Objective: The preseason prophylactic treatment of seasonal allergic rhinitis (AR) caused by pollens could alleviate AR symptoms during the pollen season. This study aimed to evaluate the effect of prophylaxis usage of suplatast tosilate on the life quality of AR patients in the pollen season, and investigate the potential mechanism of action through transcriptomic analysis. Methods: This is a randomized controlled study. AR patients allergic to weed pollens were recruited from Allergy Clinic of Peking Union Medical College Hospital from January 2020 to June 2020, and divided into prophylactic group who started to take suplatast tosilate as prophylaxis 2 weeks before the spread of weed pollens[n=10, 4 men and 6 women with age range of (34±6) years old] and control group who did not use any prophylactic treatment[n=24, 12 men and 12 women with age range of (33±9) years old]. The differences of age (t=0.381, P=0.706) and gender (χ²=0.595, P=0.715) distribution between the patients of two groups were not statistically significant. All the subjects filled in the rhinoconjunctivitis quality of life questionnaire (RQLQ) while onset of AR symptoms, and peripheral blood was drawn for transcriptomic analysis 1 month before and during the pollen season. Differences between groups were statistically analyzed through chi-square test and t test. Results: There was no significant difference in visual analogue scale of rhinitis symptom in the last pollen season between prophylactic group and control group[ 8.0 (6.4, 9.3) vs 7.3 (6.1, 8.0), Z=1.180, P=0.254]. The RQLQ score of prophylactic group was superior to that of control group in the weed pollen season (2.9±0.9 vs 3.7±0.9, t=-2.438, P=0.026). 210 differentially expressed genes of fold change ≥2 were identified, with 147 genes upregulated and 63 genes downregulated in the prophylactic group compared to the control group. Gene Ontology annotation showed that IL-12 and IL-23 related pathways were downregulated in prophylactic group (P=0.006 48). Polymerase Chain Reaction (PCR) verification of differentially expressed genes indicated that the relative expression level of HLA-G in prophylactic group was significantly lower than that in control group (0.23±0.19 vs 1.00±0.49,t=4.016, P=0.006). Conclusion: The prophylactic treatment of suplatast tosilate showed some benefit to the life quality of seasonal AR patients during the pollen season, and the potential mechanism might be related with the downregulation of IL-12 and IL-23 pathways and decreased expression of HLA-G.
目的： 花粉过敏所致的季节性变应性鼻炎（AR）患者在花粉季前接受预防性治疗可减轻花粉季期间症状。本研究拟评价预防性使用甲磺司特对于AR患者花粉季中生活质量的影响，并应用转录组学方法探讨其预防作用机制。 方法： 这是一项随机对照研究。于2020年1至6月在北京协和医院变态反应科门诊招募对杂草花粉过敏的AR患者，将患者分为两组，预防组在花粉播散前2周开始服用甲磺司特预防治疗［10例，男性4例、女性6例，年龄（34±6）岁］，对照组则不使用预防用药［24例，男、女各12例，年龄（33±9）岁］。两组患者的年龄（t=0.381，P=0.706）与性别（χ²=0.595，P=0.715）分布差异无统计学意义。在花粉季症状发作时所有患者填写鼻结膜炎生活质量调查问卷（RQLQ），在花粉季前1个月和花粉季中分别抽外周血送检转录组学分析。组间差异统计分析主要采用了χ²检验与t检验。 结果： 预防组与对照组上一年花粉季期间鼻炎症状视觉模拟评分的差异无统计学意义［8.0 （6.4，9.3） vs 7.3 （6.1，8.0），Z=1.180，P=0.254］。在花粉季期间，预防组的RQLQ评分优于对照组（2.9±0.9 vs 3.7±0.9，t=-2.438，P=0.026）。预防组和对照组相比表达差异倍数在2倍以上的基因共有210个，其中上调基因147个，下调基因63个。基因本体注释结果显示预防组中IL-12及IL-23相关通路与对照组相比明显下调（P=0.006 48）。对差异表达基因的聚合酶链式反应（PCR）验证提示，预防组HLA-G基因的相对表达量显著低于对照组（0.23±0.19 vs 1.00±0.49，t=4.016，P=0.006）。 结论： 甲磺司特的预防治疗对于提高季节性AR患者花粉季期间的生活质量可能具有一定效果，其作用机制可能与IL-12及IL-23相关通路的下调、HLA-G基因表达减少可能有关。.