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盘点:近期过敏性鼻炎研究进展盘点

2017-12-31 MedSci MedSci原创

过敏性鼻炎主要由IgE介导的介质(主要是组胺)释放,并有多种免疫活性细胞和细胞因子等参与的鼻黏膜非感染性炎性疾病。其发生的必要条件有特异性抗原即引起机体免疫反应的物质、特应性个体、特异性抗原与特应型个体二者相遇。过敏性鼻炎是一个全球性健康问题,可导致许多疾病和劳动力丧失。梅斯医学小编整理了近期过敏性鼻炎的研究进展,与大家一起分享学习!【1】Clin Immunol:过敏性鼻炎患者对屋尘螨增

过敏性鼻炎主要由IgE介导的介质(主要是组胺)释放,并有多种免疫活性细胞和细胞因子等参与的鼻黏膜非感染性炎性疾病。其发生的必要条件有特异性抗原即引起机体免疫反应的物质、特应性个体、特异性抗原与特应型个体二者相遇。过敏性鼻炎是一个全球性健康问题,可导致许多疾病和劳动力丧失。梅斯医学小编整理了近期过敏性鼻炎的研究进展,与大家一起分享学习!


2型先天淋巴样细胞(ILC2s)在起始和促进过敏免疫响应中是必要的成员。然而,研究人员在探究过程中发现了ILC2水平的过敏性鼻炎(AR)患者中的不一致性。最近,有研究人员调查了ILC2在屋尘螨(HDM)过敏性AR病人外周血中的水平,并且还调查了他们分泌2型细胞激素的能力。

研究发现,ILC2s且具有ILC2表型特性的水平在HDM-AR病人中增加。AR病人的症状得分和IL-13的水平与HDM-AR病人中的ILC2s有着正相关关系。另外,上皮细胞因子的刺激诱导了IL-5和IL-13在AR病人PBMCs中剧烈的产生。研究人员还成功的从AR病人中分离了ILC2s,并且鉴定了他们产生2型细胞激素的能力。研究还发现了ILC2s的数目在HDM-AR病人中增加了并且在上皮细胞激素存在的情况下,ILC2s产生了大量的TH2细胞激素,这也表明了ILC2在AR病人中的重要角色。


盐水洗鼻是一种额外的治疗过敏性鼻炎(AR)病人的方法。最近,有研究人员在患有季节性AR(SAR)的儿童患者中比较了21天的高渗生理盐水缓冲液(BHS)和正常生理盐水缓冲液(NSS)使用对减少鼻部症状的效果。并且还比较了这2中盐水对鼻腔细胞数(NCC)、生活质量和睡眠质量的影响。

研究人员设计的研究为21天的、开放标签的随机对照试验,包括了36名SAR儿童(年龄在6-13岁),这些儿童T5SS得分不少于5,并且接受1日2次的BHS或者NSS鼻腔冲洗。效果的测量方法包括T5SS的最小2乘均值变化(LSmc)、NCC、儿科鼻炎生活质量调查问卷(PRQLQ)和匹兹堡睡眠质量指数(PSQI)得分。研究发现,BHS提高了T5SS总得分,并且比NSS程度更高(LSmc -6.45 vs. -5.45, p < 0.001)。与NCC相比,BHS显著的降低了中性粒细胞((LSmc -0.76, p = 0.004)和嗜酸细胞(LSmc -0.46, p = 0.018)的得分,然而NSS并没有引起上述变化。与之相似,只有BHS产生了PRQLQ得分的显著提高(LSmc -0.57, p = 0.009),然而PSQI得分的提高在BHS(LSmc -0.77, p = 0.025)和NSS(LSmc -1.39,p < 0.001)之间基本相同。总之,BHS的耐受性良好。最后,研究人员指出,在患有SAR的儿童中,BHS在改善鼻部症状方面非常有效,并且NCC对生活质量具有有益的影响。


维生素D和过敏性鼻炎(AR)之间的关系仍旧不清楚。最近,有研究人员通过在患有AR的病人中检测血清25-羟甲基维生素D(25(OH)D)调水平、血嗜酸细胞和维生素D受体(VDR)在鼻粘膜上的表达调查了它们之间的关系。

研究包括了32名患有永久性过敏性鼻炎的病人和25名对照。研究人员通过酶联免疫试验检测了血清25(OH)D的水平,利用自动化的血液系统检测了外周血嗜酸细胞,然而在下鼻甲粘膜中VDR的表达则是通过免疫组化技术进行评估。更多的是,研究人员还分析了AR中的血清25(OH)D水平和血嗜酸细胞水平之间的关系。

研究发现,在AR组和对照组中,血清25(OH)D水平在并没有显著的差异(p=0.371)。有趣的是,AR组中血清25(OH)D的水平与血嗜酸细胞数目和它的比例呈现负相关关系(分别为p=0.019和p=0.010),甚至是在调整了混杂因素包括年龄、性别、身体质量指数和采血季节后上述负相关关系仍旧存在。另一方面,鼻粘膜VDR的表达水平在AR组和对照组中没有发现显著差异(p=0.231)。最后,研究人员指出,这些结果表明了在永久性AR中,血清25(OH)D也许与血嗜酸细胞成负相关关系。然而,维生素D和AR之间的关系仍旧需要进一步的分析。


