尘螨过敏原组分抗体作为变应性哮喘和/或鼻炎脱敏疗效临床生物学评估指标的应用研究

Allergic asthma and/or rhinitis are two clinically common disorders. Specific immunotherapy (SIT) as the only etiology-based treatment recognized by World Health Organization (WHO). However, there is a lack of reliable indicators or evaluation system for evaluating and monitoring the effectiveness of SIT. We have previously found a lower level of the specific immunoglobulin E (sIgE) and an elevated level of sIgG4 to Der p1 and Der p2 in response to SIT by using component-resolved diagnostic techniques. These changes of sIgE/sIgG4 ratio were more sensitive than the change of Der p alone. We thus hypothesized that the serum sIgE/sIgG4 ratio to Der p1 and Der p2 may be used as a biomarker for monitoring the SIT for allergic asthma and rhinitis. We will use a large clinical database to retrospectively examine the correlation between serum sIgE/sIgG4 ratio and SIT outcomes, determine the threshold of effective sIgE/sIgG4 ratio in response to SIT, and explore the regulatory reflect to SIT on Th17/Treg balance.

变应性哮喘和/或鼻炎是常见过敏性疾病。特异性免疫治疗(又称脱敏治疗)是WHO认可的唯一对因治疗方法，但目前缺乏客观临床疗效监测指标及评估体系。我们先前采用过敏原组分诊断技术监测屋尘螨(Der p)脱敏治疗，发现其主要抗原Der p1及Der p2组分特异性IgE(sIgE)表达降低的同时其特异性IgG4(sIgG4)表达增高，并观察到sIgE/sIgG4比率变化较Der p的sIgE/sIgG4更为敏感。因此我们提出，Der p1及Der p2 的sIgE/sIgG4可作为监测变应性哮喘和/或鼻炎脱敏疗效的生物学指标。本研究拟应用临床标本资源库回顾性评估及展开前瞻性研究，探讨sIgE和sIgG4与脱敏疗效的相关性，确定能监测疗效的sIgE/sIgG4阈值，以此为基础建立脱敏疗效的临床评估指标体系，并探索两种抗体水平变化反映在脱敏过程对Th17/Treg免疫偏移的调节作用。

变应性哮喘和/或鼻炎是常见过敏性疾病。特异性免疫治疗(又称脱敏治疗)是WHO认可的唯一对因治疗方法，但目前缺乏客观临床疗效监测指标及评估体系。研究试验已经跟进了103 例患者，并进行了不同时期患者的临床基本资料、组分抗体检测、肺功能指标、调查问卷等资料的收集和整理，发现免疫治疗前后Th17/Treg 细胞无显著性差异。研究结果说明sIgE/sIgG4 可作为临床客观指标监测和指导变应性哮喘和/或鼻炎脱敏治疗的疗效。脱敏疗效治疗起始期检测Der p1 sIgG4 水平升高，Der p sIgE/ sIgG4 治疗后显著降低，为SIT 治疗有效。低年龄开始SIT 治疗比高年龄治疗更有效，单独过敏性哮喘、鼻炎治疗疗效比合并两种疾病的疗效更好。Der p1 及Der p2 的sIgE/sIgG4 比率可用于脱敏疗效临床监测并反馈于临床指导治疗。治疗前进行屋尘螨及其主要组分sIgE 检测有助于临床的鉴别诊断，治疗后定期进行屋尘螨及其主要组分sIgG4 检测可预期SIT 患者的免疫状态。说明SIT 是一个动态的免疫过程，屋尘螨组分特异性IgE 和IgG4 在免疫过程中客观的反应了免疫状态。