季节性变应性鼻炎的减量与固定剂量治疗的比较研究

The comparison of step-down pharmacotherapy and maintaining dose therapy for seasonal allergic rhinitis

目的:在圆柏花粉过敏所致变应性鼻炎患者中,比较根据花粉浓度的减少让患者做减药治疗与坚持原治疗剂量2种治疗策略的差异。方法:采用开放性随机平行对照研究,在高峰期过后圆柏花粉浓度下降期间,将花粉过敏所致变应性鼻炎患者随机分为2个组,减药组(n=67)减少对症药物的剂量,固定组(n=68)则维持高峰期的治疗剂量,比较2组患者的鼻炎症状评分和实际用药评分。结果:减药组与固定组患者的日均鼻炎症状评分差异无统计学意义(2.45±0.32、2.43±0.41,P=0.788)。减药组对方案的依从性(80.6%)显著优于固定组(60.3%),差异有统计学意义(P=0.014)。最终减药组的实际用药评分(3.67±0.98)显著低于固定组(4.78±0.70),差异有统计学意义(P<0.001)。但在重症者群体中,重症减药组的鼻炎症状有比重症固定组更重的趋势。结论:在花粉季后期花粉浓度下降期间,对症药物的减药治疗可以在有效控制患者鼻炎的同时减少药物用量,提高患者依从性。但该种下调策略可能更适用于轻症患者,重症患者需慎重减药。

Objective:There is no standard algorithm for the modulation of pharmacologic treatment of allergic rhinitis.This study aimed to recruited allergic rhinitis patients caused by cypress pollens,and compare the step-down pharmacotherapy guided by pollen count and the maintaining therapy which keeps the previous medicine dose when the pollen count decreased.Method:This was a randomized,open-labelled,parallel control study.During the period after the pollen peak when the cypress pollen count decreased and stayed at a low level,allergic rhinitis patients were randomly divided into two groups.In the step-down group(n=67)medicine dose was reduced,while the maintaining group(n=68)kept taking the same dose as in the peak season.The rhinitis symptom score and medicine score of these two groups were recorded and compared.Result:The daily rhinitis symptom score of the step-down group showed no significant difference with the symptom score of the maintaining group,2.45±0.32 vs 2.43±0.41,P=0.788.But the medicine score of step-down group(3.67±0.98)was significantly lower than that of maintaining group(4.78±0.70),P<0.001.The compliance of step-down group(80.6%)was also better than maintaining group(60.3%),P=0.014.However,in the subgroup of patients with severe rhinitis symptoms,the symptoms of patients taking step-down therapy tended to be more severe than those maintaining the same dose.Conclusion:During the later period of the pollen season when the pollen count was relatively low,the step-down pharmacotherapy guided by pollen count could reduce the medication use,increase the compliance of patients while controlling their rhinitis symptoms effectively.But this strategy might be more suitable for patients with milder symptoms,the severe rhinitis sufferers should be cautious before reducing their medicine dose.