目的:通过总结1例度普利尤单抗联合变应原特异性免疫疗法治疗青春期难治性支气管哮喘的临床资料,提高临床医生对青春期难治性哮喘的认识。方法:回顾性分析我院收治的1例青春期难治性支气管哮喘患儿的临床资料,并进行文献复习。结果:该...目的:通过总结1例度普利尤单抗联合变应原特异性免疫疗法治疗青春期难治性支气管哮喘的临床资料,提高临床医生对青春期难治性哮喘的认识。方法:回顾性分析我院收治的1例青春期难治性支气管哮喘患儿的临床资料,并进行文献复习。结果:该患儿出院后规律雾化,加用度普利尤单抗联合变应原特异性免疫疗法治疗,支气管哮喘及特应性皮炎得到了良好控制,ACT评分、SCOARD评分、PAQLQ评分及肺功能得到明显的改善。结论:1) 度普利尤单抗联合变应原特异性免疫疗法对青春期难治性支气管哮喘疗效显著,同时可以缓解特应性皮炎的临床症状。2) 青春期支气管哮喘患儿的综合管理至关重要,合并其他2型炎症会增加其治疗难度。3) 临床医生在常规治疗的过程中需注重对患儿的健康教育和情绪管理,提高青春期支气管哮喘过渡管理水平,促进全生命周期的呼吸健康管理Objective: To improve the understanding of adolescent refractory asthma by summarizing the clinical data of a case of Dupilumab combined with allergen specific immunotherapy for adolescent refractory bronchial asthma. Methods: The clinical data of an adolescent child with refractory bronchial asthma in our hospital were retrospectively analyzed, and the literature was reviewed. Results: After regular atomization, plus Dupilumab combined with allergen specific immunotherapy, asthma and atopic dermatitis were well controlled, and ACT score, SCOARD score, PAQLQ score lung function were significantly improved. Conclusion: 1) Dupilumab combined with allergen specific immunotherapy has significant effect on refractory adolescent bronchial asthma and can also alleviate the clinical symptoms of atopic dermatitis. 2) Comprehensive management of adolescent children with bronchial asthma is crucial, and the combination of other type 2 inflammation will increase the difficulty of treatment. 3) Clinicians should pay attention to health education and emotional management of children in the process of routine treatment, to improve the transitional management level of adolescent bronchial asthma and promote the respiratory health management of the whole life cycle.展开更多
目的探讨粉尘螨变应原Derf1mRNA疫苗对哮喘小鼠的特异性免疫治疗效果。方法 50只BALB/c小鼠随机分为5组(10只/组),分别为PBS组、Derf1变应原致敏组、Derf1变应原免疫治疗组、β-actin mRNA免疫治疗组和Derf1 mRNA免疫治疗组。分别于第0...目的探讨粉尘螨变应原Derf1mRNA疫苗对哮喘小鼠的特异性免疫治疗效果。方法 50只BALB/c小鼠随机分为5组(10只/组),分别为PBS组、Derf1变应原致敏组、Derf1变应原免疫治疗组、β-actin mRNA免疫治疗组和Derf1 mRNA免疫治疗组。分别于第0、第7和第14天,PBS组小鼠腹腔注射PBS,其余4组小鼠则腹腔注射10μg Der f 1进行致敏,建立小鼠哮喘模型。自第21天起,除PBS组小鼠雾化吸入PBS,其他4组小鼠均雾化吸入100μg/ml Der f 1变应原,30 min/次,1次/d,连续7 d,观察并记录小鼠哮喘发作情况。5组小鼠于最后1次雾化吸入致敏2周后,背部皮下分别注射100μl PBS、1μg Der f1(维持致敏)、10μg Derf1(免疫治疗)、2μgβ-actin mRNA和2μg Derf1mRNA,1次/周,连续3周。最后1次皮下注射后2周处死小鼠。收集各组小鼠的支气管肺泡灌洗液(BALF),ELISA法检测γ干扰素(IFN-γ)和白介素13(IL-13)水平,并计数嗜酸粒细胞(EOS);收集各组小鼠脾组织,分离脾细胞,除PBS组外,其他4组均加入10μg/ml Der f 1培养72 h,ELISA法检测脾细胞培养上清液中IFN-γ和IL-13水平;取各组小鼠眼球血,ELISA法检测血清中总IgE以及变应原特异性IgE(sIgE)、IgG1(sIgG1)和IgG2a(sIgG2a)抗体水平。HE染色观察各组小鼠肺组织切片。结果除PBS组外,其他4组小鼠雾化吸入致敏后,均出现急性哮喘发作症状。