舌下特异性免疫治疗不同年龄组儿童变应性鼻炎的长期疗效及安全性观察

Efficacy and safety of sublingual immunotherapy of allergic rhinitis in children between 4 and 5 yearsage group and 11 and 12 years age group

目的评估舌下特异性免疫治疗儿童变应性鼻炎（allergicrhinitis，AR）不同年龄组（4—5岁组和11—12岁组）的疗效差异。方法收集能坚持治疗并定期随访的62例4—5岁年龄组（低龄组）和71例11～12岁年龄组（高龄组）患儿的资料，所有患儿均为对尘螨过敏的AR患者，随机分为舌下免疫治疗（sublingual immunotherapy，SLIT）＋药物组及单纯药物治疗组。SLIT＋药物组以标准化粉尘螨滴剂舌下含服免疫治疗，辅以对症药物治疗；单纯药物治疗组以糠酸莫米松鼻喷剂及氯雷他定片对症治疗。每3个月随访1次共随访2年。观察并记录治疗后症状得分、药物评分。治疗2年后综合评价患者主观症状，用药及治疗满意度情况。停药2年后再次综合评价患者主观症状，用药及治疗满意度情况。结果SLIT＋药物组与单纯药物治疗组相比，其2年后症状得分[分别为（1．13±1．05）、（4．68±3．09）分]，药物评分[分别为（0．07±0．04）、（0．36±0．25）分]改善情况均明显高于单纯药物治疗组（t值分别为-8．43、-8．87，P值均〈0．01）；患者主观症状评价，用药及治疗满意度亦明显高于单纯药物治疗组。低龄组主观症状评价，用药及治疗满意度与高龄组相同，停药2年后，高龄组主观症状评价，用药及治疗满意度优于低龄组。结论尘螨过敏的不同年龄患儿采用SLIT进行2年特异性免疫治疗均能获得良好效果，但停药2年后，高龄组在症状得分、药物评分、主观满意度方面优于低龄组。

Objective To evaluate the efficacy and safety of the sublingual immunotherapy with Dermatophagoides fannae drops on children with allergic rhinitis of different age groups （4 - 5 years old group and 11 - 12 years old group）. Methods Sixty-two children aged 4 -5 years, and 71 children aged 11 - 12 years, who suffered from dust mite induced allergic rhinitis, was randomly divided into the sublingual immunotherapy （SLIT） ＋ drug group and drug group. SLIT ＋ drug group was treated with a standardized sublingual immunotherapy drops of Dermatophagoides fannae and combined with symptomatic therapy, drug group was treated with mometasone furoate nasal spray and desloratadine tablets as symptomatic treatment. These children were followed up for 2 years with one visit in every 3 months, then visited at the end of the study and 2-years after the treatment ended. Symptom scores and medication scores were recorded at each visit. Comprehensive evaluation of symptoms, medication, and patients＇ degree of satisfaction were used. Results Two years after SLIT finished, symptom scores （ SLIT ＋ drug group ： 1.13 ± 1.05 ; drug group ： 4. 68 ± 3.09 ）, medication scores （ SLIT ＋ drug group ： 0.07 ± 0.04 ; drug group ： 0. 36 ± 0. 25） of SLIT ＋ drug group were significantly lower than those in drug group （ t value were - 8. 43, - 8. 87, respectively, all P 〈 O. 01 ）. Also, the subjective assessment of patients＇ symptoms, medication, and treatment satisfaction in SLIT ＋ drug group was significantly lower than those in drug group. Subjective assessment symptoms, medication, and treatment satisfaction in age group 4 - 5 was the same as in age group 11 - 12. After SLIT ended for 2 years, subjective assessment and treatment satisfaction in age 11 - 12group was better than those in age 4 -5 group in medication score. Conclusions SLIT demonstrated clinical improvement in children of different ages during 2 years treatment. Two years after withdrawal, the symptom scores, medication score and subjective satisfaction in 11 years old group are better than those in 4 - 5 years old group.