舌下特异性免疫治疗儿童过敏性哮喘86例临床疗效观察

Efficacy of sublingual immunotherapy on children with asthma

目的:研究粉尘螨滴剂舌下特异性免疫(SLIT)治疗儿童哮喘的有效性。方法:将确诊为变态反应性哮喘且粉尘螨变应原皮肤点刺试验呈阳性反应86例患儿随机分为SLIT组(n=45)和常规治疗对照组(n=41)。常规治疗组按照儿童哮喘规范化治疗方案治疗,SLIT组在常规规范化治疗的基础上,加用舌下含服粉尘螨滴剂,观察两组治疗后哮喘临床症状改善情况。并分别于治疗前、后抽取患儿静脉血,分离血清,采用ELISA法测定白细胞介素-4(IL-4)及γ干扰素(IFN-γ)的血清含量。结果:经治疗24周后,SLIT组的症状评分降低值及临床有效率均明显高于常规治疗组,差异均有统计学意义(P<0.05);SLIT组部分患儿出现红肿瘙痒等局部反应,均于次日自行消失。与治疗前相比,对照组治疗后IL-4及IFN-γ血清含量比较,差异无统计学意义(P>0.05);而SLIT组经过SLIT治疗后,IL-4水平明显下降,IFN-γ水平明显上升,差异具有统计学意义(P<0.05);治疗后SLIT组较对照组IL-4水平下降,IFN-γ水平上升,差异均有统计学意义(P<0.05)。结论:粉尘螨滴剂舌下免疫能改善哮喘儿童的症状,纠正Th1/Th2的平衡,对儿童变态反应性哮喘具有良好的效果。

Objective：To explore the efficacy of specific sublingual immunotherapy （SLIT） with dermatophagoides farinage drops in treatment of asthma in children. Methods： A total of 86 asthma chil-dren with positive skin prick test responses to dermatophagoides farinage allergens were randomly divided into two groups. SLIT group （n=45）, which received specific sublingual immunotherapy with dermatoph- agoides farinage drops, and the control group （n=41） with standardized treatment. Asthma symptom was observed. The venous blood was extracted to detect IL-4 and IFN-γ level by ELISA before and after treat- ment. Results. Compared with the control group, SLIT group showed significant decrease in symptom scores （P〈0.05） and the clinical efficiency was significantly higher than the control group （P〈0.05） . After treatment, there was no significant difference in IL-4 and IFN-γ level in control group comparing with that before the treatment （P〉0.05）, while IL-4 was significantly decreased and IFN-γ was signifi- cantly increased （P〈0.05） in SLIT group. After treatment, IL-4 was significantly decreased and IFN-γ was significantly increased （P〈0.05） in SLIT group compared with control group. Conclusions. The spe- cific sublingual immunotherapy with dermatophagoides farinage drops can improve symptoms and regulate imbalance of Th1/Th2. It is effective treatment for children with asthma.