不同疗程粉尘螨滴剂治疗儿童过敏性哮喘的远期疗效

Long-term curative effect of different-course Dust Mites Drops on children with allergic asthma

目的探讨不同疗程粉尘螨滴剂治疗儿童过敏性哮喘的远期疗效及对特异性免疫球蛋白E(sIgE)和特异性免疫球蛋白G4(sIgG4)的影响。方法前瞻性选取儿童哮喘专科门诊接诊的采用舌下含服免疫治疗(SLIT)2年的过敏性哮喘患儿67例作为研究对象,采用随机数字表法随机分为2年组(34例)和3年组(33例)。2组患儿所采用的SLIT治疗方案均为常规药物吸入+舌下含服粉尘螨滴剂,2年后,2年组停止SLIT治疗,3年组继续SLIT治疗1年,2组均每3个月门诊随访1次。比较2组治疗第2年、第3年和第4年的血清尘螨sIgE、sIgG4水平、哮喘日间症状计分(DASS)、哮喘夜间症状计分(NAS`S)和急性发作次数以及肺功能[第1秒用力呼气容积(FEV1)占预计值的百分比(FEV1%)]情况。结果与治疗第2年相比,2年组第3年及第4年急性发作次数更低,尘螨sIgG4水平更高,第4年DASS评分和NASS评分均更低(P<0.05);与治疗第2年相比,3年组第3年及第4年尘螨sIgE和嗜酸性粒细胞阳离子蛋白(ECP)水平、DASS和NASS评分以及急性发作次数均更低,sIgG4水平、CD3+、CD4+占比、CD4+/CD8+和FEV1%预计值均更高(P<0.05);2组治疗前后sIgE和sIgG4水平比较,差异均无统计学意义(P>0.05),但与2年组相比,3年组治疗第3年、第4年ECP水平、急性发作次数和DASS评分均更低(P<0.05);CD3+、CD4+占比以及CD4+/CD8+更高(P<0.05)。结论舌下含服粉尘螨滴剂治疗儿童过敏性哮喘2~4年具有稳固的临床疗效,疗程越长,疗效越巩固;且治疗2~4年后患儿sIgE水平缓慢降低,sIgG4明显升高,sIgE和sIgG4对于临床疗效的评估有一定的指导意义。

Objective To explore the long-term curative effect of different-course Dust Mites Drops on allergic asthma and their influences on specific immunoglobulin E(sIgE)and specific immunoglobulin G4(sIgG4)in children.Methods A total of 67 children with allergic asthma who underwent sublingual immunotherapy(SLIT)for 2 years at specialist clinic of children asthma in the hospital were enrolled prospectively.They were randomly divided into 2-year group(34 cases)and 3-year group(33 cases)by random number table method.SLIT treatment regimens in both groups included routine drug inhalation and sublingual Dust Mites Drops.SLIT treatment was stopped in 2-year group,but continued for 1 year in 3-year group.The outpatient follow-up was conducted every 3 months in both groups.The levels of serum dust mites sIgE and sIgG4,daytime asthma symptoms scores(DASS),nighttime asthma symptoms scores(NASS),times of acute attacks and lung function[forced expiratory volume in one second(FEV1)as a percentage of predicted value(FEV1%)]on the second year,third year and the fourth year after treatment were compared between the 2 groups.Results Compared with those on the second year after treatment,on the third year and the fourth year after treatment,times of acute attack were less,while the level of dust mite sIgG4 was higher in 2-year group.And DASS and NASS on the fourth year were lower(P<0.05).Compared with those on the second year after treatment,the levels of dust mite sIgE and eosinophil cationic protein(ECP),DASS,NASS and times of acute attacks on the third year and the fourth year after treatment were lower,while the level of sIgG4,proportions of CD3+and CD4+,CD4+/CD8+and predicted value of FEV1%were higher in 3-year group(P<0.05).There was no significant difference in levels of sIgE and sIgG4 before and after treatment between the 2 groups(P>0.05).Compared with those in 2-year group,the ECP level,times of acute attacks and DASS in 3-year group were lower(P<0.05),while of proportions of CD3+and CD4+,CD4+/CD8+were higher(P<0.05).Conclusion The 2-4 years clinical curative effect of sublingual Dust Mites Drops is stable on children with allergic asthma.The longer the course of treatment,the more consolidated the curative effect.After 2-4 years of treatment,the sIgE level was decreased slowly,while sIgG4 was increased significantly.sIgE and sIgG4 are of certain guiding significance in the evaluation of clinical curative effect.