發(fā)布時(shí)間：2018-06-28 14:26

  本文選題：變應(yīng)性鼻炎 + 免疫治療�。� 參考：《昆明醫(yī)科大學(xué)》2013年碩士論文

【摘要】：目的：研究塵螨變應(yīng)原疫苗皮下免疫療法(subcutaneous immunotherapy,SCIT)和舌下免疫療法(sublingual immunotherapy,SLIT)治療兒童中-重度持續(xù)性變應(yīng)性鼻炎(allergic rhinitis,AR)的血清IL-2、IL-4、IL-6、IL-10、TNF和IFN-y的變化情況和臨床療效。 方法：50例確診為中-重度持續(xù)性AR的患兒納入本項(xiàng)開放性對(duì)照研究。所有患兒均對(duì)屋塵螨和(或)粉塵螨過敏,年齡為5-14周歲,病程1-6年�；純弘S機(jī)分為2組,每組25例,分別采用SCIT或SLIT治療方案并長(zhǎng)期隨訪。治療前和治療1年后抽取靜脈血行流式細(xì)胞術(shù)(Flow Cytometry,FCM)測(cè)定Th1/Th2細(xì)胞因子(IL-2、IL-4、IL-6、IL-10、TNF和IFN-y)的值。并同時(shí)應(yīng)用視覺模擬量表(visual analogue scale,VAS)進(jìn)行鼻部癥狀(打噴嚏、流清涕、鼻塞和鼻癢)和總體癥狀評(píng)分。 結(jié)果：1.免疫治療1年后與治療前相比,SCIT組和SLIT組患兒血清中IL-2、IL-10和IFN-γ值明顯上升,IL-4和IL-6值下降,差異有統(tǒng)計(jì)學(xué)意義(t值分別為7.183、4.084、10.115、-8.662、-3.343；7.226、4.016、10.095、-11.015、-2.170,P值均0.05)：兩組的TNF值也有所下降,SCIT組下降差異有統(tǒng)計(jì)學(xué)意義(t值=-2.195,P值0.05),但SLIT組差異無統(tǒng)計(jì)學(xué)意義(t值=-1.859,P值0.05)。 2.兩組患兒治療前后各細(xì)胞因子的差值行組間比較,僅IFN-y差值SLIT組高于SCIT組(t值=2.508,P值0.05),其余組間比較差異均無統(tǒng)計(jì)學(xué)意義(t值分別為1.347、-1.949、0.025、0.130、-0.026,P值均0.05)。 3.免疫治療1年后,SCIT組和SLIT組患兒的流清涕、打噴嚏、鼻塞、鼻癢癥狀和總體癥狀評(píng)分均明顯下降,差異有統(tǒng)計(jì)學(xué)意義(t值分別為-18.667、-15.267、-15.544、-11.830、-19.822;-25.103、-22.992、-14.288.-140343、-22.093,P值均0.01)。 4.兩組患兒治療前后的各癥狀評(píng)分差值進(jìn)行比較,組間差異無統(tǒng)計(jì)學(xué)意義(t值分別為0.147、0.522、1.327、0.695、0.112,P值均0.05)。 5.SCIT組和SLIT組患兒治療前與治療1年后的血清細(xì)胞因子(IL-2、IL-4、IL-6、IL-10、TNF和IFN-γ)值與總體癥狀VAS評(píng)分均沒有相關(guān)性(P值均0.05)。 結(jié)論：1.特異性免疫治療能顯著提高患兒外周血中IL-2和IFN-γ (Th1類細(xì)胞因子)的表達(dá)水平,降低IL-4和IL-6(Th2類細(xì)胞因子)的表達(dá),調(diào)節(jié)Th1和Th2細(xì)胞的平衡,達(dá)到治療目的。 2.塵螨變應(yīng)原免疫治療能夠有效改善兒童變應(yīng)性鼻炎的癥狀,舌下免疫治療與皮下免疫治療有相同的臨床療效。舌下免疫治療給藥方便,無疼痛,有望替代皮下免疫治療在兒童中推廣。
[Abstract]:Objective: to study the changes and clinical efficacy of subcutaneous immunotherapy and sublingual immunotherapy in the treatment of moderate to severe persistent allergic rhinitis in children with moderate to severe persistent allergic rhinitis (allergic rhinitis AR). Methods 50 children with moderate-severe persistent AR were included in this open controlled study. All the children were allergic to house dust mites and / or dust mites aged 5-14 years and the course of disease was 1-6 years. The children were randomly divided into two groups, 25 cases in each group, treated with SCIT or SLIT respectively and followed up for a long time. Flow Cytometry (FCM) was used to measure the levels of Th1 / Th2 cytokines (IL-2 / IL-4, IL-6, IL-10, TNF and IFN-y) before and one year after treatment. At the same time, the nasal symptoms (sneezing, runny, nasal congestion and itching) and the overall symptoms were evaluated by visual analogue scale (visual analogue scale VAS). The result is 1: 1. After one year of immunotherapy, the serum levels of IL-2, IL-10 and IFN- 