变应性鼻炎舌下免疫治疗疗效的临床评估

Clinical evaluation of sublingual immunotherapy for allergic rhinitis

目的 舌下含服粉尘螨滴剂治疗尘螨过敏的变应性鼻炎(AR)主客观相结合的评价体系相对匮乏。文中旨在探讨舌下含服免疫治疗(SLIT)尘螨过敏的AR的疗效。方法 回顾性分析2017年5月至2019年8月苏州大学附属第一医院耳鼻咽喉科的206例AR患者临床资料。其中SLIT组(n=110)采用粉尘螨滴剂治疗,对照组(n=96)采用布地奈德鼻喷雾剂/氯雷他定片/孟鲁司特片治疗。比较两组治疗1年时和治疗2年时的鼻部症状总评分(TNSS)、视觉模拟量表(VAS)评分、AR相关生活质量量表(RQLQ)评分、血清总IgE(TIgE)水平、鼻声反射检查和鼻阻力检查,综合评估疗效。结果 不同治疗时间的两组患者TNSS和VAS评分较治疗前明显降低(P<0.05)。治疗2年SLIT组TNSS[1(0,1)]、VAS评分[1(0,1)]较治疗1年[3(2,4)、2.5(2,3)]明显降低(P<0.05)。治疗1、2年SLIT组TNSS和VAS评分明显低于对照组(P<0.05)。与治疗前比较,治疗1、2年两组患者的RQLQ评分明显降低(P<0.05),治疗2年SLIT组的RQLQ评分较治疗1年时明显降低(P<0.05)。与治疗前相比,治疗1、2年两组患者的NCV;、NMCA和有效阻力NR值明显改善(P<0.05);治疗2年SLIT组的上述指标较治疗1年时明显改善(P<0.05);治疗1、2年SLIT组的上述指标优于对照组(P<0.05)。与治疗前比较,治疗2年SLIT组TIgE水平明显下降(P<0.05),治疗2年SLIT组TIgE水平上述指标改善优于对照组(P<0.05)。结论 SLIT能显著改善尘螨过敏的AR患者的临床症状、生活质量、相关血清学指标和客观鼻腔功能,值得临床推广应用。

Objective Sublingual dust mite drops for the treatment of dust mite allergic rhinitis(AR) is relatively deficient in subjective and objective evaluation system. To explore the efficacy of AR administered sublingual with immunotherapy(SLIT) for dust mite allergy. Methods The clinical data of 206 AR patients in the Department of Otolaryngology in the first affiliated hospital of Soochow university from May 2017 to August 2019 were retrospectively analyzed. SLIT group(n=110) was treated with dust mite drops, and control group(n=96) was treated with Budesonide nasal spray/loratadine/Montelukast tablets. Total nasal symptom score(TNSS), visual analog scale(VAS) score, AR related quality of Life Scale(RQLQ) score, serum total IgE(TIgE) level, nasal acoustic reflex and nasal resistance examination were compared between the two groups at 1 and 2 years of treatment, and the efficacy was evaluated. Results TNSS and VAS scores in 2 groups with different treatment time were significantly lower than before treatment(P<0.05). TNSS [1(0, 1)], the VAS score [1(0, 1)] in SLIT treatment group after 2 years compared with treatment after 1 years [3(2, 4), 2.5(2, 3)] significantly decreased(P<0.05). The TNSS and VAS scores of SLIT group were significantly lower than those of control group after 1 and 2 years of treatment(P<0.05). Compared with before treatment, the RQLQ scores of patients in the 1 and 2 year group were significantly lower(P<0.05), and the RQLQ scores of patients in the SLIT group were significantly lower(P<0.05). Compared with before treatment, NCV0-7, NMCA and effective resistance NR values were significantly improved in 2 groups after 1 and 2 years of treatment(P<0.05). Compared with treatment after1 year, the indexes of SLIT group after 2 years of treatment were significantly improved(P<0.05). The indexes of SLIT group were better than those of control group after 1 and 2 years treatment(P<0.05). Compared with before treatment, the TIgE level in SLIT group decreased significantly after 2 years of treatment(P<0.05), and the improvement of TIgE level in SLIT group was better than that in control group(P<0.05). Conclusion SLIT can significantly improve the clinical symptoms, quality of life, serological indicators and objective nasal function of AR patients with dust mite allergy, which is worthy of clinical application.