小鼠BALF中,Der f 1 mRNA免疫治疗组和Der f 1免疫治疗组的IFN-γ水平分别为(897.56±105.73)和(864.48±70.62)pg/ml,均明显高于Derf1变应原致敏组[(209.05±52.28)pg/ml]和β-actin mRNA免疫治疗组[(219.47±64.72)pg/ml](P<0.01);两者IL-13水平分别为(241.64±31.41)和(321.94±41.07)pg/ml,则明显低于Derf1变应原致敏组[(520.62±43.77)pg/ml]和β-actin mRNA免疫治疗组[(507.22±42.26)pg/ml](P<0.01);两者EOS数量分别为(1.33±0.44)×105和(1.48±0.39)×105个/ml,均明显低于Derf1变应原致敏组[(3.54±0.52)×105个/ml]和β-actin mRNA免疫治疗组[(2.98±0.53)×105个/ml](P<0.01)。脾细胞培养上清的ELISA检测结果显示,Der f 1 mRNA免疫治疗组和Der f 1免疫治疗组的IFN-γ水平分别为(420.91±69.92)和(334.92±43.72)pg/ml,明显高于Der f 1变应原致敏组[(123.75±15.48)pg/ml]和β-actin mRNA免疫治疗组[(128.84±59.00)pg/ml](P<0.01);两者IL-13水平[(268.51±40.42)和[(285.26±62.21)pg/ml]则显著低于Der f 1变应原致敏组[(613.89±51.54)pg/ml]和β-actin mRNA免疫治疗组[(524.05±39.12)pg/ml](P<0.01)。血清中抗体水平的ELISA检测结果显示,Der f 1 mRNA免疫治疗组的总IgE、sIgE和sIgG1抗体水平分别为(33.72±9.78)、(22.76±8.09)和(17.87±7.59)ng/ml,均显著低于Der f 1变应原致敏组[(94.34±11.66)、(65.67±9.47)和(75.18±9.52)ng/ml]和β-actin mRNA免疫治疗组[(86.48±10.26)、(62.36±8.35)和(69.51±8.98)ng/ml](P<0.01);其sIgG2a抗体水平为(7.74±0.88)ng/ml,则明显高于Der f 1变应原致敏组[(2.81±1.17)ng/ml]和β-actin mRNA免疫治疗组[(1.06±0.11)ng/ml](P<0.01)。肺组织切片HE染色镜检结果显示,与Der f 1变应原致敏组相比,Der f 1 mRNA免疫治疗组小鼠的气道上皮和肺泡上皮细胞结构基本完整,炎症细胞浸润明显减少。结论 Derf1mRNA疫苗可有效纠正Th1/Th2失衡。展开更多
文摘目的:通过总结1例度普利尤单抗联合变应原特异性免疫疗法治疗青春期难治性支气管哮喘的临床资料,提高临床医生对青春期难治性哮喘的认识。方法:回顾性分析我院收治的1例青春期难治性支气管哮喘患儿的临床资料,并进行文献复习。结果:该患儿出院后规律雾化,加用度普利尤单抗联合变应原特异性免疫疗法治疗,支气管哮喘及特应性皮炎得到了良好控制,ACT评分、SCOARD评分、PAQLQ评分及肺功能得到明显的改善。结论:1) 度普利尤单抗联合变应原特异性免疫疗法对青春期难治性支气管哮喘疗效显著,同时可以缓解特应性皮炎的临床症状。2) 青春期支气管哮喘患儿的综合管理至关重要,合并其他2型炎症会增加其治疗难度。3) 临床医生在常规治疗的过程中需注重对患儿的健康教育和情绪管理,提高青春期支气管哮喘过渡管理水平,促进全生命周期的呼吸健康管理Objective: To improve the understanding of adolescent refractory asthma by summarizing the clinical data of a case of Dupilumab combined with allergen specific immunotherapy for adolescent refractory bronchial asthma. Methods: The clinical data of an adolescent child with refractory bronchial asthma in our hospital were retrospectively analyzed, and the literature was reviewed. Results: After regular atomization, plus Dupilumab combined with allergen specific immunotherapy, asthma and atopic dermatitis were well controlled, and ACT score, SCOARD score, PAQLQ score lung function were significantly improved. Conclusion: 1) Dupilumab combined with allergen specific immunotherapy has significant effect on refractory adolescent bronchial asthma and can also alleviate the clinical symptoms of atopic dermatitis. 2) Comprehensive management of adolescent children with bronchial asthma is crucial, and the combination of other type 2 inflammation will increase the difficulty of treatment. 3) Clinicians should pay attention to health education and emotional management of children in the process of routine treatment, to improve the transitional management level of adolescent bronchial asthma and promote the respiratory health management of the whole life cycle.
