舌下含服免疫治疗依从性分析及对策

Compliance analysis of sublingual immunotherapy and countermeasures

目的:探讨临床上舌下含服免疫治疗脱落原因、规范治疗及相应对策。方法:230例尘螨过敏为主的变应性鼻炎患者,均行舌下含服免疫治疗,按入组先后时间分为一般治疗组(104例)和干预治疗组(126例),前者按一般诊疗常规进行,后者采用系列措施加强患者管理及医患沟通,随访2组脱落及治疗规范情况,并分析其原因。结果:一般治疗组1年内脱落率为45.19%,干预治疗组为18.25%,治疗2个月内的脱落率最高。脱落原因中前3位为疗效不佳、时间(地域)原因及不良反应。一般治疗组中不规范治疗即漏滴者多于干预治疗组,漏滴原因中前3位为遗忘、感冒咳嗽停用、药物用完后中断。结论:舌下含服免疫治疗1年内脱落率高,经干预及加强患者管理后可显著降低脱落率,增强治疗的规范性和依从性。

Objective：To explore the compliance of sublingual immunotherapy（SLIT） for allergic rhinitis（AR） in real life.Method：Two hundred and thirty AR patients sensitive to house dust mites were divided into general treatment group and intervention treatment group. Both groups followed a SLIT schedule once daily. The general treatment group was in accordance with the normal clinical procedure. The intervention treatment group was given a systemic patient management including patients education of AR, common problems of SLIT in real life, regular telephone interviews and feedback, termly physician- patient communication. The compliance of the two groups was recorded and analyzed.Result：Dropouts in the first year were 47（45.19%） of the general treatment group and 23（18.25%） of the intervention treatment group respectively. More than half dropouts were happened at the first two months. Three major reasons of dropouts were no improvement of symptoms, no further consultation because of too far away or too busy and side effects. The occurrence of omission during SLIT was more frequently in general treatment group than intervention treatment group. Three major reasons of omission were forgetting, cold or cough, using up of the SLIT reagent before next consultation.Conclusion：Percentage of dropouts and omission in normal SLIT patients was comparatively high, which can be significantly improved by systemic patient managements.