Objective:The study aimed to investigate the efficacy of sublingual immunotherapy(SLIT) in treatment of adult allergic rhinitis, and to explore the predictive role of baseline serum cytokine levels in its therapeutic effect.Method:Sixty patients with moderatesevere perennial AR sensitized with house dust mites were treated for 2 years. The SLIT group(n=30) were treated with standardized dust mite vaccine SLIT and conventional drugs, and the control group(n=30) were treated with placebo and conventional drugs. The combined symptom and medication score(CSMS) were compared between the two groups to evaluate the efficacy at baseline and 2 year endpoint. According to therapeutic effect, the SLIT group and the control group were divided into subgroups respectively, and the baseline IFN-γ and IL4, IL10, IL17 levels were compared between the effective group and the ineffective group in each group. The ROC curve was drawn to find the best predictive index and the best cut-off value was calculated. Result:①There was no significant difference between the SLIT group and the control group at baseline CSMS(P>0.05). There was significant difference between the two groups at 2year endpoint CSMS(P<0.05). ②In the SLIT group, there was no significant difference between the effective group and the ineffective group with the IFN-γ and IL17(P>0.05). The IL4 level in the effective group was significantly higher than the ineffective group while the IL10 level was significantly lower(P<0.05). In the control group, there were no significant differences in the levels of IFN-γ, IL4, IL10 and IL17 between the two subgroups(P>0.05). ③Baseline IL4/IL10 has higher predictive value than IL4 and IL10 alone. The best cut-off value is 2.04, and the sensitivity and specificity of predictive value were 72.7% and 73.7% respectively. Conclusion: SLIT combined with conventional drug therapy is more effective than conventional drug therapy alone. IL4/IL10 has a better predictive role in SLIT effect than IL4 or IL10 alone. The higher the ratio, the better therapeutic effect is.
目的：观察舌下免疫法（SLIT）治疗成人变应性鼻炎（AR）的疗效，并探讨基线血清细胞因子水平对其疗效的预测意义。 方法:以屋尘螨致敏的中-重度持续性AR患者（60例）为研究对象，共治疗2年。SLIT组（30例）采用标准化尘螨疫苗SLIT及常规药物治疗，对照组（30例）采用安慰剂及常规药物治疗，比较两组基线和2年末症状药物联合评分（CSMS），评估疗效；按疗效分别将SLIT组和对照组进行组内分组比较，比较各组内有效组和无效组基线IFN-γ、IL4、IL10、IL17水平差异；绘制ROC曲线以寻找对疗效具有最佳预测意义的指标，并计算其最佳cut-off值。 结果：①SLIT组与对照组的基线CSMS比较差异无统计学意义（P>0.05），2年末组间CSMS比较差异有统计学意义（P<0.05）。②SLIT组内，有效组基线IFN-γ、IL17与无效组比较均差异无统计学意义（P>0.05），基线IL4显著较高、IL10显著较低（P<0.05）；对照组内，有效组基线IFN-γ、IL4、IL10、IL17与无效组比较均差异无统计学意义（P>0.05）。③基线IL4/IL10较IL4、IL10具有较高的预测价值，最佳cut-off值为2.04，敏感度为72.7%，特异度为73.7%。 结论：SLIT联合常规药物较单纯药物治疗AR更有效；IL4/IL10在一定程度上能较IL4、IL10更好地预测SLIT的效果，比值越大者可能疗效越佳。.
Keywords: biomakers; combined symptom and medication score; cytokine; receiver operating characteristic curve; rhinitis, allergic; sublingual immunotherapy.
Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.