屋尘螨皮下特异性免疫治疗的哮喘患儿肺功能及免疫学动态变化

冯晖; 向莉; 申昆玲

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中国当代儿科杂志 ›› 2010, Vol. 12 ›› Issue (09) : 715-719.

论著·临床研究

屋尘螨皮下特异性免疫治疗的哮喘患儿肺功能及免疫学动态变化

冯晖，向莉，申昆玲

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Dynamical changes of lung function and immunologic markers in asthmatic children receiving specific immunotherapy with standardized house dust mite extract

FENG Hui, XIANG Li, SHEN Kun-Ling

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摘要

目的：动态观察屋尘螨变应原皮下特异性免疫治疗对哮喘患儿的肺功能和免疫学影响。方法：屋尘螨过敏的轻中度哮喘患儿32例，分成治疗组(n=15)和对照组(n=17)。治疗组吸入糖皮质激素的同时加用屋尘螨变应原皮下特异性免疫治疗，对照组仅予吸入糖皮质激素治疗。检测治疗前、治疗后3月、6月、12月、18月、24月肺通气功能，观察治疗前、治疗后12月及24月哮喘发作次数并测定血清总IgE、屋尘螨特异性IgE、屋尘螨特异性IgG4、嗜酸细胞阳离子蛋白（ECP）、IL-10、IL-4及IFN-γ的变化。结果：治疗组患儿治疗后肺通气功能各项参数稳定在正常或接近正常水平；无哮喘急性发作病例的百分率治疗后高于治疗前，随治疗时间的延长而增加（P<0.05）；治疗后屋尘螨特异性IgG4高于治疗前，随着治疗时间延长而增加（P<0.01）；治疗后血清总IgE、屋尘螨特异性IgE、ECP、IL-10、IL-4、IFN-γ水平与治疗前比较，差异无统计学意义。对照组患儿治疗前后各项指标比较，差异均无统计学意义。结论：屋尘螨过敏的轻中度哮喘患儿经屋尘螨变应原皮下特异性免疫治疗2年后，肺通气功能保持正常或接近正常，无哮喘急性发作病例增加，可能与血清屋尘螨特异性IgG4浓度增高有关。［中国当代儿科杂志，2010，12（9）：715-719］

Abstract

OBJECTIVE: To study the effects of specific immunotherapy with standardized house dust mite extract on the lung function and immunologic markers in children with asthma. METHODS: Thirty-two children with mild to moderate asthma who were allergic to house dust mite were assigned to two groups: an immunotherapy group that received subcutaneous specific immunotherapy with standardized house dust mite extract beside glucocorticoids treatment (n=15) and a control group that received glucocorticoids treatment alone (n=17). Lung function was determined before treatment and 3, 6, 12, 18 and 24 months after treatment. The frequency of asthma attacks was observed before treatment and 12 and 24 months after treatment. Serum immunological markers, including total IgE, specific IgE and specific IgG4 against house dust mite (Dermatophagoides pteronyssinus, Der P), ECP, IL-10, IL-4, and IFN-γ, were measured before treatment and 12 and 24 months after treatment. RESULTS: The parameters of lung function were kept at the normal level or near normal level after treatment in the immunotherapy group. Compared with before treatment, the percentage of patients without asthma attacks increased significantly after treatment in the immunotherapy group (P<0.05) and increased more significantly with a prolonged treatment time （P<0.05). The level of serum sIgG4 against Der P increased significantly throughout the period of the immunotherapy treatment compared with before treatment (P<0.01). There were no significant differences in the levels of serum total IgE, sIgE against Der P, ECP, IL-10, IL-4 and IFN-γ before and after treatment in the immunotherapy group. There were no significant differences in all the parameters measured before and after treatment in the control group. CONCLUSIONS: Subcutaneous specific immunotherapy with standardized house dust mite extract for two years decreases the frequency of asthma attacks and the lung functions are kept in a normal level in children with asthma. The role of the specific immunotherapy may attribute to the increased level of serum sIgG4 against Der P.［Chin J Contemp Pediatr, 2010, 12 (9):715-719］

导出引用

冯晖, 向莉, 申昆玲. 屋尘螨皮下特异性免疫治疗的哮喘患儿肺功能及免疫学动态变化[J]. 中国当代儿科杂志. 2010, 12(09): 715-719

FENG Hui, XIANG Li, SHEN Kun-Ling. Dynamical changes of lung function and immunologic markers in asthmatic children receiving specific immunotherapy with standardized house dust mite extract[J]. Chinese Journal of Contemporary Pediatrics. 2010, 12(09): 715-719

