过敏性哮喘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 dermatophagoides pteronyssinus allergen cluster and conventional immunotherapy in patients with allergic asthma

目的对比过敏性哮喘集群免疫治疗与常规免疫治疗的疗效及安全性。方法 74例屋尘螨过敏性哮喘患者随机均分为集群组和常规组,采用标准化屋尘螨变应原进行免疫治疗,集群组7周、常规组16周达到维持量,随后2组每4周1次皮下注射变应原维持治疗1年。治疗前后分别检测哮喘症状及用药评分、FEV1%、FEV1/FVC、PEF%和血清屋尘螨特异性免疫球蛋白E(sIgE),记录治疗中的不良反应。结果集群组36例,常规组29例完成了治疗,集群组患者的依从性显著高于常规组。治疗后2组患者哮喘评分、用药评分和血清屋尘螨sIgE水平均显著降低(P<0.01),FEV1%、FEV1/FVC和PEF%均显著增高(P<0.01),治疗后2组间均无显著性差异(P>0.05)。集群组3例在8次皮下注射时发生全身不良反应,常规组2例在6次注射时发生全身不良反应,2组均无严重不良反应,组间不良反应率及类型均无显著性差异。结论标准化屋尘螨变应原集群免疫治疗哮喘依从性强、安全、有效。

To compare the efficacy and safety between cluster immunotherapy and conventional immunotherapy in patients with allergic asthma,who were sensitized to dermatophagoides pteronyssinus,we administrated standardized aluminum-adsorbed dermatophagoides pteronyssinus allergen vaccine according to a 7-week cluster regimen or 16-week conventional regimen during the incremental-dose phase,thereafter,all patients were administered allergen vaccine by 4-week interval in maintenance treatment phase.The efficacy and safety were assessed in terms of symptom scores,including FEV1%,FEV1/FVC,PEF%,medication scores and systemic adverse events.The results show that 36 patients in cluster group and 29 patients in conventional group completed the study,so the compliances of cluster group is better than conventional group（P 0.01）.We found that cluster and conventional immunotherapy significantly reduced symptom score and medication score and serum specific IgE（P 0.01）,while FEV1%,FEV1/FVC,PEF% significantly increased in the 2 groups（P 0.01）.The results also showed that 8 systemic adverse reactions in 3 patients occurred in cluster group,while 6 systemic adverse reactions in 2 patients in conventional group,and there was no severe systemic reaction occurred in both group.Thus we conclude that cluster immunotherapy with standardized dermatophagoides pteronyssinus allergen vaccine for patients with asthma increases patient compliance,and cluster immunotherapy is effective and safe.