中药玉屏风散(YPFS)经常用于过敏性鼻炎(AR)的治疗。之前的综述总结了YPFS的治疗效果和安全性,然而却没有亚群的分析来提供指导临床实践的详细证据。YPFS在中药临床实践指南中推荐作为治疗AR的药物,但是YPFS的治疗时间并没有特别的陈述。最近,有研究人员进行了旨在评估YPFS在治疗成年人AR中的效果和安全性的研究,并利用了最新的证据,并且还在亚群元分析中尝试确定YPFS的使用时间。

研究发现,22个随机对照试验(RCTs)总共包括了23个比较。YPFS与安慰剂、药物疗法进行了比较,并且作为一种附加的治疗与药物治疗进行了比较。元分析对4个鼻症状得分和"有效率"是可行的。另外,在YPFS组合治疗之后,4个鼻症状得分表现为降低:鼻痒(MD-0.46, 95% CI[-0.50, -0.42])、打喷嚏(MD-0.41, 95% CI[-0.47, -0.35])、鼻塞((MD-0.46, 95% CI[-0.54, -0.39])和流鼻涕(MD-0.42, 95% CI[-0.58, -0.26])。基于"有效率",元分析表明了YPFS并没有比单独的药物治疗具有更好的效果(RR1.07, 95%CI [0.94, 1.22]),但是YPFS与药物的组合使用要比单独的药物治疗更为有效(RR1.27, 95%CI [1.19, 1.34])。亚群分析表明YPFS并不比第二代抗组胺剂更好(RR1.04, 95%CI [0.90, 1.19])。更进一步的是,当使用时间超过3周时,YPFS的组合治疗效果更好((RR1.15, 95%CI [1.01, 1.32])。另外,YPFS对成年人AR具有很好的耐受性。最后,研究人员指出,中药YPFS对成年人AR是有益的。潜在的益处需要通过更多严谨的RCTs来进行评估。


过敏性鼻炎(AR)是由粘膜炎症鉴定而来的,并且由激活的免疫细胞驱使。在AR中,肥大细胞和TH2细胞也许能够减少上皮障碍的完整性,从而维持了上皮障碍的不完整性。最近,有研究人员调查了组织胺和TH2细胞在AR中促使上皮屏障障碍中的作用。

研究人员将原发性鼻上皮细胞(pNECs)的气液界面(ALI)培养物用来测量经上皮电阻,4kDa葡聚糖和紧密连接蛋白mRNA表达的细胞旁通量,并且从健康对照、AR病人和特发性鼻炎(IR)病人中搜集了鼻粘膜分泌物,并在体外进行了检测。另外,激活的TH1、TH2细胞的作用、肥大细胞和神经元也在体外进行了检测。研究人员还在体内对IL-4、IL-13、IFN-γ和TNFα 对粘膜通透性的影响进行了检测。

研究发现,组织胺和AR的鼻粘膜分泌物在体外试验中能够快速的减少上皮屏障的完整性。组织胺受体-1拮抗剂氮卓斯汀的前处理可以组织AR病人鼻粘膜分泌物对上皮完整性的早期影响。激活的TH1、TH2细胞上清能够损伤上皮完整性,当利用TNFα或者IL-4Rα单克隆抗体处理时能够分别恢复由TH1和TH2诱导的上皮屏障障碍。另外,IL-4、IFN-γ和TNFα 能够改善小鼠中鼻粘膜的通透性。在屋尘螨过敏性气道炎症小鼠模型中,IL-4拮抗剂能够阻止粘膜屏障损伤和紧密连接蛋白下调。最后,研究人员指出,在AR病理生理学中,他们的数据表明了过敏性炎症调控子在调节鼻屏障完整性中具有重要的作用。


过敏原免疫疗法在治疗屋尘螨局部过敏性鼻炎中(LAR)是一种非常有效的治疗方法。而在观察性研究中,关于花粉过敏原免疫治疗的研究却较少。最近,有研究人员评估了猫尾草皮下免疫治疗(PhI-SCIT)在LAR中的临床疗效和安全性。

研究人员设计了一个随机双盲与安慰剂对照研究,包括了56名中度到重度的对花粉过敏的LAR患者。研究发现,皮下免疫疗法(SCIT)具有短期且持续的效果,并且具有初级和继发临床治疗结果以及RQLQ得分的显著改善。SCIT在治疗的第6个月到底24个月,能够显著的增加血清slgG4的水平以及过敏原耐受性。在研究末期,83%的病人接受SCIT治疗不少于6个月,并且他们能够对猫尾草花粉的耐受浓度要比基线浓度高出了50倍,并且56%的病人展现出了阴性NAPT。这些结果表明,SCIT具有良好的耐受性。另外,在治疗过程中出现了6例轻度局部反应,并且没有发生严重的副作用事件。

最后,研究人员指出,利用脱色聚合过敏原提取物的皮下免疫治疗是对猫尾草LAR疾病的一种安全的和具有临床有效治疗效果的治疗方法。

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    2018-01-03 1e0f8808m18(暂无匿称)

    学习了.谢谢分享.

    0

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    2018-01-02 1e0f8808m18(暂无匿称)

    过敏性鼻炎新研究.学习了

    0

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    2017-12-31 120fafe0m52暂无昵称

    嗯嗯学习了

    0

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    2017-12-31 半夏微凉

    学习了谢谢分享

    0

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    2017-12-31 131****1460

    学习了受益匪浅

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