緯 in the SCIT group and the SLIT group were significantly increased, and the levels of IL-4 and IL-6 were decreased significantly (t = 7.1834.084 鹵10.115- 8.662U -3.343respectively). The serum levels of IL-2, IL-10 and IFN- 緯 in the SCIT group and the SLIT group were significantly higher than those in the control group (t = 7.1834.084). The TNF values of the two groups were also decreased (t value was 2.195 P 0.05), but there was no significant difference in the SLIT group (t value -1.859P value 0.05), but there was no significant difference between the two groups (t = -1.859P = 0.05), but there was no significant difference between the two groups (t = -1.859P = 0.05), but there was a significant difference between the two groups (t = -2.195, P = 0.05), but there was no significant difference in the SLIT group (t = -1.859P = 0.05). Only IFN-y difference was higher in SLIT group than that in SCIT group (t = 2.508, P = 0.05), but there was no significant difference between other groups (t = 1.347- 1.949U 0.0250.130- 0.026P, respectively). After one year of immunotherapy, the scores of snot, sneezing, nasal congestion, nasal itching and total symptoms in SCIT group and SLIT group were significantly decreased (t values were -18.667- 15.267- 15.544- 11.830U -19.822U -25.103- 22.992- 14.288.-140343- 22.093n, P < 0.01), and the difference was statistically significant (t = -18.667- 15.267- 15.544- 11.830U -19.822- 25.103- 22.992- 14.288.-140343- 22.093P). The difference of symptom scores before and after treatment was compared between the two groups. There was no significant difference between the two groups (t = 0.147) (t = 0.147, 0.522, 1.327, 0.6950.12, P = 0.05). 5. There was no correlation between serum cytokines (IL-2IL-4, IL-6, IL-10, TNF and IFN- 緯) and total symptom VAS score in SCIT group and SLIT group before and 1 year after treatment (P all 0.05). Conclusion 1. Specific immunotherapy can significantly increase the expression of IL-2 and IFN- 緯 (Th1 cytokines) in children's peripheral blood, decrease the expression of IL-4 and IL-6 (Th2 cytokines), regulate the balance of Th1 and Th2 cells, and achieve the therapeutic purpose. 2. Dust mite allergen immunotherapy can effectively improve the symptoms of allergic rhinitis in children. Sublingual immunotherapy has the same clinical effect as subcutaneous immunotherapy. Sublingual immunotherapy is convenient and painless. It is expected to replace subcutaneous immunotherapy in children.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R765.21

【引證文獻(xiàn)】

相關(guān)期刊論文 前2條

1 趙銳;;兒童變應(yīng)性鼻炎的特異性免疫治療分析[J];當(dāng)代醫(yī)學(xué);2015年16期

2 李科瓊;王宏;白燕;李靜;袁軻;;重慶地區(qū)6197例變應(yīng)性鼻炎兒童吸入性變應(yīng)原臨床分析[J];重慶醫(yī)科大學(xué)學(xué)報(bào);2015年05期

，

本文編號(hào)：2078280