奥马珠单抗治疗儿童哮喘的作用机制与临床应用现状

The Mechanism of Action and Current Status of Clinical Application of Omalizumab in the Treatment of Asthma in Children

摘要: 过敏性哮喘由IgE介导，Th2细胞分泌IL-4/IL-13诱导IgE生成，结合肥大细胞FcεRI受体触发炎症介质释放与气道重塑，Treg细胞功能缺陷加剧免疫失衡。奥马珠单抗通过结合游离IgE阻断FcεRI交联，下调受体表达并调节Th1/Th2平衡，减少IL-4等细胞因子分泌。儿童临床研究显示，其可降低33%急性发作风险，改善症状且安全性高，主要不良反应为轻中度注射部位反应。指南推荐用于6岁以上、血清IgE 10~700 IU/mL、高剂量ICS-LABA控制不佳的过敏性哮喘儿童，未来需借助生物标志物优化精准治疗。

Abstract: Allergic asthma is mediated by IgE, which is induced by IL-4/IL-13 secretion from Th2 cells, binding to mast cell FcεRI receptors triggers the release of inflammatory mediators and airway remodeling, and immune imbalance is exacerbated by defective Treg cell function. Omalizumab blocks FcεRI cross-linking by binding to free IgE, down-regulates receptor expression and regulates Th1/Th2 balance, and reduces cytokine secretion such as IL-4. Clinical studies in children have shown that it reduces the risk of acute exacerbation by 33%, improves symptoms and has a high safety profile, with the main adverse effect being mild to moderate injection site reactions. The guidelines recommend its use in children with allergic asthma over 6 years of age, with a serum IgE of 10~700 IU/mL, and poorly controlled by high-dose ICS-LABA, and the future needs to be optimized for precision therapy with the help of biomarkers.