变应性鼻炎屋尘螨变应原集群免疫治疗与常规免疫治疗的对照研究

Comparative study on cluster and conventional immunotherapy with Dermatophagoides pteronyssinus in patients with allergic rhinitis

目的 对比变应性鼻炎患者接受集群免疫治疗和常规免疫治疗的疗效及安全性.方法 对80例屋尘螨过敏变应性鼻炎患者随机分组,一组接受集群免疫治疗,每周就诊1次,每次就诊注射2～3次,6周后达到维持剂量.另一组接受常规免疫治疗,每周就诊1次,每次就诊注射1次,14周后达到维持剂量.达维持剂量后两组病例继续以维持剂量治疗1年,治疗期间通过症状评分、药物评分,血清屋尘螨特异性IgG4和不良反应发生情况评价免疫治疗的疗效和安全性.结果 接受集群免疫治疗的患者更早出现症状评分的改善和对症药物使用的减少（第6周）,更早出现血清屋尘螨特异性IgG4的升高（第6周）.在剂量递增阶段,集群免疫治疗组进行534次注射,有3例出现6次全身不良反应,全身不良反应发生率为1.12％（6/534）；常规免疫治疗组591次注射,共3例出现5次全身反应,全身性不良反应的发生率为0.85％（5/591）,两组不良反应发生率差异无统计学意义（x2=0.333,P＞0.05）.结论 对治疗变应性鼻炎而言,集群免疫治疗与常规免疫治疗相比,可以更早地实现症状的改善和药物使用的减少,且具有同样的安全性,是一种有效、安全的治疗方法.

Objective To compare the efficacy and safety of a 6-week cluster schedule of specific immunotherapy with that of a 14-week conventional schedule for the treatment of subjects with persistent allergic rhinitis（AR）.Methods The trial was a prospective and randomized study involving 80 patients with persistent AR,who were allergic to Dermatophagoides pteronyssinus.While 40 patients were randomly assigned to the cluster schedule reaching the maintenance dose within 6 weeks,the other 40 patients were randomly assigned to the conventional schedule reaching the maintenance dose within 14 weeks.Symptom scores and medication scores were used to evaluate the clinical efficacy.Serum specific IgG4 level was examined to mark immunologic change,adverse reactions were recorded during the treatment.Results Cluster group achieved clinical efficacy（reducing symptom scores and medication score）and increasing serum specific IgG4 sooner（after 6 weeks treatment）.During the incremental dose phase,there were 6 systemic adverse reactions（1.12% of all injection）in 3 patients in cluster group and there were 5 systemic adverse reactions（0.85% of all injection）in 3 patients in conventional group.No severe systemic reactions occurred in both group.There was no difference between the 2 groups in frequency or type of systemic reaction（x2 =0.333,P 〉 0.05）.Conclusion The cluster schedule is a safe alternative to the conventional schedule with the advantage of achieving clinical effecacy sooner.