| 2. 舌下免疫疗法:最早报道用舌下免疫疗法是在1980 年,WHO 在1988 年确认了其有效性,在欧洲是除了皮下注射免疫外应用较广的脱敏疗法。其安全性和耐受性已经在过敏性患者的实验中得到证实,适应证和皮下注射疗法相同,但能避免皮下注射时的严重全身性不良反应。其作用机制可能是降低了血浆中的嗜酸性阳离子蛋白,减少了过敏作用的延期反应,升高了IL-12 的水平和IgG4/ IgE 的比率[22] 。Gomez等[23 ] 采用双盲随机对照实验,比较对屋尘螨过敏且血浆IgE ≥200 UI 的哮喘患者舌下免疫与安慰剂的效果,舌下免疫治疗组症状加重的很少(P < 0. 001) ,并且FEV1 比治疗前有很大提高,很少再需要沙丁胺醇,很好地改善了患者的生活质量。Gammeri 等[24] 对105 例患者快速舌下免疫耐受的评估研究中,只有1 例患者在第一次初始剂量后30 min 出现轻微的局部症状,随后又自行消失,其他患者的耐受性都很好,这些数据表明快速的SIT 安全且耐受性好,即使在大剂量时也这样。舌下免疫使患者的症状和肺功能好转,沙丁胺醇的用量也减少,并且发作的频率下降,此外,舌下免疫疗法不需要特殊的设备,患者在家里就可以操作,因此在欧洲南美洲澳大利亚和东南亚做为一种很有前景的治疗措施已被接受。但是舌下免疫疗法的具体有效剂量、治疗程序、治疗持续时间等都是现在关注的焦点[23 ] ,而且这种疗法还没有在严重哮喘患者应用过,也没有相关的给予混合变应原的非交叉反应的回顾性研究。随着研究的发展该疗法将会得到更广泛的应用,特别是儿童哮喘患者。
3. 雾化吸入脱敏:雾化吸入脱敏又称局部支气管黏膜免疫疗法,是通过从低剂量向高剂量逐步过渡的吸入变应原疫苗,提高支气管对变应原的免疫性和降低支气管对变应原的敏感性的一种方法。李超乾等[25 ] 用卵清蛋白(OVA) 注射和雾化吸入制作致敏大鼠哮喘模型,再用OVA 雾化吸入脱敏后检测血清IL-4 和IFN-γ浓度,结果显示雾化吸入脱敏的大鼠不管是症状,还是病理、病理生理以及支气管肺组织中IL-4/ IFN-γ表达或血清中IL-4 和IFN-γ浓度的异常改变,均得到了纠正,而对照组则改变不明显,提示减敏是成功的论文怎么写。尹玉敏等[26 ] 对30 例缓解期哮喘患者雾化吸入变应原治疗显示雾化吸入的疗效比皮下注射和舌下含服效果好,认为雾化吸入是一种较为安全、有效、简便、依从性高的SIT 方法,与口服法相比具有用药剂量小、见效快、不良反应少和使用方便等优点,且疗效显著,全身不良反应极轻。特异性变应原雾化吸入治疗过敏性哮喘的可能机制: ①反复雾化吸入形成黏膜免疫耐受;②治疗后失衡的Th1/ Th2 模式得到纠正;③可能诱导分泌IL-4 的细胞凋亡。临床研究表明吸入的剂量是治疗能否成功的关键,也是避免出现诱发气管痉挛的关键,研究已经证实吸入免疫疗法诱发支气管痉挛的几率明显大于其它免疫治疗方法,临床上应引起足够重视。
前景展望
尽管目前对过敏性疾病的脱敏疗法机制不十分清楚，各种机制都参与其中医学检验论文，但临床上应用的疗效还是值得肯定的。目前研究主要进一步明确SIT的效应机制和如何研发有效的，标准化的疫苗。主要的研究方向为：重组变应原及其衍生物，包括非致敏性变应原多肽和非致敏性IgE结合半抗原医学检验论文，DNA疫苗[27]。另外，几个近期的研究显示，有助于增强SIT在呼吸道过敏疾病中治疗的地位（1）提高变应原制剂的标准化。（2）更好的理解SIT的免疫机制。（3）在引入舌下含服片时需严格登记和监控。（4）要加强处方使用的合理性[28]。标准化等方法和舌下含服等途径的不断应用也为进一步增加和稳定疗效及治疗提供了更好的发展方向。同时，也将进一步揭开SIF免疫机制。
参考文献
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