自体全血注射治疗对自体血清皮肤试验阳性的慢性自发性荨麻疹的疗效观察

Autologous whole blood injections to patients with chronic spontaneous urticaria and positive autologons serum skin test： an efficacy evaluation

目的评价自体全血注射治疗对自体血清皮肤试验（ASST）阳性的慢性自发性荨麻疹的疗效。方法对慢性自发性荨麻疹患者在临床病史评估的基础上进行皮肤点刺试验（sPT）及ASST；选择ASST阳性且常见变应原皮肤点刺试验阴性的100例患者，随机分为治疗组（60例）和对照组（40例）。两组均给予规则口服氯雷他定片，并尝试逐渐减量至可控制症状的最小服药量；治疗组同时接受每周1次的自体全血注射治疗，连续治疗12周。在治疗后的第3和6个月评价所有患者荨麻疹疾病活动程度（UAS）、皮肤病生活质量指数（DLQI）和每月抗组胺药物总服用量。采用SPSS13．0统计软件，对治疗前后UAS、DLQI、累计抗组胺药物总量以及治疗前后ASST诱导的风团／红晕直径行t检验，组间疗效比较采用秩和检验。结果治疗组在治疗前（基线）和治疗后第3个月、第6个月时的UAS分别为5．73±0．51、1．57±1．42、0．69±0．92；对照组分别5．32±0．79、3．65±1．53、2．65±1．61，经秩和检验，两组在治疗前UAS评分差异无统计学意义；与基线相比较，治疗后第3和第6个月，两组UAS均有不同程度改善。治疗3个月后，治疗组和对照组UAS改善程度分别为69％和35％；治疗6个月后分别为81％和53％，两组差异均有统计学意义（P〈0．05）。治疗组抗组胺药物平均月需量（第3个月平均8．63片，第6个月平均3．83片）均较对照组显著减少（分别为16．85片和15．27片）。结论自体全血注射联合抗组胺药治疗可有效改善ASST阳性慢性自发性荨麻疹患者的UAS和DLQI，且可显著减少患者对抗组胺药物的总需求量。

Objective To evaluate the efficacy of autologous whole blood injections in patients with chronic spontaneous urticaria and positive autologous serum skin test （ASST）. Methods After assessment of clinical history, patients with chronic spontaneous urticaria underwent skin prick test （SPT） and ASST. Then, 100 patients with positive ASST but negative SPT for common allergens were randomly classified into treatment group （n=60） and control group （n = 40）. Oral loratadine was given to all the patients with a gradual taper-ing to the least maintenance dose. Patients in the treatment group were also injected with autologous whole blood once a week for 12 times. Patients were evaluated by urticaria activity score （UAS） and dermatology life quality index （DLQI） at the baseline, the end of the 3rd and 6th month after the initial treatment. The total amount of antihistamines required for the control of urticaria every month was calculated. The UAS, DLQI, accumulative amount of administrated antihistamines, and the diameter of wheal/flush induced by autologous serum were compared by t test before and after the treatment, and the efficacy was compared by rank sum test between the two groups. Results No significant difference was observed between the control and treatment group in UAS at the baseline （5.73±0.51 vs. 5.32 ±0.79, P〉 0.05）. The UAS reached 1.57±1.42 and 0.69±0.92 with a decrease rate of 69% and 81% in the treatment group, and 3.65 ±1.53 and 2.65 ±1.61 with a decrease rate of 35% and 53% in the control group, respectively at the end of the 3rd and 6th month, and statistical difference was observed for the decrease in both groups at the two time points （all P 〈 0.05）. The total amount of antihistamines required for the control of urticaria per month averaged 8.63 pills and 3.83 pills respectively in the treatment group after 3 and 6 months of treatment, significantly less than that in the control group （16.85 and 15.27 pills, respectively）. Conclusions The combination of oral antihistamine and autologous whole blood injections can not only reduce disease activity and improve patients＇ quality of life, but also decrease the total amount of antihistamines required for the control of urticaria.