支气管哮喘特异性免疫治疗的研究进展

目前,通过调节辅助T细胞Th1/Th2平衡和介导免疫耐受等机制治疗支气管哮喘的特异性免疫治疗(STT)越来越引起人们的重视,SIT通过皮下注射和舌下含服变应原疫苗等给药方式区别于糖皮质激素的吸入治疗.STT虽然还存在局部或全身等不良反应和仅作为吸入激素的辅助和附加治疗,但因其具有疗效肯定、持久等特点,随着STT制剂的标准化、治疗的规范,SIT将具有广阔的应用前景.     

尘螨标准化免疫治疗85例哮喘儿童疗效相关指标分析

目的 观察哮喘特异性免疫治疗(Specific immunotherapy,SIT)过程中变应原注射时间、变应原累积注射量及糖皮质激素吸入剂量、最高呼气流量、总IgE、螨特异性IgE等的变化.方法 根据纳入标准选择2005年2月-2008年6月我院哮喘免疫治疗中心就诊的过敏性哮喘患儿,进行同期对照回顾性分析,其中治疗组接受尘螨标准化变应原特异性免疫治疗,以每4次变应原注射为观察点,历时3.4年,观察治疗时间、变应原累积注射量、糖皮质激素吸入量、最高呼气流量变化、总IgE和螨特异性IgE变化,对照组仅行药物治疗,比较两组糖皮质激素吸入量及哮喘发作情况,并在SIT结束时评估疗效.结果 SIT组85例,男45例,女40例,年龄(7.6±1.4)岁,对照组病例50例,单纯药物治疗,男28例,女22例,年龄(7.7±1.5)岁.SIT第20次注射、治疗(38.7±2.4)周时,变应原累积注射量达(69.7±4.8)μg,糖皮质激素吸入量明显少于对照组(t=2.359,P＜0.05);SIT组最高呼气流量较治疗前升高,有统计学意义(F=7.874,P＜0.05);SIT前后总IgE变化无统计学意义(t=0.313,P＞0.05),螨特异性IgE变化无统计学意义(tDerp=0.517,tDerf=0.717,P＞0.05);SIT组疗程结束时患儿家长对病情主观评价:45.9%表示明显好转,36.5%表示中度好转,16.5%表示稍有好转,1.1%表示无改变;两组患儿在治疗结束时进行疗效评估,SIT组控制率达85.5%,对照组为62.0%,两组比较差异有统计学意义(x2=10.150,P＜0.01),提示SIT有效..结论 哮喘特异性免疫治疗第20次注射后,螨过敏性哮喘患儿糖皮质激素吸入剂量显著减少;85%以上患儿在SIT结束时哮喘得到控制;总IgE和螨特异性IgE变化无统计学意义.     

尘螨标准化免疫治疗85例哮喘儿童疗效相关指标分析

Objective The scientific basis and the clinical effectiveness of allergen specific immunotherapy (SIT) administered by subcutaneous injection are well established. This study aimed to observe the changes in amount of inhaled corticosteroids, total IgE, specific IgE, peak expiratory flow rate (PEF), etc. during a standardized SIT against house dust mite in allergic asthmatic children. Method Children (5-13 years old) with mild to moderate allergic asthma seen from February 2005 to June 2008 were enrolled into this study. A non- randomized retrospective study was performed. All children were diagnosed sensitive to dust mites, the treatment group accepted standardized dust mite allergen specific immunotherapy. Each fourth injections were defined as observation points, the study took 3.4 years. The investigators recorded the treatment, the cumulative allergen extract, changes of daffy doses of inhaled corticosteroid, peak expiratory flow (PEF), total IgE (TIgE), specific IgE (SIgE). The control group only received inhaled corticosteroids. The daily doses of inhaled corticosteroid and the number of asthma attacks,and the control rate were compared between the 2 groups. Result Totally 85 children were treated with SIT [(7.6 ± 1.4) years], 45 males and 40 females; 50 children received only drug treatment [(7.7 ± 1.5)years], 28 males and 22 females. The cumulative dose of allergen was up to (69.7 ± 4.8) μg after the 20 times injection, the dose of inhaled corticosteroids was significantly less than that in the control group ( t =2. 359, P ＜ 0.05). PEF was significantly higher than that of pre-treatment level ( F = 7.874, P ＜ 0.05 ).TIgE and SIgE had no significant change (t = 0.313, P ＞ 0.05, tDerp = 0.517, tDerf = 0.717,P ＞ 0.05 ). After the treatment, the control rate of the SIT group was 85.5%, that of the control group was 62.0% (X2 =10.150, P ＜0.01). Conclusion The standardized SIT against house dust mite could reduce steroid use in mild to moderate allergic asthmatic children. After ( 38.7± 2.3 ) weeks, the cumulative dose of allergen was up to (69.7 + 4.8) μg, inhaled corticosteroid was significantly reduced. At the end of SIT, 85% of patients obtained complete control of asthma. Total IgE and mite-specific IgE had no significant changes.     

