2型糖尿病、肥胖和代谢综合征与患者报告的气源性过敏原皮下免疫治疗反应的相关性：一项真实世界横断面研究

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中文摘要

背景： 尽管近期研究已探讨代谢疾病对免疫系统的影响，但关于这些疾病及其治疗如何影响特应性疾病治疗手段（包括皮下免疫治疗（SCIT））的数据有限。
目的： 目的是在真实世界环境中评估2型糖尿病（T2DM）、肥胖、代谢综合征与患者报告的SCIT临床反应之间的相关性。
方法： 我们开展了一项观察性横断面研究，纳入2024年7月至9月期间在纽约布朗克斯Montefiore医疗中心接受SCIT的成人。SCIT反应通过视觉模拟量表评分评估，包括整体过敏性鼻炎（AR）症状、鼻塞、流涕和眼部症状，并按T2DM、肥胖（体重指数≥30 kg/m²）和代谢综合征进行分层。
结果： 共纳入95例患者，平均±标准差年龄为51±16岁，大多数为女性（71%）。25例患者（26%）患有T2DM，53例（56%）肥胖，27例（28%）患有代谢综合征。在整个队列中，67%的患者SCIT后整体AR症状改善，72%鼻塞改善，67%流涕改善，63%眼部症状改善。T2DM与整体症状改善的几率显著降低相关（比值比[OR] 0.23 [95%置信区间{CI}，0.06-0.89]；p = 0.037）。代谢综合征患者在SCIT期间整体AR症状改善（OR 0.21 [95% CI，0.03-0.61]；p = 0.010）、鼻塞改善（OR 0.24 [95% CI，0.06-0.88]；p = 0.036）和流涕改善（OR 0.22 [95% CI，0.06-0.75]；p = 0.019）的几率显著较低。使用二甲双胍、胰岛素、磺脲类药物或胰高血糖素样肽-1受体激动剂未显著影响SCIT反应。
结论： T2DM和代谢综合征可能识别出SCIT后改善较低的患者亚组。需要前瞻性研究来确定代谢紊乱是否能预测SCIT相关反应性。

英文摘要

Background: Although recent studies have examined the impact of metabolic diseases on the immune system, limited data exist on how these conditions and their treatments affect therapeutic approaches for atopic diseases, including subcutaneous immunotherapy (SCIT). Objective: The objective was to evaluate the association of type 2 diabetes mellitus (T2DM), obesity, metabolic syndrome, and patient-reported clinical response to SCIT in a real-world setting. Methods: We conducted an observational cross-sectional study of adults receiving SCIT at Montefiore Medical Center, Bronx, New York, between July and September 2024. The SCIT response was assessed by using visual analog scale scores for overall allergic rhinitis (AR) symptoms, nasal congestion, rhinorrhea, and ocular symptoms, stratified by T2DM, obesity (body mass index ≥ 30 kg/m²), and metabolic syndrome. Results: Overall, 95 patients were included, with a mean ± standard deviation age of 51 ± 16 years, the majority being women (71%). Twenty-five patients (26%) had T2DM, 53 (56%) were obese, and 27 (28%) had metabolic syndrome. In the entire cohort, 67% had improvement in overall AR symptoms with SCIT, 72% in nasal congestion, 67% in rhinorrhea, and 63% in ocular symptoms. T2DM was associated with significantly reduced odds of overall symptom improvement (odds ratio [OR] 0.23 [95% confidence interval {CI}, 0.06-0.89]; p = 0.037). The patients with metabolic syndrome had significantly lower odds of improvement in overall AR symptoms (OR 0.21 [95% CI, 0.03-0.61]; p = 0.010), nasal congestion (OR 0.24 [95% CI, 0.06-0.88]; p = 0.036), and rhinorrhea (OR 0.22 [95% CI, 0.06- 0.75]; p = 0.019) while on SCIT. Use of metformin, insulin, sulfonylureas, or glucagon-like peptide-1 receptor agonists did not significantly influence the SCIT response. Conclusion: T2DM and metabolic syndrome may identify a subgroup of patients with lower improvement after SCIT. Prospective studies are needed to determine whether metabolic disorders predict SCIT-associated responsiveness.