中图分类号： R562.2+5

参考文献

［1］Bousquet J, Lockey R, Malling HJ, Alvarez-Cuesta E, Canonica GW, Chapman MD, et al. Allergen immunotherapy: therapeutic vaccines for allergic diseases［J］. Ann Allergy Asthma Immunol,1998, 81(5 Pt 1):401-405.
［2］向莉，申昆玲，张亚梅，贺建新，张杰，任亦新，等. 3～14岁哮喘和变应性鼻炎患儿吸入型致敏原分布特征比较［J］. 中国实用儿科杂志, 2006, 21（8）:581-583.
［3］中华医学会儿科学分会呼吸学组. 儿童支气管哮喘防治常规(试行)［J］. 中华儿科杂志, 2004, 42(2):100-106.
［4］Jacobsen L. Preventive aspects of specific immunotherapy［J］. Arb Paul Ehrlich Inst Bundesamt Sera Impfstoffe Frankf A M, 2003, (94):141-145.
［5］Eng PA, Borer-Reinhold M, Heijnen IA, Gnehm HP. Twelve-year follow-up after discontinuation of preseasonal grass pollen immunotherapy in childhood［J］.Allergy, 2006, 61(2):198-201.
［6］Jacobsen L, Niggemann B, Dreborg S, Ferdousi HA, Halken S, H-st A, et al. Specific immunotherapy has long-term preventive effect of seasonal and perennial asthma: 10-year follow-up on the PAT study［J］. Allergy, 2007, 62(8):943-948.
［7］Cevit O, Kendirli SG, Yilmaz M, Altintas DU, Karakoc GB. Specific allergen immunotherapy: effect on immunologic markers and clinical parameters in asthmatic children［J］. Investig Allergol Clin Immunol, 2007,17(5):286-291.
［8］Platts-Mills TA, Vaughan JW, Blumenthal K, Pollart Squillace S, Sporik RB. Serum IgG and IgG4 antibodies to Fel d 1 among children exposed to 20 μg Fel d 1 at home: relevance of a nonallergic modified Th2 response［J］. Int Arch Allergy Immunol, 2001, 124(1-3):126-129.
［9］向莉，申昆玲，张琪，熊珍谊. 4岁以下哮喘患儿特应性状态及其与临床特征关系［J］. 中国当代儿科杂志, 2006, 8（6）：457-460.
［10］Basomba A, Tabar AI, Rojas DH, García BE, Alamar R, Olaguíbel JM, et al. Allergen vaccination with a liposome-encapsulated extract of Dermatopbagoides pteronyssinus: a randomized, double-blind, placebo-controlled trial in asthmatic patients［J］. J Allergy Clin Immunol, 2002,109(6):943-948.
［11］Mothes N, Heinzkill M, Drachenerg KJ, Sperr WR, Krauth MT, Majlesi Y, et al. Allergen-specific immunotherapy with a monophosphoryl lipid A-adjuvanted vaccine: reduced seasonnaly boosted immunoglobulin E production and inhibition of basophil histamine release by therapy-induced blocking antibodies［J］. Clin Exp Allergy, 2003, 33(9):1198-1208.
［12］Wachholz PA, Durham SR. Induction of ‘blocking’ IgG antibodies during immunotherapy［J］. Clin Exp Allergy, 2003, 33(9):1171-1174.
［13］Van Neerven RJ, Wikborg T, Lund G. Blocking antibodies induced by specific allergy vaccination prevent the activation of CD4+ T cell by inhibiting serum-IgE-facilitated allergen presentation［J］. J Immunol, 1999, 163(5):2944-2952.
［14］Jutel M, Akdis M, Budak F, Aebischer-Casaulta C, Wrzyszcz M, Blaser K, et al. IL-10 and TGF-beta cooperate in the regulatory T cell response to mucosal allergens in normal immunity and specific immunotherapy［J］. Eur J Immunol, 2003, 33(5):1205-1214.
［15］Ferreira MB, Santos AS, Santos MC, Carlos ML, Barbosa MA, Carlos AG. Nasal ECP patterns and specific immunotherapy in mite-allergic rhinitis patients［J］. Eur Ann Allergy Clin Immunol, 2005, 37(3):96-102.
［16］O′Brien RM, Byron KA, Varigos GA, Thomas WR. House dust mite immunotherapy results in a decrease in Der p2-specific IFN-γ and IL-4 expression by circulating T lymphocytes［J］. Clin Exp Allergy, 1997,27(1): 46-51.
［17］Gardner LM, Thien FC, Douglass JA, Rolland JM, O′Hehir RE. Induction of T ‘regulatory’ cells by standardized house dust mite immunotherapy: an increase in CD4+CD25+interleukin 10+ T cells expressing peripheral tissue trafficking markers［J］. Clin Exp Allergy, 2004, 34（8）:1209-1219.