特异性免疫治疗对哮喘患儿自然杀伤细胞和嗜碱性细胞的影响

摘要

目的 探讨特异性免疫治疗哮喘患儿NK细胞活性和嗜碱性细胞表达变化的意义.方法 将60例轻、中度哮喘患儿(均对屋尘螨过敏)分为两组,其中治疗组30例,采用屋尘螨特异性免疫治疗联合吸入糖皮质激素为主的哮喘防治方案；对照组30例,仅采用吸入激素为主的哮喘防治方案.检测两组治疗前后NK细胞活性和嗜碱性粒细胞表达以及血清总IgE、屋尘螨特异性IgE (DP-IgE)、嗜酸性细胞阳离子蛋白(ECP)水平,评价两组患儿治疗前后哮喘急性发作次数,比较治疗前后哮喘控制测试(C-ACT)评分和最大用力呼气峰流速(PEF)测试结果.结果 治疗组治疗后外周血NK细胞活性(12.01±1.41)％,明显高于对照组(10.11±2.49)％(t=3.83,P=0.00).治疗组治疗后嗜碱性粒细胞含量、血清总IgE及DP-IgE水平下降程度均明显高于对照组(Z=2.23～3.57,P均＜0.05)；治疗后两组哮喘急性发作次数较治疗前均明显减少,C-ACT评分和PEF结果较治疗前均有提高,治疗组更优于对照组,差异有统计学意义(t=3.63～4.02,P均＜0.01).结论 特异性免疫治疗联合规范化防治使哮喘患儿病情更趋稳定,哮喘控制效果更理想.特异性免疫治疗能显著提高机体NK细胞活性、减少嗜碱性粒细胞含量.%Objectives To explore the change of natural killer (NK) cells activities and the percentage of basophilic leukocytes during specific immunotherapy in children with asthma. Methods Sixty children with mild to moderate asthma allergic to house dust mite were randomly assigned to two groups. The immunotherapy group received subcutaneous specific immunotherapy with standardized house dust mite extract in addition to glucocorticoids treatment (n=30), and the control group received glucocorticoids treatment only (n=30). The activities of NK cells and the percentage of basophilic leukocytes in peripheral blood, and the serum total IgE, specific IgE against house dust mite (DP-IgE) and serum eosinophil cationic protein (ECP) were measured before and after treatment. The acute asthmatic episodes were recorded, children asthma control test (ACT) were performed and peak expiratory flow (PEF) were measured before and after treatment. Results After treatment, the NK cells activities of the immunotherapy group was significantly higher than those of the control group (12.01±1.41% vs. 10.11±2.49%, t=3.83, P=0.00); More significant reduction in the percentage of basophilic leukocytes, total IgE and DP-IgE were found in the immunotherapy group than that in the control group (Z=2.23～3.57, all P＜0.05). Moreover, the obvious reduction in frequency of acute episodes of asthma and the improvement of PEF and ACT were seen in both groups, especially in the immunotherapy group after treatment (t=3.63, 4.02, all P＜0.01). Conclusions Compared with use of glucocorticoids only, the combined use of specific immunotherapy and glucocorticoids leads to better asthma control. It suggested that the increase in NK cells activities and the reduction in percentage of basophilic leukocytes may contribute to the efficacy of the specific immunotherapy.