舌下含服粉尘螨滴剂治疗螨过敏性哮喘患儿的长期疗效

Long-term efficacy of sublingual immunotherapy with Dermatophagoides Farianae Drops in children with allergic asthma sensitized to dust mites

目的观察舌下特异性免疫治疗（subl ingualimmunotherapy，SLIT）在治疗期间及停药后1年对过敏性哮喘患儿的疗效。方法开放、回顾性研究。选择2009年5月至8月在南京医科大学附属南京儿童医院呼吸科就诊的主要对尘螨[粉尘螨和（或）户尘螨]过敏的轻、中度过敏性哮喘患儿80例，年龄4～14岁。所有患儿人组时（基线）均已接受抗哮喘药物治疗3个月。分组：（1）SLIT组39例，抗哮喘药物治疗的同时，采用SLIT2年，停止SLIT后再随访1年，共随访3年；（2）药物组4l例，仅采用抗哮喘药物治疗，随访3年。比较SLIT组和药物组在基线，治疗第2年结束时、第3年结束时（停止SLIT1年时）的哮喘症状评分、用药评分、停药例数、人组前1年、治疗第3年哮喘急性发作频率。结果（1）症状评分：SLIT2年结束时，SLIT组患儿哮喘日间症状评分低于药物组（0．18±0．06，0．93±0．12，Z=-4．873，P〈0．05），夜间症状评分差异无统计学意义；停止SLIT1年时，SLIT组患儿哮喘日间症状评分（0．18±0．06）和夜间症状评分（0．05±0．04）均低于药物组（日间1．46±0．72，夜间0．66±0．14，Z=-5．082，-4．019，P均〈0．05）。（2）用药评分和停药例数：SLIT2年结束时和停止SLIT1年时，SLIT组用药评分（0．31±0．07和0．17±0．06）均低于药物组（0．75±0．12和0．87±0．17，Z=-2．813，-4．106，P均〈0．05）；SLIT组停药例数（20例，29例）均多于药物组（10例，13例）（X2=6．167，14．581，P均〈0．05）。（3）入组前1年两组哮喘急性发作频率差异无统计学意义，治疗第3年（停止SLIT1年）间，SLIT组哮喘急性发作频率小于药物组（0．69±1．20，1．20±1．44，Z=-1．968，P〈0．05）。结论SLIT能明显改善哮喘的症状，减少药物使用和哮喘急性发作，同时在停止SLIT后1年仍能保持疗效。

Objective To observe the efficacy of sublingual immunotherapy （SLIT） in children with allergic asthma during the treatment and 1 year after the treatment. Method This is an open and retrospective study; 80 children with mild-moderate allergic asthma between 4 and 14 years of age were chosen from the Department of Respiratory Medicine, Nanjing Children＇s Hospital Affiliated to Nanjing Medical University from May to August, 2009. All children were sensitized to Dermatophagoides Farianae and/or Dermatophagoides Pteronyssinus and have received anti-asthma drug therapy for 3 months （baseline）. Thirty-nine children in SLIT group underwent 2-year SLIT and combined with anti-asthma drug, these children were then followed up for 1 year. Forty-one children in drug group only received anti-asthma drug and were followed up for 3 years. The scores of asthma symptom, scores of asthma medication and the number of discontinuation of anti-asthma drug were compared between the SLIT group and drug group for the baseline,end of the 2rid year and 3rd year treatment. The frequency of acute attack of asthma was also compared between the two groups for 1 year before the treatment and the 3rd year treatment. Result （ 1 ） At baseline,the asthma symptom scores,the medication scores and the frequency of acute attack of asthma in 1 year before the treatment of the two groups showed no significant difference. （ 2 ） After 2-year SLIT, the daytime asthma symptom scores of SLIT group were lower than the drug group （0. 18 -＋0.06,0. 93 -＋0. 12, Z = - 4. 873, P 〈 0. 05 ） , the night asthma symptom scores of the two groups showed no significant difference. One year after SLIT,the daytime and night asthma symptom scores of SLIT group were both lower than those of the drug group （ daytime SLIT group vs. Drug group ： 0. 18 -＋ 0. 06 vs. 1.46 ＋ 0. 72, Z = - 5. 082, P 〈 0.05 ; night SLIT group vs. Drug group ：0.05 ＋ 0.04 vs. O. 66 ＋ 0.14,Z = - 4.019, P 〈 0.05 ）. （3） At the end of SLIT and 1 year after SLIT, the medication scores of SLIT group were both lower than those of the drug group （End of SLIT SLIT group vs. Drug group：0. 31 -＋0. 07 vs. O. 75 ＋0. 12,Z = -2. 813 ,P 〈 0. 05 ; 1 year after SLIT SLIT group vs. Drug group ：0. 17 -＋ 0. 06 vs. O. 87 ＋- 0. 17, Z = - 4. 106, P 〈 0. 05 ）, the number of discontinuation of anti-asthma drug of SLIT group were both more than the drug group （ End of SLIT SLIT group vs. Drug group ： 20 vs. 10, X2 = 6. 167, P 〈 0. 05 ; 1 year after SLIT SLIT group vs. Drug group ：29 vs. 13, x2 = 14. 581, P 〈 0.05 ）. （4） In the 3rd year, the frequency of acute attack of asthma in SLIT group was significantly lower than that of drug group （0. 69 ＋ 1.20, 1.20 ＋ 1.44, Z = - 1. 968, P 〈 0. 05）. Conclusion SLIT can significantly improve the symptoms of asthma, reduce the use of anti-asthma drug and reduce the frequency of the acute attack of asthma. Meanwhile, the efficacy could still maintain 1 year after the SLIT treatment.