儿童螨过敏性鼻炎的免疫治疗

Immunotherapy of mite allergic rhinitis in children

目的探讨舌下脱敏治疗对螨虫致敏过敏性鼻炎患儿的疗效。方法回顾性研究2014年3月至2019年9月就诊于首都医科大学附属北京儿童医院耳鼻咽喉头颈外科门诊490例螨虫致敏过敏性鼻炎患儿,并依据患儿的临床情况,将其分成低龄儿童组、脱敏治疗时长组、个体化剂量调整组及多重过敏疗效评估组,记录患儿在首诊、治疗12个月、24个月及36个月时的鼻部总症状评分(TNSS)、视觉模拟量表评分(VAS)及总用药评分(TMS),并计算症状药物联合评分(CSMS)。结果共有374例(76.32%)患儿完成了本次研究。其中低龄儿童用药组中,≤3岁组与>3岁组在用药12个月后的CSMS(2.20±1.61、2.50±1.78)、TNSS(2.80±2.32、3.60±2.71)及VAS(3.50±1.16、3.90±1.43)显著低于首诊时的评分CSMS[(4.50±1.44、5.30±1.32)、TNSS(6.20±1.89、7.50±2.19)、VAS(5.40±2.33、5.90±1.61)];此外,在脱敏治疗不同时间组中,完成36个月脱敏治疗患儿,仅在3年组中,评分分别为TNSS(0.90±0.97)、VAS(1.30±1.19)和CSMS(1.70±1.28),完成24个月脱敏疗程患儿在2年组和3年组的评分分别为TNSS(2.10±0.95、2.00±0.97)、VAS(3.00±1.56、3.10±1.68)、CSMS(3.10±1.15、2.90±1.19),完成12个月脱敏治疗患者在1年组、2年组和3年组中评分为TNSS(3.20±1.27、3.10±1.41、3.20±1.41)、VAS(4.50±2.11、4.70±2.19、4.50±2.17)和CSMS(4.20±1.39、3.70±1.32、4.10±1.39);脱敏治疗疗效不佳患儿在进行个体化增量后6个月(即治疗后12个月)达到与对照组相近的评分,即4号4滴组、4号5滴组和对照组的评分CSMS(2.90±1.56、2.90±1.88、2.40±1.69)、TNSS(4.70±2.98、3.90±2.77、3.80±2.45)和VAS(4.20±1.29、4.50±1.62、4.20±1.14);多重过敏患者脱敏2年后最终达到与单一过敏患者相近的疗效,单一过敏组、合并1~2种过敏原和合并3种以上过敏原组评分分别为CSMS(2.30±0.50、2.10±1.01、1.90±1.01)、TNSS(3.50±2.62、3.70±2.62、3.20±2.82)和VAS(4.50±1.00、4.10±1.57、3.80±1.54)。结论脱敏治疗在低龄儿童用药、多重过敏等方面均可发挥疗效,部分患儿在剂量调整后获得更好疗效。

Objective To study the effect of sublingual immunotherapy on children with mite allergic rhinitis.Methods Four hundred and ninety patients with mite allergic rhinitis have been recruited by Beijing Children′s Hospital from March 2014 to September 2019 and divided into 4 groups of young children group,different treatment duration group,individualized dose adjustment group and multiple allergy evaluation group,the clinical scores of total nasal symptoms score(TNSS),visual analogue scale scores(VAS)and total medication score were recorded at the first visit,12 months,24 months and 36 months after treatment,and the combined symptom and medication score(CSMS)score was calculated.Results A total of 374 patients(76.32%)completed this study.Among them,the CSMS(2.20±1.61,2.50±1.78),TNSS(2.80±2.32,3.60±2.71)and VAS(3.50±1.16,3.90±1.43)in≤3-year-old group and children over 3-year-old group of young children set after use of 12 months were significantly lower than the score at the first time of diagnosis(respectively CSMS:4.50±1.44,5.30±1.32;TNSS:6.20±1.89,7.50±2.19;VAS:5.40±2.33,5.90±1.61).In addition,in the duration and efficacy set,the patients who completed the immunotherapy for 36 months can only be observed in the 3-year group,the scores were TNSS(0.90±0.97),VAS(1.30±1.19),CSMS(1.70±1.28);the scores of patients who completed the immunotherapy for 24 months in 2-year group and 3-year group were TNSS(2.10±0.95,2.00±0.97),VAS(3.00±1.56,3.10±1.68)and CSMS(3.10±1.15,2.90±1.19)and the patients who completed 12-month immunotherapy were scored in 1-year group,2-year group and 3-year group with TNSS(3.20±1.27,3.10±1.41,3.20±1.41),VAS(4.50±2.11,4.70±2.19,4.50±2.17)and CSMS(4.20±1.39,3.70±1.32,4.10±1.39)respectively;patients with poor efficacy in sublingual immunotherapy achieved a score similar to the control group after 6 months of dose adjustment(equals to 12 months after treatment),that were CSMS(2.90±1.56,2.90±1.88,2.40±1.69),TNSS(4.70±2.98,3.90±2.77,3.80±2.45)and VAS(4.20±1.29,4.50±1.65,4.20±1.14)of 4 drops group,5 drops group and control group;sublingual immunotherapy for patients with multiple allergens for 2 years finally achieved similar efficacy to patients with single allergen,with CSMS(2.30±0.50,2.10±1.01,1.90±1.01),TNSS(3.50±2.62,3.70±2.62,3.20±2.82)and VAS(4.50±1.00,4.10±1.57,3.80±1.54)in single allergen group,combined with 1-2 allergens group and combined with 3+allergens group.Conclusions Sublingual immunotherapy plays a corresponding role in the treatment of low-age children,multiple allergy children,and some children get better after dose adjustment.