舌下含服尘螨滴剂治疗单一或多重过敏原儿童变应性鼻炎的疗效观察

Effect of sublingual dust mite drops on single or multiple allergens allergic rhinitis in children

目的:评估标准化尘螨滴剂舌下特异性免疫治疗(SLIT)对儿童变应性鼻炎的疗效。方法:回顾性分析174例接受标准化粉尘螨滴剂进行SLIT 2年的患儿。按变应原种类分为单一尘螨过敏组(61例)和尘螨合并其他过敏组(113例)。通过比较治疗前后的症状评分、药物评分和炎症因子检测,进行疗效分析。结果:(1)治疗前和治疗2年后患儿的症状评分:单一尘螨过敏组为(11.27±1.46)分和(3.48±1.50)分;尘螨合并其他过敏组为(11.54±1.50)分和(3.59±1.56)分;组内比较差异有统计学意义(P<0.01)。2组间症状评分,单一尘螨过敏组为(7.68±3.23)分,尘螨合并其他过敏组为(8.14±2.56)分,组间症状评分无明显差异(P>0.05)。(2)2组患儿治疗前后药物评分:单一尘螨过敏组为(1.67±0.43)分和(0.52±0.40)分,尘螨合并其他过敏组为(1.64±0.44)分和(0.55±0.41)分,组内比较差异有统计学意义(P<0.01);2组间药物评分单一尘螨过敏组为(1.16±0.61)分,尘螨合并其他过敏组为(1.28±0.55)分,组间症状评分差异无统计学意义(P>0.05)。(3)治疗后血清特异性IgG4均有增高(P<0.01)。(4)免疫治疗后降低了IL4、IL17α的高表达;升高了IL2、TGF-β1的低表达(P<0.05)。结论:尘螨SLIT可以明显改善单一尘螨过敏和尘螨合并其他过敏患儿的鼻部症状,减少对症药物的使用,且2组疗效相当。尘螨SLIT不仅可以用于治疗单一尘螨过敏的患儿,也可以用于治疗尘螨合并其他过敏的患儿。尘螨血清特异性IgG4升高可以作为免疫治疗有效的预测指标。免疫治疗后可以恢复Thl/Th2/Th17和Treg平衡。

Objective：Evaluation of the efficacy of standardized dust mite drops in sublingual immunotherapy（SLIT）for allergic rhinitis in children.Method：A retrospective analysis of 174 children who received SLIT with standardized dermatophagoides farinae drops for 2 years.These patients had been divided into two groups：monoasensitized group（n=61）and polysensitized group（n=113）.The total medication score（TMS）,total nasal symptoms score（TNSS）and inflammatory factors were evaluated before and after SLIT treatment.Result：（1）After SLIT treatment for 2.0 year,the TNSS in the monosensitized group is（11.27±1.46）and（3.48±1.50）,polyasensitized group is（11.54±1.50）and（3.59±1.56）,there are significant difference of TNSS between two groups（P〈0.01）.But the improvements of the TNSS between the two groups have no significant difference（P〈0.05）,the monosensitized group is（7.68±3.23）;polysensitized group is（8.14±2.56）.（2）Two groups of children with TMS before and after treatment were obviously improved,monosensitized group is（1.67±0.43）and（0.52±0.40）,polysensitized group is（1.64±0.44）and（0.55±0.41）.There are significant difference of TMS between two groups（P〈0.01）.But the improvements of the TMS between the two groups have no obvious difference（P〈0.05）,the monsensitized group is（1.16±0.61）;polysensitized group is（1.28±0.55）.（3）Specific IgG4 serum is increased after treatment（P〈0.01）.（4）After immunotherapy,the expression of IL4 and IL-17αis down-regulated,IL-2 and TGF-β1 is up-regulated.Conclusion：（1）Dust mites under the SLIT,can significantly improve the monosensitized and polyasensitized allergic children nasal symptoms,reduce the drug use,and two groups have the equivalent effect.（2）Dust mite drops SLIT,can be used to the monosensitized and polyasensitized allergic children.（3）The rise of dust mites specific IgG4 can be used as immunotherapy effective predictors.（4）After immunotherapy,Thl/Th2/Thl7 and Treg can be re-balanced.