标准化屋尘螨变应原皮下特异性免疫治疗儿童变应性鼻炎伴哮喘远期疗效研究

Clinical effect of standardized house dust mite allergen subcutaneous specific immunotherapy on allergic rhinitis with asthma in children for 10 years

目的探讨屋尘螨变应原皮下特异性免疫治疗(SCIT)对儿童变应性鼻炎伴哮喘的远期疗效及影响因素。方法选择2007年~2010年期间,就诊于北部战区总医院过敏反应科,诊断为屋尘螨过敏为主的变应性鼻炎伴哮喘的患者,并接受标准化SCIT治疗≥36个月,并在治疗结束第5年(T1期)和第10年(T2期)接受随访,资料完整的患者进行回顾性研究。所有患者在治疗前(T0期)、第5年(T1期)和第10年(T2期)已建立档案,分别进行哮喘控制测试评分(ACT)、鼻炎症状评分(TNSS)、鼻炎伴随症状评分(TNNSS)、总用药评分(TMS)和视觉模拟评分(VAS);分析并比较性别、过敏原种类对SCIT远期疗效的影响。结果SCIT治疗后T1期、T2期的ACT、TNSS、TNNSS、TMS、VAS评分较T0期均显著改善,差异均有统计学意义(P<0.05);SCIT治疗后T1期、T2期的ACT、TNSS、TNNSS、TMS、VAS评分比较差异均无统计学意义(P>0.05);不同性别SCIT治疗后T1期、T2期的ACT、TNSS、TNNSS、TMS、VAS评分比较差异均无统计学意义(P>0.05);按照过敏原种类对反映病情评估指标的ACT、TNSS和VAS评分进行比较,差异均有统计学意义(P<0.05),其中单一尘螨过敏原组哮喘和鼻炎总有效率显著高于合并花粉过敏多重过敏原组,差异具有统计学意义(P<0.05)。结论SCIT能显著改善儿童哮喘和变应性鼻炎的症状及生活质量,减少对症药物的使用,在停止治疗后的5~10年仍能维持长期疗效且安全性好,单一过敏原组的疗效显著高于多重过敏原组,提示过敏原数量(单一或多重过敏原)会影响SCIT治疗效果。

Objective To investigate the long-term efficacy and influencing factors of subcutaneous specific immunotherapy(SCIT)with house dust mite allergens in children with allergic rhinitis and asthma.Methods Patients who were diagnosed as house dust mite allergic rhinitis with asthma from 2007 to 2010 and received standard SCIT treatment for≥36 months at the Department of Allergic Reactions,Northern Theater General Hospital were selected,and at the end of the treatment a retrospective study was conducted on patients with complete data who were followed up in the 5th year(T1 period)and the 10th year(T2 period).All patients have established files before treatment(T0 period),5th year(T1 period)and 10th year(T2 period),and the Asthma Control Test Score(ACT),Rhinitis Symptom Score(TNSS),Rhinitis Accompanying Symptom Score(TNNSS),Total Medication Score(TMS)and Visual Analogue Score(VAS)were performed respectively.The effects of gender and allergen types on the long-term efficacy of SCIT were also analyzed and compared.Results After SCIT treatment,ACT,TNSS,TNNSS,TMS and VAS scores at T1 and T2 stages were significantly improved compared with those at T0 stage,with statistical significance(P<0.05).After SCIT treatment,there were no significant differences in ACT,TNSS,TNNSS,TMS and VAS scores at T1 and T2 stages(P>0.05).There were no significant differences in ACT,TNSS,TNNSS,TMS and VAS scores between different genders after SCIT treatment at T1 and T2(P>0.05).Allergen types had statistical significance in ACT,TNSS and VAS scores reflecting disease assessment indicators(P<0.05).The total effective rate of asthma and rhinitis in the single allergen group was significantly higher than that in the multiple allergen group with pollen allergy,and the difference was statistically significant(P<0.05).Conclusion SCIT can significantly improve the symptoms and quality of life of children with asthma and allergic rhinitis,reduce the use of symptomatic drugs,and maintain long-term efficacy and good safety after 5-10 years of discontinuation of treatment.The efficacy of the single allergen group was significantly higher than that of the multiple allergens group,suggesting that the number of allergens(single or multiple allergens)could affect the efficacy of SCIT treatment.