变应原鼻腔激发试验在尘螨特异性免疫治疗疗效评估中的应用价值

Value of allergen nasal provocation test in assessment of the efficacy of house dust mites specific immunotherapy

目的本研究旨在通过变应原鼻腔激发试验(nasal provocation test,NPT)评估尘螨特异性免疫治疗(allergen immunotherapy,AIT)的疗效,探讨NPT在AIT疗效评估中的应用价值。方法纳入83例接受尘螨AIT治疗的变应性鼻炎患者,伴或不伴支气管哮喘。比较AIT治疗前及治疗后1年,患者症状评分(symptom score,SS)、每日用药评分(daily medication score,DMS)、症状用药评分(combined symptom and medication score,CSMS)、鼻结膜炎生活质量量表(rhinoconjunctivitis quality of life questionnaire,RQLQ)评分、NPT和皮肤点刺试验(skin prick test,SPT)的变化。结果AIT治疗1年后与治疗前比较,SS(P<0.0001),DMS(P<0.0001),CSMS(P<0.0001),RQLQ(P<0.0001)均差异有统计学意义。CSMS疗效评估有效率为73.49%,NPT疗效评估有效率为42.17%,SPT在治疗前后差异无统计学意义(P>0.05)。CSMS与NPT疗效评估具有一致性(Kappa=0.437,P<0.001);并且两者在治疗前NPT激发浓度非原液的54例患者中,显示出更好的一致性(Kappa=0.895,P<0.001)。第1年NPT评估无效的48例患者中,25例完成第2年随访,其中12例(48.00%)在第2年NPT评估显示有效;而治疗前NPT激发浓度非原液的12例患者中,10例(83.33%)在第2年NPT评估显示有效。结论NPT可作为尘螨AIT疗效评估的指标之一,尤其对于治疗前NPT在较低浓度即出现阳性反应的患者具有更高的评估价值。

Objective To investigate the value of nasal provocation test(NPT)in evaluating the efficacy of allergen immunotherapy(AIT)in patients with dust mite induced allergic rhinitis(AR).Methods A total of 83 patients with dust mite induced AR with/without asthma were included.Symptom score(SS),daily medication score(DMS),combined symptom and medication score(CSMS),rhinoconjunctivitis quality of life questionnaire(RQLQ),NPT and skin prick test(SPT)were assessed before and after 1 year AIT.Results There were statistical differences in SS(P<0.0001),DMS(P<0.0001),CSMS(P<0.0001),and RQLQ(P<0.0001)after 1 year of AIT compared with pre-treatment.The effective rate of CSMS was 73.49%,and the effective rate of NPT was 42.17%.CSMS was consistent with NPT in efficacy assessment(Kappa=0.437,P<0.001);while in 54 patients with pre-treatment NPT concentrations other than the original concentration,CMSM and NPT showed better consistence(Kappa=0.895,P<0.001).Among the 48 patients with ineffective NPT assessment in the first year,25 patients completed the second-year follow-up,and 12 patients(48.00%)showed effective in NPT.However,10 out of 12 patients(83.33%)with NPT concentration other than original solution pre-treatment showed effective NPT at the second year.Conclusion NPT can be used as one of the indicators for efficacy evaluation for dust mite induced AR patients,especially for patients with positive NPT induced at lower concentrations before treatment.