免疫治疗对变应性鼻炎患者特异性IgG4水平的影响

目的探讨免疫治疗前、后尘螨变应性鼻炎患者特异性IgG4（specific IgG4,sIgG4）水平的变化。方法屋尘螨变应性鼻炎患者25例随机分为治疗组15例和对照组10例,治疗组按计划疗程皮下注射安脱达屋尘螨脱敏疫苗,对照组于症状出现时应用氯雷他定和布地奈德鼻喷雾剂。分别于治疗前及治疗后4、16、24、48周,采用四层双抗夹心ELISA法检测2组血清螨sIgG4,采用反式夹心化学荧光免疫法测定2组血清螨sIgE水平,评估2组5症状评分法（total 5symptom scores,T5SSs）评分,Spearman等级相关性分析各时间点血清螨sIgG4和sIgE水平与T5SS评分的相关性。结果治疗组治疗后4、16、24、48周血清螨sIgG4水平（954（714,2 798）、3 081（2 157,9 683）、5 326（4 329,14 290）、9 978（8 652,18 683）AU/L）较治疗前（478（335,1 458）AU/L）增高（P〈0.05）,治疗16、24、48周T5SS评分（4.35（3.24,5.38）,3.27（2.25,4.53）,3.11（2.19,4.20））较治疗前（9.30（7.40,11.15））降低（P〈0.05）;治疗前与治疗后4、16、24、48周比较,治疗组血清螨sIgE水平,对照组血清螨sIgG4、sIgE水平及T5SS评分比较差异均无统计学意义（P〉0.05）;Spearman等级相关分析结果显示,治疗组治疗后相应时段血清螨sIgG4水平与T5SS评分呈负相关（r=-0.471,P=0.003）,sIgE水平与症状评分无相关性（r=0.073,P=0.114）。结论 sIgG4可作为客观评估尘螨变应性鼻炎特异性免疫治疗临床效果的一个免疫学指标。

Influence of specific immunotherapy on specific IgG4 in patients with allergic rhinitis

Objective To explore the change of specific IgG4 before and after specific immunotherapy（SIT）in patients with allergic rhinitis to Dermatophagoides pteronyssinu（Der p）.Methods Twenty-five patients with allergic rhinitis to Der p were randomly divided into treatment group（n=15）and control group（n=10）.Treatment group received SIT with subcutaneous injection of Alutard SQ standardized Der p vaccine,and control group received loratadine and budesonide nasal spray.The four-layer double antibody sandwich ELISA was used to detect serum specific IgG4 and transsandwich chemical fluorescence immunoassay was used to detect specific IgE level before and 4,16,24,48 weeks after treatment.The results were evaluated by total 5symptom scores（T5SSs）,and Spearmans rank correlation analysis was used to analyze the correlation of specific IgG4 and specific IgE levels with T5 SSs at different time points.Results The serum specific IgG4 levels were 954（714,2 798）,3 081（2 157,9 683）,5 326（4 329,14 290）and 9 978（8 652,18 683）AU/L in treatment group in 4,16,24 and 48weeks after treatment,higher than the specific IgG4 level before treatment（478（335,1 458）AU/L）（P〈0.05）.T5 SSs were 4.35（3.24,5.38）,3.27（2.25,4.53）and 3.11（2.19,4.20）in treatment group in 16,24 and 48weeks after treatment,lower than T5 SS before treatment（9.30（7.40,11.15））（P〈0.05）.In comparison with before treatment,specific IgE in treatment group,and specific IgG4,specific IgE and T5 SSs in control group showed no significant differences in 4,16,24 and 48weeks after treatment（P〉0.05）.Spearmans rank correlation analysis showed specific IgG4 was negatively correlated with T5SSs（r=-0.471,P=0.003）,and specific IgE was not correlated with T5SSs（r=0.073,P=0.114）in treatment group at all time points after treatment.Conclusion Specific IgG4 might be a potential immunologic marker for evaluating the clinic efficacy of SIT on allergic rhinitis to Der p.