荨麻疹与螨性过敏的关系及粉尘螨注射液免疫治疗  

Urticaria in Relation to Mite Sensitivity and Immunotherapy with Injectio dermatophagoidei farinae

作　　者：邢道荣[1] 温廷桓[2] 余扬林[3] 魏志平[3] 李益明[4] 韩天[4] 

机构地区：[1]徐州医学院病原学教研室,徐州221002 [2]复旦大学上海医学院医学螨类研究室,上海200032 [3]徐州医学院附属医院皮肤科,徐州221006 [4]徐州医学院寄生虫学兴趣小组,徐州221002

出　　处：《中国寄生虫学与寄生虫病杂志》2008年第6期422-427,共6页Chinese Journal of Parasitology and Parasitic Diseases

摘　　要：目的检测荨麻疹和其他皮疹患者对螨的敏感性,并观察粉尘螨注射液特异性免疫治疗(SIT)荨麻疹螨敏阳性者的临床疗效。方法1998-2005年对皮肤科门诊的皮疹患者采用粉尘螨(Df)变应原皮肤点刺试验(SPT)检测螨敏情况。将荨麻疹螨敏反应SPT≥++患者分成3组:A组粉尘螨注射液常规特异性免疫治疗,皮下注射1∶100000(w/v)0.3、0.6和1.0ml,各剂量1次/周×3周,1∶10000和1∶5000(w/v)的剂量、疗程同上,即剂量递增期共9周;1∶5000(w/v)1.0ml/(次·周)×6周,即维持剂量期。B组粉尘螨注射液冲击特异性免疫治疗,3个浓度各治疗1d,各浓度的3个剂量间隔30min,即剂量递增期共3d;1∶5000(w/v)1.0ml/(次·d)×6d,即维持剂量期。A组和B组各1疗程后改用维持量1∶5000(w/v)1.0ml每2周1次,维持1年。C组为对照组,用抗组胺药物治疗,依巴斯汀10mg/d+盐酸西替利嗪10mg/d,7d为1个疗程(以后需要时用)。观察各组的治疗效果。用ELISA测定20患者粉尘螨注射液特异性免疫治疗前后血清总IgE(tIgE)和粉尘螨特异性IgE(sIgE)水平的变化。结果2685例皮疹患者中,荨麻疹患者螨敏阳性率为70.3%(1754/2496),高于湿疹患者的63.5%(54/85)和过敏性紫癜患者的60.6%(63/104)(P<0.05)。248例荨麻疹螨敏SPT≥++患者接受粉尘螨注射液特异性免疫治疗,1年后临床总有效率为91.1%(226/248),其中基本控制和显效者占66.1%(164/248),高于抗组胺药物治疗组[12.7%(20/158)](P<0.01);冲击特异性免疫治疗起效快,其最终疗效也优于常规特异性免疫治疗(基本控制+显效为76.7%>55.0%)(P<0.05)。20例荨麻疹螨敏患者tIgE水平特异性免疫治疗1年后比免疫治疗前下降,粉尘螨sIgE水平显著上升(P<0.01)。结论尘螨变应原皮肤点刺试验对荨麻疹螨敏具有病因诊断价值,粉尘螨注射液特异性免疫治疗对荨麻疹螨敏者有较好的疗效。此外,冲击免疫治疗起效快且优于常规免疫治疗。Objective To investigate the prevalence of mite sensitivity in patients with urticaria or other skin rashes, and to observe the clinical efficacy of a specific immunotherapy （SIT） by the Injectio dermatophagoidei farinae for the patients. Methods In 7-year period （1998-2005）, skin prick test （SPT） with a dust mite （Df） allergen was carried out to detect the prevalence of mite sensitivity in OPD patients suffering from skin rashes. Among the patients sensitive to mite with SPT≥＋＋ response, 3 groups were established. In group A, routine SIT with Injectio dermatophagoidei farinae was conducted. In 9-week increasing dose phase, three stepwise increasing volumes （0.3ml, 0.6 ml and 1.0 ml） each case was injected subcutaneously with mite concentration of 1：100000 （w/v） , 1：10000 （w/v） or 1：5 000 （w/v） respectively once a week, followed by a maintenance dose phase for an injection with 1：5000 （w/v） 1.0 ml/wk for 6 weeks. Group B received rush SIT with mite injections. A total of 15 injections in a course of therapy with same concentration and volume was given as those for the routine ones except shortened intervals, namely, 9 initial injections completed in 3 days by three injections of each concentration per day with two 30 min intervals, maintenance doses were then provided in 6 days with 1：5 000 （w/v） 1.0 ml/d. Thereafter, both groups A and B were maintained for one year with a dose of 1：5 000 （w/v） 1.0 ml every 2 wk. Group C received antihistamine treatment as control, the patients received daily oral Ebastine 10 mg in the morning and Cetirizine dihydrochloride 10 mg in the evening for one week course and pro re nata later. Levels of serum tIgE and serum mite sIgE were detected by ELISA in 20 urticaria cases before and after one year mite SIT. Results Altogether, 2 685 cases with skin rashes were detected by Df allergen SPT. The prevalence of urticaria cases sensitive to mite was 70.3% （ 1 754/2 496）, which was higher than that of eczema 63.5% （54/85

关 键 词：荨麻疹 尘螨过敏 变应原 皮肤点刺试验 粉尘螨注射液 特异性免疫治疗 抗组胺治疗 

分 类 号：R757.3[医药卫生—皮肤病学与性病学]