阶梯疗法治疗常年性变应性鼻炎的疗效评价及机理探讨

An approach to the efficacy and therapeutic mechanism of step-by-step medication regimen on perennial allergic rhinitis

目的研究应用阶梯疗法治疗常年性变态反应性鼻炎(PAR),观察补体C_3在PAR治疗前后变化,探讨治疗机理。方法对92例PAR患者进行随机分组研究,观察、比较阶梯疗法、鼻腔局部用药为主的对照治疗的近、远期疗效,并测定补体C_3和血清免疫球蛋白IgG、IgA、IgM含量。结果①阶梯疗法对PAR的近、远期显效率分别为87.50%和82.14%,对照治疗组分别为36.67%和8%,阶梯疗法的近、远期疗效优于对照治疗组,经统计处理差异非常显著。②治疗前PAR患者血清C_3含量显著低于健康对照检测组正常人,经阶梯疗法治疗2～4周的患者症状完全控制或显著改善,血清C_3水平明显提高,达到正常范围。结论阶梯疗法具有见效快,近、远期显效率高,医疗费用低,以及药物不良反应少而轻等特点,其疗效机理可能与提高补体至适当水平有关,从而在有效消除补体C_3对鼻粘膜损伤作用的同时,保持了补体C_3对鼻粘膜的保护作用。

PURPOSE To study the possibility of specially designed step-by-step medication regimen (SSMR) in the treatment of perennial allergic rhinitis (PAR) and the influence of complement C3 on pathology and recovery of PAR.Mb I HODS The short-and long-term treatment effects were investigated in 92 patients with PAR who received SSMR and topical (intranasal) administration in a randommized study.The concentrations of complement C3 and immunoglobulins(IgG,IgA,IgM) were measured.RESULTS The short-and long-term marked effect rates were 87.50% and 82.14% in SSMR group,and 36.67 % and 8 % respectively in the patients who received intranasal administration.The results were significantly better in patients receiving SSMR than those receiving intranasal administration.The level of serum C3 in PAR patients was significantly lower than that in normal controls before treatment.The serum C3 concentration was significantly increased,which was within normal limits,2 ~ 4 weeks after SSMR in patients whose symptoms disappeared or greatly diminished.CONCLUSION The results suggest that the SSMR may become the first-choice treatment of PAR because of its rapid effectiveness,high marked effect rate of both short-and long-term,lower cost and unnoticeable side effects.It is conceivable that therapeutic mechnism ofSSMR on PAR may be related to the favourable elevation of complement C3.