尘螨标准化免疫治疗85例哮喘儿童疗效相关指标分析

Objective The scientific basis and the clinical effectiveness of allergen specific immunotherapy (SIT) administered by subcutaneous injection are well established. This study aimed to observe the changes in amount of inhaled corticosteroids, total IgE, specific IgE, peak expiratory flow rate (PEF), etc. during a standardized SIT against house dust mite in allergic asthmatic children. Method Children (5-13 years old) with mild to moderate allergic asthma seen from February 2005 to June 2008 were enrolled into this study. A non- randomized retrospective study was performed. All children were diagnosed sensitive to dust mites, the treatment group accepted standardized dust mite allergen specific immunotherapy. Each fourth injections were defined as observation points, the study took 3.4 years. The investigators recorded the treatment, the cumulative allergen extract, changes of daffy doses of inhaled corticosteroid, peak expiratory flow (PEF), total IgE (TIgE), specific IgE (SIgE). The control group only received inhaled corticosteroids. The daily doses of inhaled corticosteroid and the number of asthma attacks,and the control rate were compared between the 2 groups. Result Totally 85 children were treated with SIT [(7.6 ± 1.4) years], 45 males and 40 females; 50 children received only drug treatment [(7.7 ± 1.5)years], 28 males and 22 females. The cumulative dose of allergen was up to (69.7 ± 4.8) μg after the 20 times injection, the dose of inhaled corticosteroids was significantly less than that in the control group ( t =2. 359, P ＜ 0.05). PEF was significantly higher than that of pre-treatment level ( F = 7.874, P ＜ 0.05 ).TIgE and SIgE had no significant change (t = 0.313, P ＞ 0.05, tDerp = 0.517, tDerf = 0.717,P ＞ 0.05 ). After the treatment, the control rate of the SIT group was 85.5%, that of the control group was 62.0% (X2 =10.150, P ＜0.01). Conclusion The standardized SIT against house dust mite could reduce steroid use in mild to moderate allergic asthmatic children. After ( 38.7± 2.3 ) weeks, the cumulative dose of allergen was up to (69.7 + 4.8) μg, inhaled corticosteroid was significantly reduced. At the end of SIT, 85% of patients obtained complete control of asthma. Total IgE and mite-specific IgE had no significant changes.     

舌下特异性免疫治疗进展

对于症状得到控制的轻中度过敏性哮喘和过敏性鼻炎患儿,尤其是单一过敏原过敏的患儿,应用舌下特异性免疫治疗(SLIT)可能是恰当的选择.要得到确切的临床疗效,应该从儿童早期即开始应用SLIT盯,且治疗持续时间要长.使用高剂量的SLIT比低剂量的SLIT更安全有效.SLIT的依从性主要取决于患儿的社会经济因素、家庭因素及治疗过程中不良反应的严重程度,而与患儿的年龄及免疫治疗类型无关.通过长期的临床试验研究发现,不论是过敏性鼻炎还是过敏性哮喘,使用SLIT不会产生任何严重的致命性的不良反应.有关SLIT的新疫苗和新剂型的开发应用以及新的适用范围研究的不断深入,将在过敏患儿中扩大SLIT的使用范围.     

