屋尘螨皮下特异性免疫治疗的哮喘患儿肺功能及免疫学动态变化

目的：动态观察屋尘螨变应原皮下特异性免疫治疗对哮喘患儿的肺功能和免疫学影响。方法：屋尘螨过敏的轻中度哮喘患儿32例，分成治疗组(n=15)和对照组(n=17)。治疗组吸入糖皮质激素的同时加用屋尘螨变应原皮下特异性免疫治疗，对照组仅予吸入糖皮质激素治疗。检测治疗前、治疗后3月、6月、12月、18月、24月肺通气功能，观察治疗前、治疗后12月及24月哮喘发作次数并测定血清总IgE、屋尘螨特异性IgE、屋尘螨特异性IgG4、嗜酸细胞阳离子蛋白（ECP）、IL-10、IL-4及IFN-γ的变化。结果：治疗组患儿治疗后肺通气功能各项参数稳定在正常或接近正常水平；无哮喘急性发作病例的百分率治疗后高于治疗前，随治疗时间的延长而增加（P<0.05）；治疗后屋尘螨特异性IgG4高于治疗前，随着治疗时间延长而增加（P<0.01）；治疗后血清总IgE、屋尘螨特异性IgE、ECP、IL-10、IL-4、IFN-γ水平与治疗前比较，差异无统计学意义。对照组患儿治疗前后各项指标比较，差异均无统计学意义。结论：屋尘螨过敏的轻中度哮喘患儿经屋尘螨变应原皮下特异性免疫治疗2年后，肺通气功能保持正常或接近正常，无哮喘急性发作病例增加，可能与血清屋尘螨特异性IgG4浓度增高有关。［中国当代儿科杂志，2010，12（9）：715-719］

Dynamical changes of lung function and immunologic markers in asthmatic children receiving specific immunotherapy with standardized house dust mite extract

Objective To study the effects of specific immunotherapy with standardized house dust mite extract on the lung function and immunologic markers in children with asthma.Methods Thirty-two children with mild to moderate asthma who were allergic to house dust mite were assigned to two groups:an immunotherapy group that received subcutaneous specific immunotherapy with standardized house dust mite extract beside glucocorticoids treatment (n=15) and a control group that received glucocorticoids treatment alone (n=17).Lung function was determined before treatment and 3,6,12,18 and 24 months after treatment.The frequency of asthma attacks was observed before treatment and 12 and 24 months after treatment.Serum immunological markers,including total IgE,specific IgE and specific IgG4 against house dust mite (Dermatophagoides pteronyssinus,Der P),ECP,IL-10,IL-4,and IFN-γ,were measured before treatment and 12 and 24 months after treatment.Results The parameters of lung function were kept at the normal level or near normal level after treatment in the immunotherapy group.Compared with before treatment,the percentage of patients without asthma attacks increased significantly after treatment in the immunotherapy group (P < 0.05) and increased more significantly with a prolonged treatment time (P < 0.05).The level of serum sIgG4 against Der P increased significantly throughout the period of the immunotherapy treatment compared with before treatment (P < 0.01).There were no significant differences in the levels of serum total IgE,sIgE against Der P,ECP,IL-10,IL-4 and IFN-γ before and after treatment in the immunotherapy group.There were no significant differences in all the parameters measured before and after treatment in the control group.Conclusions Subcutaneous specific immunotherapy with standardized house dust mite extract for two years decreases the frequency of asthma attacks and the lung functions are kept in a normal level in children with asthma.The role of the specific immunotherapy may attribute to the increased level of serum sIgG4 against Der P.