尘螨变应性鼻炎特异性免疫治疗的疗效预测指标探讨

doi:10.6040/j.issn.1673-3770.0.2016.224

摘要/Abstract

摘要： 目的观察变应性鼻炎(AR)患者接受变应原特异性免疫治疗1年后血清总IgE(tIgE)和特异性IgE(sIgE)水平的变化,探讨皮下免疫治疗(SCIT)和舌下免疫治疗(SLIT)的疗效预测指标。方法以尘螨致敏的中-重度持续性AR患者完成免疫治疗1年的病例作为研究对象,采用患者自评的方式对治疗效果进行主观评价,比较治疗前后血清tIgE、屋尘螨(Dp)和粉尘螨(Df)sIgE水平的变化,并依据治疗有效与否进行分层分析。对免疫治疗前患者的基线血清IgE抗体水平与治疗效果的关系进行分析,应用ROC曲线获得具有最佳预测效果的血清指标及其最佳临界值(cut-off值)。结果完成1年免疫治疗的SCIT组(50例)和SLIT组(58例)患者中,有效率分别为64.0%和65.5%,两组治疗效果的差异无统计学意义(P>0.05)。免疫治疗1年后与治疗前相比较,两组血清tIgE、Dp-sIgE和Df-sIgE水平的变化均无统计学意义(P>0.05),仅SCIT组有效患者血清Dp-sIgE水平的下降有统计学意义(P<0.05)。基线血清Dp-sIgE/tIgE比值对SCIT疗效具有最佳预测效果,其最佳cut-off值为11.95%,敏感性为71.9%,特异性为83.3%。而基线血清Df-sIgE水平对SLIT疗效具有最佳预测效果,其最佳cut-off值为27.95 IU/ml(4级),敏感性为52.6%,特异性为85.0%。结论免疫治疗前患者的血清sIgE水平可在一定程度上对治疗效果进行预测,sIgE水平较高或sIgE/tIgE比值较大的患者更容易取得满意疗效。

关键词: 免疫球蛋白E, 免疫治疗, ROC曲线, 生物标志物, 变应性鼻炎

Abstract: Objective To investigate the changes of serum total IgE(tIgE)and specific IgE(sIgE)levels in patients with allergic rhinitis(AR)one year after allergen-specific immunotherapy, and so as to explore the predictive biomarkers for therapeutic effects of subcutaneous immunotherapy(SCIT)and sublingual immunotherapy(SLIT). Methods Patients with moderate-to-severe persistent AR who completed one year of dust mite specific immunotherapy were enrolled in this study. The effectiveness of immunotherapy was evaluated by patient-reported outcomes. The changes of serum tIgE, Dp-sIgE and Df-sIgE levels were compared before and after immunotherapy, and these antibody levels were stratified analyzed based on the responders and nonresponders of treatment. The baseline serum IgE levels before immunotherapy were tested for correlation with clinical response to the treatment, and the best predictive biomarkers and cut-off value for discriminating between responders and nonresponders were estimated on the basis of the receiver operator characteristic(ROC)curve. Results The effective rate of the SCIT group(n=50)and the SLIT group(n=58)was 64% and 65.5% after one year immunotherapy, respectively. And there was no statistical significant difference between the two groups(P>0.05). Also, no significant differences in the levels of tIgE, Dp-sIgE and Df-sIgE were observed in both groups before and after immunotherapy(P>0.05). However, a significant decreased serum Dp-sIgE level was found in the responders of treatment in the SCIT group. The using of baseline serum Dp-sIgE/tIgE ratio > 11.95% as a biomarker of effective SCIT yielded a sensitivity value of 71.9% and a specificity of 83.3%. As for SLIT, the serum Df-sIgE levels > 27.95 IU/ml(grade 4)yielded a sensitivity value of 52.6% and a specificity of 85.0%. Conclusion Serum sIgE level before immunotherapy could be a useful biomarker for predicting response to the treatment. Generally, patients with higher levels of sIgE or sIgE/tIgE ratios may be more likely to achieve therapeutic effect.

Key words: Allergic rhinitis, Immunotherapy, Biomarkers, Receiver operating characteristic curve, Immunoglobulin E

中图分类号:

R765.21

周文成,袁源,程雷. 尘螨变应性鼻炎特异性免疫治疗的疗效预测指标探讨[J]. 山东大学耳鼻喉眼学报, 2016, 30(4): 43-49.

ZHOU Wencheng, YUAN Yuan, CHENG Lei. Predictive biomarkers for dust mite specific immunotherapy in patients with allergic rhinitis.[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2016, 30(4): 43-49.

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