舌下特异性免疫治疗进展

对于症状得到控制的轻中度过敏性哮喘和过敏性鼻炎患儿，尤其是单一过敏原过敏的患儿，应用舌下特异性免疫治疗（SLIT）可能是恰当的选择。要得到确切的临床疗效，应该从儿童早期即开始应用SLIT，且治疗持续时间要长。使用高剂量的SLIT比低剂量的SLIT更安全有效。SLIT的依从性主要取决于患儿的社会经济因素、家庭因素及治疗过程中不良反应的严重程度，而与患儿的年龄及免疫治疗类型无关。通过长期的临床试验研究发现，不论是过敏性鼻炎还是过敏性哮喘，使用SLIT不会产生任何严重的致命性的不良反应。有关SLIT的新疫苗和新剂型的开发应用以及新的适用范围研究的不断深入，将在过敏患儿中扩大SLIT的使用范围。     

儿童支气管哮喘诊断治疗进展

近年来,对于支气管哮喘的基础和临床研究均取得了一定的成果。现就免疫调节机制——新的“卫生学假说”的提出、儿童支气管哮喘与呼吸道重塑、《全球哮喘防治创议》2006版精髓——达到和维持支气管哮喘控制的治疗、婴幼儿喘息与支气管哮喘的关系、我国儿童支气管哮喘诊治指南的修订等若干问题进行分析。     

儿童支气管哮喘诊治进展评述

支气管哮喘(哮喘)是小儿常见的慢性肺部疾病,近年来发病率在世界范围内逐年增加,已引起国际社会的广泛关注.早期确诊及规范化治疗对预后至关重要.     

舌下特异性免疫治疗进展

对于症状得到控制的轻中度过敏性哮喘和过敏性鼻炎患儿,尤其是单一过敏原过敏的患儿,应用舌下特异性免疫治疗(SLIT)可能是恰当的选择.要得到确切的临床疗效,应该从儿童早期即开始应用SLIT盯,且治疗持续时间要长.使用高剂量的SLIT比低剂量的SLIT更安全有效.SLIT的依从性主要取决于患儿的社会经济因素、家庭因素及治疗过程中不良反应的严重程度,而与患儿的年龄及免疫治疗类型无关.通过长期的临床试验研究发现,不论是过敏性鼻炎还是过敏性哮喘,使用SLIT不会产生任何严重的致命性的不良反应.有关SLIT的新疫苗和新剂型的开发应用以及新的适用范围研究的不断深入,将在过敏患儿中扩大SLIT的使用范围.     

儿童幽门螺杆菌感染与支气管哮喘

支气管哮喘(哮喘)是儿童时期最常见的呼吸道慢件疾病之一,其本质和特征是慢性非特异性炎症和气道高反应性,但引起哮喘发生的原因和机制还不完伞清楚.幽门螺杆菌(HP)也是一种全球流行的病原菌,在儿童中有很高的感染率.近年来通过流行病学调查研究表明,儿童HP感染和哮喘之间存在一定的负相关,即在儿童早期(15岁以前)感染HP可预防或者减少哮喘的发生.其可能的机制为减少胃食管反流,影响T细胞分化的卫生假说等.     

儿童支气管哮喘监测的研究进展

目前儿童支气管哮喘(哮喘)的治疗主要是依据临床症状和肺功能,尽可能地应用最小剂量的类固醇来控制呼吸道炎症.儿童哮喘监测和预后评估的方法多种多样,主要包括主观和客观临床指标的测定或评估,以及诸如生活质量和哮喘治疗费用等社会经济指标的评估.与传统的监测方法相比,呼出气一氧化氮和痰嗜酸性细胞等的检测尽管有一些不足之处,但仍不失为安全、简易、无创性的儿童哮喘监测方法.     

白血病过继免疫治疗的研究进展

过继细胞免疫治疗是指在体外激活免疫活性细胞,然后输给带瘤宿主,使免疫活性细胞在体内杀伤、溶解肿瘤细胞,直接或间接介导抗瘤效应的一种新型的治疗方法.该文主要对用于白血病治疗的几种免疫活性细胞过继免疫新策略(包括自然杀伤细胞、人工抗原递呈细胞、白血病细胞分化的抗原递呈细胞、CD4+ T细胞及Th17细胞和混合免疫细胞)的最...     

白血病过继免疫治疗的研究进展

过继细胞免疫治疗是指在体外激活免疫活性细胞,然后输给带瘤宿主,使免疫活性细胞在体内杀伤、溶解肿瘤细胞,直接或间接介导抗瘤效应的一种新型的治疗方法.该文主要对用于白血病治疗的几种免疫活性细胞过继免疫新策略(包括自然杀伤细胞、人工抗原递呈细胞、白血病细胞分化的抗原递呈细胞、CD4+ T细胞及Th17细胞和混合免疫细胞)的最新进展进行综述.