舌下含服免疫治疗对变应性鼻炎患儿的临床疗效

目的探讨粉尘螨滴剂舌下含服特异性免疫治疗(sublingual immunotherapy,SLIT)对变应性鼻炎(allergic rhinitis,AR)患儿血清sIgG4、IL-10和IL-33表达水平的作用,并对SLIT的临床疗效进行评估。方法在2016年2月—2016年8月,宁波市医疗中心李惠利医院入组了70例AR患儿,将这些患儿随机分为SLIT试验组(SLIT配合对症药物)和药物对照组(仅对症药物),每组各35例患儿。分别在治疗前、治疗半年、治疗1年、治疗2年时,通过酶联免疫吸附法测定血清sIgG4、IL-10和IL-33的表达水平,同时对患儿的总鼻部症状评分(total nasal symptoms score,TNSS)和总用药评分(total medication score,TMS)进行评估。结果经过2年的治疗后,与药物对照组相比,SLIT试验组的TNSS评分和TMS评分显著降低(P<0.01)。与治疗前相比,AR患儿经过2年的免疫治疗后,SLIT组的sIgG4和IL-10的水平显著上升(P<0.05),而IL-33的水平显著下降(P<0.05)。2年治疗后药物对照组的sIgG4、IL-10和IL-33的水平都未发生明显的改变。2年治疗结束时2组的sIgG4、IL-10和IL-33水平存在明显的差异(P<0.05)。结论标准化粉尘螨滴剂SLIT对尘螨引起的儿童AR具有疗效,并且血清sIgG4、IL-10和IL-33表达水平的变化可能作为评估SLIT疗效的指标。

Clinical Efficacy of Sublingual Immunotherapy on Children with Allergic Rhinitis

OBJECTIVE To explore the effect of sublingual immunotherapy(SLIT) with standardized dermatophagoides farinae drops on serum sIgG4, IL-10 and IL-33 levels and evaluate the clinical efficacy of SLIT for the treatment of allergic rhinitis(AR) in children. METHODS Seventy children patients with dust-mite AR collected from Ningbo Medical Center of Lihuili Hospital between February and August 2016 were randomly assigned to SLIT group(SLIT combined with pharmacotherapy, n=35) and control group(only pharmacotherapy, n=35). Serum levels of sIgG4, IL-10 and IL-33 were measured by ELISA before and after SLIT for 6 months, 1 year and 2 years, total nasal symptoms score(TNSS) and total medication score(TMS) were evaluated. RESULTS TNSS and TMS scores of SLIT group was significantly lower than the control group after 2 years'' treatment(P<0.01). Compared with before treatment, the levels of sIgG4 and IL-10 increased significantly and IL-33 decreased significantly in children with AR after 2 years'' SLIT(P<0.05). The level of sIgG4, IL-10 and IL-33 in control group did not differ significantly before and after 2 years'' treatment. Meanwhile, a significant difference was found in the expression of sIgG, IL-10 and IL-33 between two groups at the end of 2 years'' treatment(P<0.05). CONCLUSION SLIT with dermatophagoides farinae drops is efficient treatment for children with HDM-induced AR. The change of serum sIgG4, IL-10 and IL-33 level may be used as an indicator to assess the clinical efficacy of SLIT.