舌下含服粉尘螨滴剂治疗儿童变应性鼻炎起效时间和疗效观察

Onset time and efficacy of sublingual immunotherapy with Dermatophagoides farinae drops in children with allergic rhinitis

目的 评价舌下含服标准化粉尘螨滴剂免疫治疗（sublingual immunotherapy,SLIT）尘螨引起的儿童变应性鼻炎（allergic rhinitis,AR）的起效时间和临床疗效.方法 回顾性分析143例接受舌下含服粉尘螨滴剂治疗（sublingual immunotherapy,SLIT）的中-重度持续性AR患儿的病例资料.其中100例完成24个月治疗且随访资料完整,将100例患儿按年龄分为4～8岁年龄组（低龄儿童组,52例）和9 ～14岁年龄组（大龄儿童组,48例）.采用前后自身对照的方法,分别在治疗前和治疗后1、2、3、6、12、24个月末评估每位患儿的鼻部症状评分（total nasal symptom score,TNSS）、药物评分（total medication score,TMS）和视觉模拟量表评分（visual analogue scale,VAS）的变化.采用SPSS 19.0软件对数据进行统计学分析.结果 与治疗前相比,两组患儿的TNSS、TMS和VAS在治疗后3个月均显著降低,差异有统计学意义（低龄儿童组：Z值分别为-3.843、-3.534、-3.940,大龄儿童组：Z值分别为-3.938、-3.405、-3.953,P值均＜0.05）;而低龄儿童组在治疗后2个月TNSS和VAS分别为（6.4±1.6）、（5.3±1.4）分,较治疗前的（8.6±1.2）、（7.9±1.6）分明显降低,差异有统计学意义（Z值分别为-3.843、-3.940,P值均＜0.05）.100例患儿中共5例（5％）出现局部不良反应,2例（2％）出现轻微全身不良反应,未出现严重全身不良反应.结论 舌下含服标准化粉尘螨滴剂是治疗尘螨引起的儿童中-重度持续性AR的一种安全有效的治疗方法,可在治疗3个月左右观察到疗效.

Objective To investigate the onset time and efficacy of sublingual immunotherapy （SLIT） with Dermatophagoides farinae drops in children with house dust mites （HDM）-induced allergic rhinitis （AR）.Methods One hundred and forty three children with perennial moderate to severe HDM-induced AR were treated by SLIT with standardized Dermatophagoides farinae extract.One hundred children who finally completed two years treatment were divided into two groups according to the age：younger children group （aged 4-8 years,n =52） and older children group （aged 9-14 years,n =48）.Respectively,Each children was assessed before and after 1 st,2nd,3rd,6th,12th,24th months of the treatment.Total nasal symptom score （TNSS）,total medication score （TMS） and visual analogue scale （VAS） were evaluated at each visit.All clinical data were analyzed retrospectively with the SPSS 19.0software.Results TNSS,TMS and VAS of two groups decreased significantly after three months of the treatment compared with before （younger children group：Z value was-3.843,-3.534,-3.940,older children group：Z value was-3.938,-3.405,-3.953,all P 〈 0.05）.TNSS and VAS of younger children group decreased significantly after two months of the treatment compared with before （6.4 ± 1.6,5.3 ±1.4vs8.6±1.2,7.9±1.6,Zvaluewas-3.843,-3.940,bothP〈0.05）.Five children （5%）experienced local adverse events and 2 children（2%） experienced mild systemic adverse events.No severe adverse events happened during the treatment.Conclusions SLIT with Dermatophagoides farinae drops is an efficient and safe treatment for children with HDM-induced AR.Its onset of action can be observed as early as 3 months after treatment.