抗原特异性免疫治疗对花粉症的长期疗效

目的:探讨抗原特异性免疫治疗(specific immunotherapy,SIT)对花粉症患者的疗效及作用机制.方法:选择对夏秋季豚草(Ragweed)和蒿草(Atremisa vulgaris)过敏的花粉症患者(过敏性鼻炎或哮喘)235例,随机分为SIT组:包括过敏性鼻炎组(n=65);过敏性鼻炎 哮喘组(n=60);对症治疗组(symptomatic therapy,ST),同样包括过敏性鼻炎组(n=56),和过敏性鼻炎 哮喘组(n=54).健康对照组(n=43).应用UniCAPsystem免疫荧光法、双抗体夹心ELISA法、放射比浊法和瑞氏染色法分别测定血清特异性IgE(sIgE)、总IgE(tIgE)、嗜酸性粒细胞阳离子蛋白(ECP)、IgG水平和外周血嗜酸性粒细胞(Eos)计数.分别比较二组治疗前、后上述各种参数、肺功能指标、症状评分和皮肤试验指数的变化.结果:治疗前,患者血清sIgE、tIgE、ECP水平、血Eos计数、tIgE:IgG值均明显升高(P＜0.01).经SIT治疗后,上述指标均明显下降,而IgG含量明显上升(P＜0.01).肺功能指标、症状评分和皮肤试验指数均在治疗后有明显改善(P＜0.05).其中临床控制率40%,有效率57.7%(显效46.4%,好转11.3%),无效率仅为2.3%,不良反应8.9%.ST组治疗前、后上述各种参数无明显改变,其中23%的过敏性鼻炎患者发生了哮喘.ST组以上各种参数无改变.结论:SIT能明显改善过敏性鼻炎和哮喘的临床症状,增加血清IgG水平,减少IgE的生成并抑制Eos的募集.

Long-term effect evaluation of antigen specific immunotherapy for patients with pollen allergy

AIM: To evaluate the effectiveness of allergen specific immunotherapy (SIT) in treating patients with pollinosis. METHODS: A total of 235 patients with pollen allergy were recruited into the study and were randomly divided into two groups: SIT group with subgroups: allergic rhinitis group (n=65) and allergic rhinitis + asthma group (n=60), and ST (symptomatic therapy) group with subgroups: allergic rhinitis group (n=56) and allergic rhinitis + asthma group (n=54). Forty-three healthy individuals were taken as controls. The levels of serum total IgE (tIgE), specific IgE (sIgE) and eosinophil cantionic protein (ECP) were determined with Uni CAP system. IgG was measured and eosinophil numbers were counted. The above-mentioned indices, lung function indices, symptomatic score and skin test results were compared between the two groups before and after treatment. RESULTS: The elevated levels of tIgE, sIgE, ECP and tIgE: IgG in the sera and eosinophil counts in peripheral blood of the patients were significantly reduced, whereas the level of IgG increased following treatment with SIT. Lung function, symptomatic score and skin test result all improved after the treatment with SIT. Approximately 40% of the patients were clinically cured and 57.7% responded to SIT. Only 2.3% remained unchanged and about 8.9% patients suffered side effects of SIT. No changes in the above-mentioned indices were observed in ST group. CONCLUSION: SIT can improve the symptoms of the patients with allergic rhinitis and asthma by increasing the level of serum IgG, decreasing the IgE and inhibiting the eosinophil counts in peripheral blood.