淋巴免疫治疗对特应性皮炎儿童患者 皮肤屏障功能及免疫功能的影响

Effect of lymphatic immune therapy on skin barrier function and immune function in pediatric patients with atopic dermatitis

摘要:

目的 探讨淋巴免疫治疗对特应性皮炎儿童患者皮肤屏障功能及免疫功能的影响。方法 选取 2014年1 月-2015 年1 月福建医科大学附属泉州第一医院收治的100 例特应性皮炎儿童患者，按随机数字表 法将入选者分为皮下注射组（50 例）和淋巴注射组（50 例），均进行屋尘螨过敏原制剂注射，皮下注射组实施 上臂肘部正中的皮下注射，淋巴注射组则实施腹股沟处的淋巴结注射，比较两组患者的治疗效果、皮肤屏障 功能、免疫功能及不良反应等。结果 治疗后16 和20 周，淋巴注射组患者特应性皮炎评分（SCORAD）低 于皮下注射组（P <0.05），治疗后68 周差异无统计学意义（P >0.05）。治疗完成后，皮下注射和淋巴注射组患者 用药评分均低于各组治疗前（P <0.05），但治疗后两组间用药评分比较差异无统计学意义（P >0.05）。两组患 者血清屋尘螨特异性免疫球蛋白E（sIgE）低于治疗前（P <0.05），特异性免疫球蛋白G4（sIgG4）高于治疗前（P < 0.05），而治疗后两组间sIgE 与sIgG4 差异均无统计学意义（P >0.05）。治疗后两组的皮损区和非皮损区经表皮水 分丢失量（TEWL）下降，且淋巴注射组下降幅度大于皮下注射组（P <0.05）。皮下注射组CD4+、CD4+/CD8+、 自然杀伤细胞（NK）低于淋巴注射组，CD8+、B 细胞高于淋巴注射组（P <0.05）。此外，淋巴注射组患者的不 良反应发生率低于皮下注射组。结论 淋巴免疫治疗缩短了常规特应性皮炎的疗程，减少了注射剂量和次数，增 强了皮肤屏障功能，改善免疫力，降低全身不良反应发生率，显效快，安全性高，临床疗效显著，值得推广。

Abstract:

Objective To investigate the effect of lymphatic immune therapy on skin barrier function and immune function in pediatric patients with atopic dermatitis. Methods One hundred children with atopic dermatitis in our hospital between January 2014 and January 2015 were divided into a subcutaneous injection group (50 cases) and a lymph injection group (50 cases). All of them were injected with preparation of house dust mite allergen. The subcutaneous injection group was given subcutaneous injection in the middle elbow of the upper arm, and the lymph injection group was given injection into the lymph nodes of the groin. The therapeutic effect, skin barrier function, immune function and adverse reactions were compared between the two groups. Results After treatment for 16 and 20 w, the Scoring Atopic Dermatitis Index (SCORAD) scores in the lymph injection group were significantly lower than those in the subcutaneous injection (P < 0.05), but there was no more difference between the 2 groups at the 68th w after treatment (P > 0.05). The medication scores of the subcutaneous injection and lymphatic injection group after treatment were significantly lower than those before treatment (P < 0.05), but there was no significant difference between the two groups after treatment (P > 0.05). In both groups, serum house dust mite specific IgE (sIgE) after treatment was significantly lower than that before treatment (P < 0.05), sIgG4 was significantly higher than that before treatment (P < 0.05); however, ther was no significant difference in sIgE or sIgG4 between the two groups after treatment (P > 0.05). In the two groups, the transepidermal water loss (TEWL) of skin lesions and non-lesion areas was significantly decreased after treatment, and the decrease in the lymphatic injection group was significantly greater than that in the subcutaneous injection group (P < 0.05). The CD4+/CD8+ ratio in the subcutaneous injection group was significantly lower, and the number of CD4+ T cells and NK cells was smaller, while the number of CD8+ T cells and B cells were significantly larger than those of the lymphatic injection group (P < 0.05). In addition, the incidence of adverse reactions in the lymphatic injection group was significantly lower than that in the subcutaneous injection group (P < 0.05). Conclusions The lymphatic immunotherapy can shorten the course of conventional treatment for atopic dermatitis, decrease the injection dosage and times, enhance the skin barrier function, improve immunity, and reduce the systemic adverse reaction rate. It is markedly effective and highly safe, and worth promoting.