哮喘儿童中止皮下特异性免疫治疗原因分析

Causes of stopping subcutaneous specific immunotherapy in asthmatic children

目的通过分析哮喘儿童中止皮下特异性免疫治疗(subcutaneous specific immunotherapy,SCIT)的原因,探讨如何提高SCIT依从性。方法对2005年6月至2010年10月期间接受SCIT,但未完成3年疗程的哮喘患儿进行电话随访,了解中止SCIT原因,并对其进行分析。结果共616例哮喘患儿接受SCIT,322例(52.3%)未完成3年疗程,其中127例(39.4%)配合完成电话随访。127例中,53例(41.7%)认为效果差而中止,29例(22.8%)因哮喘症状缓解而中止,12例(9.4%)因价格贵、10例(7.9%)因过程繁琐、10例(7.9%)因不良反应,9例(7.1%)因路程远、4例(3.1%)因没时间治疗而中止。127例患儿中,SCIT治疗的第一年内中止例数最多,占69例(54.3%),第二年内28例(22.0%),第三年内30例(23.6%)。目前,该127例患儿中,有85例(66.9%)达控制水平。中止SCIT后规律吸入糖皮质激素(ICS)组与不规律ICS组的哮喘控制水平差异有统计学意义(P<0.01)。结论哮喘儿童中止SCIT的主要原因有疗效差、症状缓解、价格贵、不良反应等。让患儿及其家长了解SCIT疗程及其起效较慢的特点,鼓励采用客观指标对病情进行评估,积极防治不良反应,对提高SCIT的依从性有重要意义。

Objective To improve the compliance with subcutaneous specific immunotherapy（SCIT） by analyzing the causes of stopping SCIT in asthmatic children.Methods A telephone follow-up was conducted in the asthmatic children who received SCIT but did not finished the 3-year course of treatment from June 2005 to October 2010,so as to analyze the causes of stopping SCIT.Results A total of 616 asthmatic children received SCIT,and 322（52.2%） of them stopped SCIT.A total of 127 cases（39.4%） of the 322 children received telephone follow-up.In the 127 children,53（41.8%） stopped the SCIT for the reason of bad effecacy,29（22.8%） for remission of asthma,12（9.4%） for expensive fees,10（7.9%） for complex process of treatment,10（7.9%） for adverse reaction,9（7.1%） for long distance from the hospital,and 4（3.1%） for having no time for treatment.And 69（54.3%） of them stopped SCIT in the first year,28（22.1%） in the second year,and 30（23.6%） in the third year.Currently,85 cases（66.9%） of the 127 asthmatic children were up to the control level,and the other 42 cases were not.There was significant difference in the control level of asthma berween the group receiving treatment with regular inhaled corticosteroids（ICS） and the group receiving treatment with irregular ICS（P0.01）.Conclusions Bad efficacy,remission of asthma,expensive fees,complex process of treatment,and adverse reaction are the main reasons contributing to the stop of SCIT in asthmatic children.To improve the compliance with SCIT,It is important to make the patients and their parents understand the long treatment course and slow effect of SCIT,encourage them to use objective indices for evaluating the state of asthma,and effectively prevent and treat the adverse reactions.