本文關(guān)鍵詞： 變應(yīng)性鼻炎 變應(yīng)原特異性免疫治療 皮下注射特異性免疫治療 沖擊免疫治療 嗜酸性粒細(xì)胞 免疫球蛋白E 免疫球蛋白G 白介素-10 白介素-12 γ干擾素　出處：《南昌大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:變應(yīng)性鼻炎作為耳鼻喉科常見病、多發(fā)病之一,其發(fā)病機(jī)制尚未完全闡明,但其發(fā)病率呈逐年增長,尤其是在發(fā)展中國家。AR雖然沒有明顯的生命危險(xiǎn),但其嚴(yán)重影響患者的日常生活、學(xué)習(xí)和工作,造成個(gè)人和社會(huì)的經(jīng)濟(jì)負(fù)擔(dān)(藥物控制)。特異性免疫治療是治療變應(yīng)性鼻炎的有效治療措施,臨床上常用的2種給藥方式分別是:皮下注射免疫治療(SCIT)和舌下含服免疫治療(SLIT)。本文著重探討沖擊免疫治療方案對(duì)變應(yīng)性鼻炎的療效及其相關(guān)影響因素。方法:回顧性分析2013年2月至2015年7月于我院診斷為變應(yīng)性鼻炎,同時(shí)采用沖擊免疫治療方法完成劑量累加階段的62例患者的臨床資料,采用病例自身對(duì)照方法研究,統(tǒng)計(jì)學(xué)上采用配對(duì)設(shè)計(jì)的t檢驗(yàn)方法進(jìn)行統(tǒng)計(jì)分析。1、對(duì)比完成1周沖擊免疫治療前后患者癥狀評(píng)分、體征評(píng)分以及VAS評(píng)分的改變,評(píng)價(jià)其療效;2、全自動(dòng)血液分析儀測定患者完成沖擊免疫治療前后外周血嗜酸性粒細(xì)胞計(jì)數(shù)的變化,評(píng)價(jià)其療效;3、Beekman特定蛋白檢測儀檢測血清總免疫球蛋白E(Ig E)和免疫球蛋白G(Ig G)的濃度在沖擊免疫治療前后的變化,評(píng)價(jià)其療效;4、ELISA法測定患者沖擊免疫治療前后血清中IFN-γ、IL-12、IL-10、Ig G1、Ig G4的濃度變化,評(píng)價(jià)沖擊免疫治療的相關(guān)影響因素;5、觀察治療過程中患者發(fā)生的不良反應(yīng)事件,簡要評(píng)價(jià)其安全性。結(jié)果:1、患者完成沖擊免疫治療后癥狀評(píng)分較治療前有所降低,差異具有統(tǒng)計(jì)學(xué)意義。2、完成沖擊免疫治療后患者外周血中嗜酸性粒細(xì)胞計(jì)數(shù)較前降低,其中單純塵螨過敏組的變化具有統(tǒng)計(jì)學(xué)意義。3、完成沖擊免疫治療后患者血清總Ig E、Ig G的濃度較前有所升高,單純塵螨過敏組血清Ig G濃度變化具有統(tǒng)計(jì)學(xué)意義。4、完成沖擊免疫治療后患者血清IFN-γ、IL-12、IL-10的濃度均升高,其中合并多種變應(yīng)原組在治療前后IL-12和IFN-γ的濃度變化無統(tǒng)計(jì)學(xué)意義;其余各組的變化均有統(tǒng)計(jì)學(xué)意義。5、完成沖擊免疫治療后患者血清Ig G1、Ig G4的濃度均升高,其中單純塵螨過敏組血清Ig G4的濃度變化具有統(tǒng)計(jì)學(xué)意義,血清Ig G1濃度變化無明顯統(tǒng)計(jì)學(xué)意義。6、治療過程中無明顯全身過敏反應(yīng),僅出現(xiàn)注射部位紅斑、硬結(jié)、腫脹、腫脹等局部不良反應(yīng)。結(jié)論:1、沖擊免疫治療能有效改善患者的TNSS評(píng)分、體征評(píng)分、VAS評(píng)分,對(duì)AR的治療具有良好的療效;2、沖擊免疫治療可通過產(chǎn)生Ig G抗體發(fā)揮作用,還可通過調(diào)整Th1/Th2的動(dòng)態(tài)平衡發(fā)揮作用。3、沖擊免疫治療是一種安全的劑量累加階段給藥方式。
[Abstract]:Objective: allergic rhinitis is one of the most common diseases in otolaryngology. The pathogenesis of allergic rhinitis has not been fully elucidated, but the incidence of allergic rhinitis is increasing year by year, especially in developing countries. However, it seriously affects the daily life, study and work of the patients, resulting in a personal and social economic burden. (drug control and specific immunotherapy is an effective treatment for allergic rhinitis. The two commonly used methods of administration in clinic are subcutaneous immunotherapy (SCITT) and sublingual immunotherapy (SLITT). The therapeutic effect of shock immunotherapy on allergic rhinitis and its related influencing factors were discussed in this paper. The diagnosis of allergic rhinitis in our hospital from February 2013 to July 2015 was retrospectively analyzed. At the same time, the clinical data of 62 patients in the dose-accumulation stage were completed by means of shock immunotherapy, and the case-control study was used. T test was used to analyze the symptoms, signs and VAS scores of patients before and after 1 week of shock immunotherapy. To evaluate its curative effect, the changes of eosinophil count in peripheral blood were measured by automatic blood analyzer before and after shock immunotherapy. To evaluate the efficacy of Beekman specific protein detection instrument, the changes of serum total immunoglobulin (IgE) and immunoglobulin G (GG) concentrations before and after shock immunotherapy were evaluated. To evaluate the effect of shock immunotherapy, to determine the concentration of IFN- 緯 -12 IL-12, IL-10, Ig, Ig, and IgG4 in serum before and after shock immunotherapy, and to evaluate the related influencing factors of shock immunotherapy, and to observe the adverse events in the course of treatment. Results the symptom score of the patients after shock immunotherapy was lower than that before treatment, and the difference was statistically significant. The eosinophil count in peripheral blood of patients with shock immunotherapy was lower than that before. The changes of the allergic group of dust mite were statistically significant. The serum concentration of IgE Ig was increased after Impulse immunotherapy. The changes of serum IgG concentration were statistically significant in simple dust mite allergy group. The serum levels of IFN- 緯 IL-12 IL-10 were increased after shock immunotherapy, but the concentrations of IL-12 and IFN- 緯 in patients with multiple allergens were not significantly changed before and after treatment. The changes of the other groups were statistically significant. The serum levels of IgG4 in the patients with pneumoconidia hypersensitivity group were significantly higher than those in the control group after Ig G1 + Ig G4 treatment, and there was a significant difference in the concentration of IgG4 in the patients with simple dust mite allergy group. There was no significant change in serum Ig G 1 concentration. 6. There was no obvious systemic allergic reaction during the treatment, only erythema, sclerotia and swelling occurred at the injection site. Conclusion impact immunotherapy can effectively improve the TNSS score and physical sign score of patients, and has a good curative effect on AR treatment. Shock immunotherapy can play an important role by producing IgG antibody. By adjusting the dynamic balance of Th1/Th2, impulse immunotherapy is a safe dose-accumulation method.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R765.21

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本文編號(hào)：1539092