尘螨变应原疫苗对变态反应性哮喘的脱敏作用

Desensitization Therapy for Allergic Asthma with Dust Acarid Allergen Vaccine

目的 :评价尘螨变应原疫苗对变态反应性哮喘患者进行脱敏治疗的疗效及安全性。方法 :根据变态原皮试结果和血清sIgE水平选择脱敏治疗起始浓度和剂量 ,进行常规脱敏治疗及维持脱敏治疗 ,初始脱敏浓度 5或 5 0TU·mL 1 和剂量 0 .0 5mL等 ,以后每次注射都逐步增加剂量或浓度 ,直至患者达到最大耐受浓度 5 0 0 0TU·mL 1 和剂量 0 .8～ 1.0mL ,再以此浓度和剂量行维持脱敏治疗 ,总疗程 15～ 2 1个月。比较 15 2例患者在尘螨变应原疫苗 [阿罗格 (r) >NHD(r) ]脱敏治疗前后的症状积分、肺功能及血清特异性IgE及IL 4水平。结果 :166例患者中有 15 2例坚持完成脱敏治疗 ,治疗前后的症状积分分别为 (9.4± 2 .4)及 (3 .2± 1.7)分 ,肺功能FEV1 分别为 (1.98± 0 .72 )及 (2 .3 7± 0 .79) ,PEFR分别为 (6.3± 2 .1)及 (7.4± 2 .5 )L·s 1 ,血清尘螨特异性IgE水平分别为 (15 .3± 2 .3 )及 (3 .2± 1.4)KUA·L 1 ,IL 4水平为(5 3 4.7± 78.6)及 (3 16.3± 72 .7)ng·mL 1 ,均差异有极显著性 (P <0 .0 1)。 15 2例中有 62例出现局部不良反应 ,未出现全身不良反应。结论 :用尘螨变应原疫苗对尘螨致变态反应性哮喘患者进行尘螨特异性脱敏治疗是一种有效、安全的治疗方法。

Objective:To assess the therapeutic effectiveness and safety rate of desensitization therapy with the dust acarid allergen vaccine for patients with dust acarid allergic asthma. Methods:166 patients with dust acarid allergic asthma were subjected to the study. The initial concentration and dosis of the vaccine were determined according to the result of the allergen skin test and level of serum IgE. Routine as well as maintaining desensctization therapy was carried out. The initial vaccine concentration and dosis ranged from 5 TU·mL -1 to 50 TU·mL -1. The dosis or concentration of the vaccine was gradually increased with every succeeding injection until the maximal tolerable concentration 5 000 TU·mL -1 and dosis 0.8-1.0 mL were reached. This concentration and dosis were maintained throughout the total course of desensitization therapy lasting 15-21 months. The symptom integral,pulmonary function,specific serum IgE and IL-4 levels of 152 patients before and after the desensitization therapy were compared. Results:152 of the 166 patients insisted on to complete the course of treatment. Before and after the treatment,the symptom integral was (9.4±2.4) and (3.2±1.7),the pulmonary function force expiratory volume in one second(FEV 1) was (1.98±0.72) and (2.37±0.79) L,peak expiratory flow rate (PEFR) was (6.3±2.1) and (7.4±2.5) L·s -1,level of specific acarid serum IgE was (15.3±2.3) and (3.2±1.4) KUA·L -1,and the level of serum IL-4 was (534.7±78.6)and (316.3±72.7) ng·mL -1, respectively. The differences were all highly significant( P <0.01). Only 62 of the 152 patients showed local adverse reactions,no systemic ones were encountered. Conclusion:Desensitization therapy with dust acarid allergen vaccine was shown to be an effective and safe method for the treatment of dust acarid allergic asthma.