舌下特异性免疫治疗对尘螨过敏性哮喘儿童的作用

Efficacy of sublingual immunotherapy in children with dust mite allergic asthma

目的观察舌下特异性免疫治疗(sublingual immunotherapy,SLIT)联合吸入糖皮质激素(inhaled corticosteroids,ICS)与单独ICS治疗尘螨过敏轻、中度哮喘儿童的临床疗效,为哮喘的联合治疗提供更多的选择方案。方法对尘螨过敏的轻、中度哮喘患儿32例随机分为两组:SLIT组(SLIT联合ICS治疗,18例)和对照组(单独ICS治疗,14例)。两组共30例完成为期1年的临床观察。比较两组患儿ICS给药总量、哮喘日间和夜间症状评分、皮肤点刺试验、肺功能、血清sIgE和sIgG4值、VAS评分(visual analog scale)的差异。结果 SLIT组在1年治疗结束ICS给药总量较对照组显著减少;与对照组相比,SLIT组的日、夜间哮喘症状评分显著降低,肺功能FEF25-75%值显著增加,sIgE值及VAS评分降低,差异有统计学意义(P<0.05);皮肤点刺反应计分、FEV1及sIgG4值两组差异无统计学意义(P>0.05)。在整个随访期两组均无严重不良反应。结论 SLIT联合ICS治疗在改善尘螨致敏哮喘患儿的日、夜间哮喘症状、肺功能及VAS评分方面的疗效优于单独使用ICS治疗。

Objective To compare the efficacy of sublingual immunotherapy（SLIT） combined with inhaled corticosteroids（ICS） versus ICS alone in children with mild and moderate dust mite allergic asthma.Methods Thirty-two children with mild and moderate dust mite allergic asthma were randomly divided into two groups： SLIT＋ICS（n=18） and ICS alone（n=14）.A total of 30 children completed the one year clinical observation.The amount of ICS administration,the day and night symptom scores,skin-prick test and pulmonary function test results,serum specific immunoglobulin E（sIgE） and G4（sIgG4） levels and visual analog scale（VAS） scores were compared between the two groups.Results By the end of one year the SLIT＋ICS group had significantly decreased amount of ICS administration than the ICS alone group.Compared with the ICS alone group,the day and night symptom scores decreased,FEF25-75% increased significantly,and serum sIgE levels and VAS scores were significantly reduced in the SLIT＋ICS group.There were no statistical differences in the skin-prick test results,and FEV1 and sIgG4 levels between the two groups.No severe adverse events occurred in both groups during the follow-up period.Conclusions SLIT combined with ICS may produce a better efficacy than ICS alone in the improvement of day and night symptoms,pulmonary function and VAS scores in children with dust mite-allergic asthma.