Effect of sublingual immunotherapy with Dermatophagoides Farinae on the expression of specific IgG4 in patients with allergic rhinitis in Hainan area
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摘要: 目的 探讨粉尘螨舌下免疫治疗对于海南地区变应性鼻炎(AR)患者的特异性IgG4(sIgG4)表达水平的影响。方法 选取72例三代均为海南本地岛民且诊断为粉尘螨变应性鼻炎的患者，随机分为对照组36例和SLIT组36例，分别在治疗前、治疗6个月、治疗12个月、治疗18个月后检测患者sIgG4、sIgE的表达水平，评估患者的症状评分、用药评分及VAS评分，同时记录不良反应。最终通过对2组患者4个时间点收集到的相关数据进行统计分析，观察海南地区AR患者接受舌下特异性免疫治疗后其sIgG4抗体表达水平的改变情况。结果 与治疗前相比，治疗后SLIT组患者的症状评分、药物评分及VAS评分均显著改善(P＜0.05)，血清sIgG4显著升高(P＜0.01)，血清sIgE无显著性变化(P>0.05)；对照组患者的症状评分、药物评分和VAS评分也有显著改善(P＜0.05)，血清sIgG4、血清sIgE水平无显著性变化(P>0.05)。2组相比，SLIT组在治疗12个月和18个月后症状评分、用药评分及VAS评分均显著低于对照组(P＜0.05)；SLIT组sIgG4表达水平在治疗6个月、12个月和18个月后均显著高于对照组(P＜0.01)。2组sIgE表达水平无明显差异(P>0.05)。2组均未出现严重不良反应，SLIT组出现2例轻微不良反应。结论 粉尘螨舌下免疫治疗疗效显著，同时可显著增加粉尘螨AR患者体内sIgG4的表达水平，sIgG4有望作为客观评估变应原特异性免疫治疗临床疗效的一个免疫学指标。Abstract: Objective The aim of this study is to investigate the effect of sublingual immunotherapy with Dermatophagoides Farinae on the expression of specific IgG4(sIgG4) in patients with allergic rhinitis (AR) in Hainan area.Method Seventy-two patients with dust-mite allergic rhinitis, all three generations of whom were local islanders in Hainan, were randomly divided into control group(36 cases) and SLIT group(36 cases). sIgG4 and sIgE expression levels were detected before treatment, 6 months after treatment, 12 months after treatment, and 18 months after treatment. The patient's symptom score, medication score, VAS score and adverse reactions was also assessed. Finally, through statistical analysis of the relevant data collected at 4 time points in the two groups of patients, the efficacy, safety and changes of sIgG4 antibody expression level in patients with allergic rhinitis receiving sublingual specific immunotherapy in Hainan were observed.Result Symptoms scores, medication scores and VAS scores were significantly improved in the SLIT group after treatment compared with before treatment(P < 0.05), and serum sIgG4 increased significantly(P < 0.01), serum sIgE showed no significant change(P>0.05). In the control group, symptom scores, medication scores and VAS scores were also significantly improved compared with before treatment(P < 0.05), while serum sIgG4 and sIgE showed no significant change(P>0.05). When comparing the two groups, Symptoms scores, medication scores and VAS scores of the SLIT group were significantly lower than those of the control group at 12 months and 18 months after treatment(P < 0.05). sIgG4 expression levels in the SLIT group were significantly higher than those in the control group after 6, 12 and 18 months of treatment(P < 0.01). There was no significant difference in sIgE expression level between the two groups(P>0.05). No severe systemic adverse reactions occurred in the two groups, and 3 patients showed mild adverse reactions in the SLIT group.Conclusion Sublingual immunotherapy of Dermatophagoides Farinae was effective and could increase the expression of sIgG4 in patients with Dermatophagoides farinae AR, sIgG4 is expected to be an immunological marker for the objective evaluation of the clinical efficacy of Hapten.
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Key words:
- allergic rhinitis /
- sublingual specific immunotherapy /
- sIgG4
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表 1 2组不同治疗时间鼻炎症状评分比较
分，M(Q1，Q3) 组别 治疗前 治疗时间 6个月 12个月 18个月 SLIT组 9.36(7.22，11.35) 7.62(6.68，8.87)1) 5.32(4.48，6.13)1)3) 2.52(1.56，3.21)2)3) 对照组 9.28(7.13，11.40) 8.38(7.74，9.62) 7.73(6.65，8.90)1) 6.83(5.70，7.78)1) 与治疗前相比，1)P＜0.05，2)P＜0.01；与对照组相比，3)P＜0.05。 
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表 2 2组不同治疗时间对症用药评分
分，M(Q1，Q3) 组别 治疗前 治疗时间 6个月 12个月 18个月 SLIT组 3.25(2.24，4.35) 1.72(1.18，2.87)1) 0.00(0.00，0.13)1)2) 0.00(0.00，0.00)1)2) 对照组 3.01(1.98，4.20) 1.58(1.04，2.62)1) 1.67(1.12，2.90)1) 1.70(1.09，2.78)1) 与治疗前比较，1)P＜0.05；与对照组比较，2)P＜0.05。
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表 3 2组不同治疗时间VAS评分
分，M(Q1，Q3) 组别 治疗前 治疗时间 6个月 12个月 18个月 SLIT组 4.20(3.64，5.05) 0.78(0.30，1.47)1) 0.51(0.17，1.23)1)2) 0.32(0.11，0.74)1)2) 对照组 4.20(3.08，4.97) 0.87(0.54，1.82)1) 0.83(0.41，2.16)1) 1.52(1.02，2.81)1) 与治疗前比较，1)P＜0.05；与对照组比较，2)P＜0.05。
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表 4 2组不同治疗时间血清粉尘螨sIgG4水平
AU/L，M(Q1，Q3) 组别 治疗前 治疗时间 6个月 12个月 18个月 SLIT组 452(364，1 135) 5384(4 453，14 639)1)2) 9953(8 754，18 725)1)2) 11 023(9 588，19 897)1)2) 对照组 522(408，1 196) 631(562，1 384) 496(412，1 078) 561(420，1 288) 与治疗前比较，1)P＜0.01；与对照组比较，2)P＜0.01。
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表 5 2组不同治疗时间血清粉尘螨sIgE水平
kU/L，M(Q1，Q3) 组别 治疗前 治疗时间 6个月 12个月 18个月 SLIT组 16.23(5.31，38.26) 17.22(6.28，39.27) 16.29(5.64，37.99) 15.86(5.48，37.57) 对照组 15.85(4.92，41.03) 17.86(6.89，40.23) 17.08(5.16，39.88) 15.63(5.22，38.05)
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