文摘目的探讨粉尘螨变应原Derf1mRNA疫苗对哮喘小鼠的特异性免疫治疗效果。方法 50只BALB/c小鼠随机分为5组(10只/组),分别为PBS组、Derf1变应原致敏组、Derf1变应原免疫治疗组、β-actin mRNA免疫治疗组和Derf1 mRNA免疫治疗组。分别于第0、第7和第14天,PBS组小鼠腹腔注射PBS,其余4组小鼠则腹腔注射10μg Der f 1进行致敏,建立小鼠哮喘模型。自第21天起,除PBS组小鼠雾化吸入PBS,其他4组小鼠均雾化吸入100μg/ml Der f 1变应原,30 min/次,1次/d,连续7 d,观察并记录小鼠哮喘发作情况。5组小鼠于最后1次雾化吸入致敏2周后,背部皮下分别注射100μl PBS、1μg Der f1(维持致敏)、10μg Derf1(免疫治疗)、2μgβ-actin mRNA和2μg Derf1mRNA,1次/周,连续3周。最后1次皮下注射后2周处死小鼠。收集各组小鼠的支气管肺泡灌洗液(BALF),ELISA法检测γ干扰素(IFN-γ)和白介素13(IL-13)水平,并计数嗜酸粒细胞(EOS);收集各组小鼠脾组织,分离脾细胞,除PBS组外,其他4组均加入10μg/ml Der f 1培养72 h,ELISA法检测脾细胞培养上清液中IFN-γ和IL-13水平;取各组小鼠眼球血,ELISA法检测血清中总IgE以及变应原特异性IgE(sIgE)、IgG1(sIgG1)和IgG2a(sIgG2a)抗体水平。HE染色观察各组小鼠肺组织切片。结果除PBS组外,其他4组小鼠雾化吸入致敏后,均出现急性哮喘发作症状。小鼠BALF中,Der f 1 mRNA免疫治疗组和Der f 1免疫治疗组的IFN-γ水平分别为(897.56±105.73)和(864.48±70.62)pg/ml,均明显高于Derf1变应原致敏组[(209.05±52.28)pg/ml]和β-actin mRNA免疫治疗组[(219.47±64.72)pg/ml](P<0.01);两者IL-13水平分别为(241.64±31.41)和(321.94±41.07)pg/ml,则明显低于Derf1变应原致敏组[(520.62±43.77)pg/ml]和β-actin mRNA免疫治疗组[(507.22±42.26)pg/ml](P<0.01);两者EOS数量分别为(1.33±0.44)×105和(1.48±0.39)×105个/ml,均明显低于Derf1变应原致敏组[(3.54±0.52)×105个/ml]和β-actin mRNA免疫治疗组[(2.98±0.53)×105个/ml](P<0.01)。脾细胞培养上清的ELISA检测结果显示,Der f 1 mRNA免疫治疗组和Der f 1免疫治疗组的IFN-γ水平分别为(420.91±69.92)和(334.92±43.72)pg/ml,明显高于Der f 1变应原致敏组[(123.75±15.48)pg/ml]和β-actin mRNA免疫治疗组[(128.84±59.00)pg/ml](P<0.01);两者IL-13水平[(268.51±40.42)和[(285.26±62.21)pg/ml]则显著低于Der f 1变应原致敏组[(613.89±51.54)pg/ml]和β-actin mRNA免疫治疗组[(524.05±39.12)pg/ml](P<0.01)。血清中抗体水平的ELISA检测结果显示,Der f 1 mRNA免疫治疗组的总IgE、sIgE和sIgG1抗体水平分别为(33.72±9.78)、(22.76±8.09)和(17.87±7.59)ng/ml,均显著低于Der f 1变应原致敏组[(94.34±11.66)、(65.67±9.47)和(75.18±9.52)ng/ml]和β-actin mRNA免疫治疗组[(86.48±10.26)、(62.36±8.35)和(69.51±8.98)ng/ml](P<0.01);其sIgG2a抗体水平为(7.74±0.88)ng/ml,则明显高于Der f 1变应原致敏组[(2.81±1.17)ng/ml]和β-actin mRNA免疫治疗组[(1.06±0.11)ng/ml](P<0.01)。肺组织切片HE染色镜检结果显示,与Der f 1变应原致敏组相比,Der f 1 mRNA免疫治疗组小鼠的气道上皮和肺泡上皮细胞结构基本完整,炎症细胞浸润明显减少。结论 Derf1mRNA疫苗可有效纠正Th1/Th2失衡。
