舌下含服和皮下注射免疫治疗儿童变应性鼻炎的临床疗效观察

Effect comparison between subcutaneous immunotherapy and sublingual immunotherapy for pediatric allergic rhinitis

目的比较舌下免疫治疗(sublingual immunotherapy,SLIT)、皮下免疫治疗(subcutaneous immunotherapy,SCIT)及单纯药物治疗儿童变应性鼻炎(allergic rhinitis,AR)的临床疗效并初步探索其免疫机制。方法收集能坚持治疗并定期随访的螨过敏变应性鼻炎儿童90例,按数字随机法分成3组,SLIT组(30例)、SCIT组(30例)和单纯药物治疗组(30例)。通过症状评分、药物评分和视觉模拟评分量表(VAS)评价各组治疗后临床疗效,并检测治疗前后血清中总IgE、螨特异性IgE、特异性IgG4的含量。结果经过2年的治疗,SLIT组和SCIT组患儿的症状评分、药物评分及VAS较治疗前均明显减少且差异具有统计学意义(P均<0.01),与药物治疗组相比差异具有统计学意义(P均<0.01)。两组免疫治疗组总IgE和螨特异性IgE水平未见明显改变,但血清中螨特异性IgG4水平明显升高(P<0.01)。结论相对于单纯药物治疗儿童AR,采用SLIT和SCIT治疗能够有效改善患儿的症状,减少药物使用,变应原特异性IgG4的增高可作为预测免疫治疗疗效的参考指标。

Objective To compare clinical efficacy of sublingual immunotherapy （SLIT） and subcutaneous immunotherapy （SCIT） for allergic rhinitis in children, and to study their immunological mechanisms. Methods 90 children with allergic rhinitis caused by Dermatophagoides pteronyssinas （ Der P ） were randomly allocated to SLIT （ n = 30 ） , SCIT （ n = 30 ） or pharmaeotherapy （ n = 30 ） . Symptom, medication and visual analogue scores （ VAS ） at the baseline and two years after treatment were recorded to evaluate the clinical efficacy. Meanwhile, their total IgE, Der p-specific IgE and IgG4 were measured. Results After two years of treatment, scores of symptom, medication and VAS got significant reduction in both SLIT and SCIT groups compared with those before treatment （ all P 〈 0.01 ）. The differences of their total IgE, Der p-specific IgE before and after treatment were statistically insignificant （ all P 〉 0.05 ） while those of Der p-specific IgG4 were significant （ both P 〈 0.01 ）. After treatment, the score differences between SLIT group and pharmacotherapy group, SCIT group and pharmacotherapy group were significant （ both P 〈 0. 01 ）. Conclusions Compared with pharmacotherapy, both SLIT and SCIT can get better symptoms improvement in pediatric allergic rhinitis caused by Der P and reduce the dose of drugs. Der p-specific IgG4 can be used as an immunological marker for efficacy prediction of immunotherapy.