屋尘螨特异性免疫治疗的哮喘患儿对尘螨过敏原免疫反应的变化

目的观察经屋尘螨特异性免疫治疗(SIT)的哮喘患儿对尘螨过敏原特异性免疫反应的变化。方法选取54例尘螨过敏性哮喘患儿,其中男性38例,女性16例;年龄6~11岁,平均年龄9岁1个月。27例经标准化屋尘螨过敏原皮下SIT疗程1.5~2.0年患儿作为SIT组,另27例未经SIT患儿作为对照组。应用最大呼气流量-容积曲线测定方法测定肺通气功能,参数为第1秒用力呼气容积(FEV1)占预计值百分比(FEV1%);应用荧光酶联免疫法测定2组患儿血清屋尘螨特异性IgE和特异性IgG4浓度;分离患儿外周血单个核细胞(PBMC),经质量浓度20μg/mL屋尘螨蛋白浸液刺激并培养48 h后,检测CD4+CD25+Foxp3+调节性T淋巴细胞(Treg细胞)的相对数量和可分泌白细胞介素10(IL-10)的Treg细胞百分比;同时留取细胞培养上清液应用酶联免疫吸附分析检测细胞因子IL-4、干扰素-γ(IFN-γ)和转化生长因子β1(TGF-β1)水平。结果 SIT组患儿肺功能FEV1%与对照组相比,差异无统计学意义(P>0.05);SIT组IgG4水平显著高于对照组,差异有极显著统计学意义(P<0.000 1)。SIT组IgE水平与对照组相比,差异无统计学意义(P>0.05);两组刺激后Treg细胞百分数分别与各自该组内未经刺激时基础水平的差异无统计学意义。两组间PBMC无论是否经屋尘螨蛋白浸液刺激时Treg细胞百分数的差异无统计学意义(P>0.05);SIT组刺激后Treg细胞百分数高于自身未经刺激基础水平1.56倍。对照组经刺激后与未接受刺激比较,Treg细胞百分数无显著变化;SIT组PBMC培养上清液中IL-4和TGF-β1浓度显著低于对照组,IFN-γ浓度显著高于对照组,差异有统计学意义(P<0.05)。结论屋尘螨SIT的哮喘患儿对尘螨过敏原特异性免疫反应表现为Treg细胞比率增加,Th1/Th2免疫反应平衡改变,屋尘螨特异性IgG4浓度增高,提示发生对尘螨过敏原特异性免疫耐受的特征。

Changes of specific immune-response in asthmatic children with subcutaneous house dust mite specific immunotherapy

Objective To investigate the changes of specific T cell immune-response to house dust mite(HDM) in asthmatic children with subcutaneous HDM specific immunotherapy(SIT).Methods A total of 54 HDM-allergic asthmatic children were enrolled(male 38 and female 16,aged 6-11 years old,mean age 9 years and 1 month) in the present study,of which 27 were treated with HDM SIT for 1.5 ~ 2.0 years(SIT group) and the other 27 without HDM SIT were employed as control group.Pulmonary function were evaluated for all patients...