗法治疗儿童过敏性鼻炎合并哮喘的有效性,并分析其机制。方法选取2022年10月—2023年7月淳安县第一人民医院收治的70例过敏性鼻炎合并哮喘患儿,按随机数字表法分为观察组和对照组,每组35例。两组均接受常规治疗,观察组皮下注射屋尘螨变应原制剂(SCIT)。比较两组患儿治疗前后的鼻炎症状评分(TNSS)、鼻炎伴随症状评分(TNNSS)、总用药评分(TMS)、肺功能、白细胞介素-10(IL-10)、转化生长因子-β1(TGF-β1)、CD4^(+)/Treg水平,分析两组不良反应发生情况。结果治疗前,观察组TNSS评分为(7.12±0.65)分,TNNSS评分为(2.45±0.97)分,TMS评分为(3.67±1.28)分,对照组TNSS评分为(7.08±0.57)分,TNNSS评分为(2.37±1.02)分,TMS评分为(3.54±1.15)分;治疗1年后,观察组TNSS评分为(2.02±0.85)分,TNNSS评分为(0.44±0.13)分,TMS评分为(0.25±0.16)分,对照组TNSS评分为(4.14±1.09)分,TNNSS评分为(0.78±0.25)分,TMS评分为(1.03±0.85)分,两组评分均降低,且观察组均低于对照组(均P<0.05)。治疗前,观察组用力肺活量(FVC)为(86.75±3.35)%,1 s用力呼气容积(FEV_(1))为(87.16±3.53)%,呼气峰流速(PEF)为(84.62±3.46)%,对照组FVC为(86.49±3.18)%,FEV_(1)为(87.42±3.68)%,PEF为(84.11±3.23)%;治疗1年后,观察组FVC为(92.78±3.96)%,FEV_(1)为(94.81±3.22)%,PEF为(96.43±3.69)%,对照组FVC为(89.82±3.87)%,FEV_(1)为(89.97±3.45)%,PEF为(89.75±3.58)%,两组FVC、FEV_(1)、PEF均提高,且观察组均高于对照组(均P<0.05)。治疗前,观察组IL-10为(3.79±1.25)pg/ml,TGF-β1为(8.43±2.01)pg/ml,CD4^(+)/Treg为(5.59±1.18),对照组IL-10为(3.88±1.32)pg/ml,TGF-β1为(8.37±2.13)pg/ml,CD4^(+)/Treg为(5.45±1.34);治疗1年后,观察组IL-10为(10.59±2.38)pg/ml,TGF-β1为(20.05±4.36)pg/ml,CD4^(+)/Treg为(9.29±2.23),对照组IL-10为(7.51±2.03)pg/ml,TGF-β1为(16.46±3.85)pg/ml,CD4^(+)/Treg为(7.69±2.08),两组IL-10、TGF-β1、CD4^(+)/Treg均提高,且观察组均高于对照组(均P<0.05)。观察组不良反应发生率为2.86%,与对照组(8.57%)相比,差异无统计学意义(χ^(2)=0.265,P>0.05)。结论SCIT能够明显缓解过敏性鼻炎合并哮喘患儿的症状,疗效良好,其机制可能与免疫细胞功能调节有关。

Objective To explore the efficacy of allergen specific immunotherapy in treatment of allergic rhinitis in children with asthma,and to analyze the therapeutic mechanism.Methods A total of 70 cases of allergic rhinitis children with asthma admitted to the First People's Hospital of Chun'an County from October 2022 to July 2023 were selected and divided into observation group and control group according to random number table method,35 cases in each group.The patients in the two groups received routine treatment,and in addition,the patients in observation group received subcutaneous injection of house dust mite allergen preparation(SCIT).The rhinitis symptom score(TNSS),rhinitis concomitant symptom score(TNNSS),total medication score(TMS),lung function,interleukin-10(IL-10),transforming growth factor-β(TCF-β1),and CD4^(+)/Treg before and after treatment were compared between the two groups.The incidence rates of adverse reactions in the two groups were analyzed.Results Before treatment,TNSS score was(7.12±0.65)points,TNNSS score was(2.45±0.97)points,TMS score was(3.67±1.28)points in observation group,TNSS score was(7.08±0.57)points,TNNSS score was(2.37±1.02)points,TMS score was(3.54±1.15)points in control group.After one year of treatment,TNSS score was(2.02±0.85)points,TNNSS score was(0.44±0.13)points,TMS score was(0.25±0.16)points in observation group,TNSS score was(4.14±1.09)points,TNNSS score was(0.78±0.25)points,TMS score was(1.03±0.85)in control group.The scores in the two groups decreased,and the scores in observation group were lower than those in control group(all P<0.05).Before treatment,forced vital capacity(FVC)was(86.75±3.35)%,forced expiratory volume in the first second(FEV_(1))was(87.16±3.53)%,peak tidal expiratory flow(PEF)was(84.62±3.46)%in observation group,andFVC was(86.49±3.18)%,FEV,was(87.42±3.68)%,PEF was(84.11±3.23)%in control group.After one year of treatment,FVC was(92.78±3.96)%,FEV,was(94.81±3.22)%,PEFwas(96.43±3.69)%in observation group,FVC was(89.82±3.87)%,FEV,was(89.97±3.45)%,PEF was(89.75±3.58)%in control group,FVC,FEV_(1),and PEF in the two groups increased,and the indicators in observation group were higher than those in control group(all P<0.05).Before treatment,the levels of IL-10,TCF-β1,and CD4^(+)/Treg in observation group were(3.79±1.25)pg/ml,(8.43±2.01)pg/ml,and(5.59±1.18),respectively,the levels of IL-10,TGF-β1,and CD4^(+)/Treg in control group were(3.88±1.32)pg/ml,(8.37±2.13)pg/ml,and(5.45±1.34),respectively.After one year of treatment,the levels of IL-10,TGF-β1,and CD4^(+)/Treg in observation group were(10.59±2.38)pg/ml,(20.05±4.36)pg/ml,and(9.29±2.23),respectively,the levels of IL-10,TCF-β1,and CD4^(+)/Treg in control group were(7.51±2.03)pg/ml,(16.46±3.85)pg/ml,and(7.69±2.08),respectively.The levels of IL-10,TCF-β1,and CD4^(+)/Treg in the two groups increased,and the indicators in observation group were higher than those in control group(all P<0.05).The incidence rate of adverse reactions in observation group was 2.85%,compared with control group(8.57%),there was no statistically significant dfference(χ^(2)=0.265,P>0.05).Conclusion SCIT can significantly relieve the symptoms of children with allergic rhinitis combined with asthma,which has a good therapeutic effect.The mechanism may be related to the regulation of immune cell function.