淋巴免疫治疗特应性皮炎30例疗效观察

Intralymphatic Immunotherapy for Patients with Atopic Dermatitis

目的探讨过敏原淋巴免疫治疗特应性皮炎的临床疗效和安全性。方法 60例对屋尘螨过敏的特应性皮炎患者,随机分为治疗组和对照组,每组各30例,对照组给予0.1%糠酸莫米松乳膏(Mometasone furoate cream)、1.2%维生素B_6软膏(Vitamin B_6 ointment)、氯雷他定片(Loratadine tablets)、富马酸酮替芬片(Ketotifen fumarate tablets)等基础药物治疗,治疗组在上述药物治疗的基础上,超声引导下分别于0周、4周、8周、12周、16周、20周行腹股沟淋巴结内注射屋尘螨过敏原制剂,除0周用药剂量为100SQ-U外,其余5次剂量均为1 000SQ-U。治疗前后两组患者分别行血清屋尘螨特异性免疫球蛋白E(sIgE)检测、特应性皮炎评分(SCORAD),用药评分,并记录患者疗程中的不良反应。结果治疗组患者治疗后4,8,12,16,20周SCORAD分别为(31.70±3.31)、(28.97±2.93)、(24.37±2.71)、(22.07±2.56)、(18.60±2.18),低于治疗前(0)周(33.03±4.92),差异有统计学意义(P<0.01);12,16,20周SCORAD均低于对照组同时间SCORAD[(27.40±3.77)、(26.50±3.15)、(23.67±2.71)],差异有统计学意义(P<0.01)。治疗组治疗后药物评分(1.61±0.98)和血清屋尘螨sIgE浓度(4.44±3.68)kU/L明显低于治疗前[(4.63±1.54)、(8.94±5.86)kU/L],且明显低于对照组[(2.42±0.60)、(7.88±4.50)kU/L],差异均有统计学意义(P<0.01)。30例淋巴免疫治疗患者进行了180次浅表淋巴结注射,无局部不良反应和全身不良反应发生。结论过敏原淋巴免疫治疗特应性皮炎不仅临床疗效显著,而且大大缩短了疗程,减少了过敏原剂量、注射次数和不良反应的发生,为安全、有效的病因治疗方法。

Objective To investigate the clinical efficacy and safety of intralymphatic immunotherapy with allergen vac- cine for atopic dermatitis. Methods Sixty patients with atopic dermatitis who were allergic to dermatopha- guides pteronyssinus were randomly divided into intralymphatic immunotherapy group and control group, 30 cases in each group. Patients in control group were treated with essential drugs while patients in treatment group were given essential drugs and 6 ultrasound-guided injection of standardized aluminum-adsorbed der- matophagoides pteronyssinus allergen vaccine（ Alutard ALK, Denmark） in superficial inguinal lymph nodes once every 4 week. The levels of serum sIgE for dermatophagoides pteronyssinus and SCORADs before and after treatment were used to evaluate clinical efficacy. Adverse reactions were also recorded. Results In comparison with control group, SCORADs were significantly lower in intralymphatic immunotherapy group at 12 weeks after allergen injection. （P 〈 0.01 ）. The medication scores and the levels of serum sIgE for derma2 tophagoides pteronyssinus were lower in intralymphatic immunotherapy than in controls at 20 weeks after al- lergen injection. Thirty patients receiving 180 intralymphatic injections had no local and systemic adverse re- action. Conclusion Intralymphatic immunotherapy with standardized dermatophagoides pteronyssinus aller- gen vaccine is an effective and safe regimen for atopic dermatitis.