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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Th2细胞因子IL-4和IgE水平均较对照组高,而Th1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,哮喘患者血清中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<0.05)。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<0.01);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)。而在哮喘患者的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。
Objective: To investigate the effect of inhalation of allergen vaccine (AV) on the balance between Th1 / Th2 cytokines (IL-2 and IL-4) and serum IgE levels in T lymphocytes of patients with bronchial asthma. Methods: Ninety patients with remission asthma were randomly divided into three groups: 30 patients in AV (group A) and 30 patients in sublingual group (group B); 30 In addition, 32 healthy people without history of asthma and allergy and no acute respiratory infection in the past 3 months were selected as the control group. The efficacy of three different specific immunotherapy (SIT) methods was evaluated. Results: The levels of Th2 cytokines IL-4 and IgE in asthma patients before SIT were higher than those in control group, while Th1 cytokine IL-2 was lower (all P <0.01). After 1 year of SIT, the level of IL-2 in the serum of asthmatic patients was significantly higher than that before treatment, and the levels of IL-4 and IgE were also significantly decreased. The difference was statistically significant before and after treatment (all P <0.05). Statistical analysis showed that there was a significant positive correlation between serum IL-4 and IgE (r = 0.264, P <0.01). There was a significant negative correlation between IL-2 and IgE (r = -0.369, P <0.05 ). There was a significant negative correlation between IL-2 and IL-4 (r = -0.277, P <0.01). However, in the SIT of asthmatic patients, the efficacy of the three routes of administration was over 86%, with no significant difference (P> 0.05). Conclusions: AV aerosol inhalation of SIT can shift the allergen-specific response of asthma patients from Th2 to Th1, thereby regulating the balance between Th1 / Th2 cytokines in asthmatic patients; AV aerosol inhalation can be directly administered compared to other routes of administration Acting on target organs is a safe, effective and easy SIT method that patients are more receptive to.