变应原疫苗雾化吸入对支气管哮喘患者Th1/Th2细胞因子平衡的调控

目的：探讨变应原疫苗（AV）雾化吸入对支气管哮喘患者T淋巴细胞表达Th1／Th2细胞因子（IL-2和IL-4）之间的平衡以及血清IgE水平调控作用。方法：选择90例缓解期哮喘患者作为观察对象，随机分为3组，雾化吸入AV（A组）30例；舌下含服AV（B组）30例；皮下注射AV（C组）30例；另选择无哮喘及过敏性病史，且近3个月无急性呼吸道感染的32例健康者作为对照（对照组），并对3种不同的特异性免疫治疗（SIT）方法进行疗效评定。结果：哮喘患者在SIT前血清Thz细胞因子IL-4和IgE水平均较对照组高，而Th，细胞因子IL-2则低，差异均有统计学意义（均P〈0．01）。SIT1年以后，哮喘息者血清中IL-2水平较治疗前明显增高，IL-4及IgE的水平也明显降低，治疗前后比较差异均有统计学意义（均P〈O．05）。统计学处理结果显示血清中IL-4与IgE水平之间存在显著正相关（r=0．264，P〈O．01）；IL-2与IgE水平之间存在显著负相关（r=-0．369，P〈0．05）；IL-2与IL-4水平之间存在显著负相关（r=-0．277，P〈0．01）。而在哮喘息者的SIT中，3种给药途径疗效均达86％以上，差异无统计学意义（P〉0．05）。结论：AV雾化吸入SIT能使哮喘患者变应原特异性应答从Th2转移到Th1，从而调节哮喘患者Th1／Th2细胞因子之间的平衡；与其他给药途径相比AV雾化吸入能直接作用于靶器官，是一种安全、有效、简便的SIT方法，患者更易接受。

An experimental study on the regulation of expression of Th1/Th2 cytokines by allergen vaccine atomization inhalation in patients with asthma

OBJECTIVE: To explore the role of specific immunotherapy treatment (SIT) with allergen vaccine (AV) atomization inhalation in regulation of the expression of Th1/Th1 cytokines (IL-2 and IL-4) by T lymphocyte and serum IgE level in asthmas. METHOD: Ninety cases with asthma in remission were randomly divided into three groups and each group contained thirty patients who received SIT respectively with atomization inhalation (A group), sublingual contained (B group) and hypodermic injection (C group). 32 healthy subjects were as control group. Before and after treatment, the expression of IL-2 and IL-4, total IgE level were measured by radio-immune. The three SIT treatments were evaluated. RESULT: Before SIT treatment, compared with the normal control group, the patients' serum level of Th2 cytokines IL-4 and total IgE had significantly increased, the level of Th1 cytokines IL-2 had significantly reduced. There were statistical significance between the asthma and normal control (t = 4.869, 5.598, 10.009, P < 0.01). After 12 months SIT treatment, the patients' serum IL-2 showed increased, the serum IL-4 and total IgE showed reduced, the difference was statistical significant (t = 7.303, 2.494, 2.225, P < 0.05). There was good positive correlation between the level of IL-4 and the total IgE (r = 0.264, P < 0.01), there was good negative correlation between the level of IL-2 and the total IgE (r = -0.369, P < 0.001), and there was good negative correlation between the level of IL-2 and IL-4 (r = -0.277, P < 0.01). The effects among A, B, C groups were similar (all were over 86%), without statistical significance (chi2 = 0.055, P > 0.05). CONCLUSION: The specific response to antigen may be transferred from Th2 to Th1 by SIT with AV atomization inhalation, and mediated between balance of Th1/Th2 in patients with asthma. This method is thought a direct influence on the target organ. It is safe, simple and valid and can be easily accepted by sufferers.