舌下含服尘螨特异性免疫治疗小儿支气管哮喘合并变应性鼻炎临床观察  

Clinical observation of sublingual dust mite specific immunotherapy in treatment of children with asthma and allergic rhinitis

作　　者：刘晓颖[1] 王群[1] 皇惠杰 高琦[1] 苗青[1] 刘永革[1] 关辉[1] 向莉[1] 

机构地区：[1]首都医科大学附属北京儿童医院,北京100045

出　　处：《山东医药》2016年第20期5-8,共4页Shandong Medical Journal

基　　金：首都特色课题(Z151100004015030);北京市科技计划(Z131100006813044)

摘　　要：目的探讨舌下含服尘螨特异性免疫治疗小儿支气管哮喘(简称哮喘)合并变应性鼻炎的临床效果。方法选择尘螨致敏的哮喘合并变应性鼻炎患儿35例,均给予控制哮喘及鼻炎药物治疗同时行舌下免疫治疗(SLIT)24个月。观察治疗前、治疗后每6个月(共24个月)随访时平均每日症状用药计分(SMS)、峰流速值(PEFR)变化率,评估哮喘控制测试(ACT/C-ACT)及哮喘鼻炎视觉模拟评分(VAS),同时观察肺功能变化。同期检测血清户尘螨s Ig E、粉尘螨s Ig E和总Ig E水平。结果随访6、12、18、24个月平均SMS均低于治疗前,ACT/C-ACT评分均高于治疗前,哮喘、鼻炎VAS均低于治疗前(P均<0.05)。除18、24个月最大用力呼气峰流量占预计值的百分比、清晨和夜间PEFR变化率高于治疗前(P<0.05)外,其余肺功能指标与治疗前比较均无统计学差异。随访6个月时,血清户尘螨、粉尘螨s Ig E及总Ig E水平均较治疗前明显降低(P均<0.05),但血清户尘螨、粉尘螨s Ig E水平与治疗24个月时比较无统计学差异。结论 SLIT可明显改善尘螨致敏哮喘合并变应性鼻炎患儿的临床症状,减少哮喘及变应性鼻炎相关用药量,但对肺功能影响较小;长期坚持SLIT可能改变机体对过敏原的免疫反应。Objective To observe the clinical effect of two-year sublingual dust mite specific immunotherapy in treatment of children with allergic rhinitis and asthma. Methods Thirty-five children sensitizing to dust mite with mild or moderate asthma complicated with allergic rhinitis received 24-month sublingual immunotherapy（ SLIT） and drug treatment of asthma and rhinitis at the same time. We recorded the daily medication scores（ SMS） and peak expiratory flow rate（ PEF）before treatment and every 6 months after treatment. We assessed the asthma control test / children-asthma control test（ ACT/C-ACT）,visual analog scale（ VAS） and observed the pulmonary function. Serum dermatophagoides pteronyssinus s Ig E,dermatophagoides farinae s Ig E and whole Ig E levels were detected. Results At the follow-up of 6,12,18 and 24 months,the mean SMS was significantly lower than that before treatment（ all P〈 0. 05）,ACT / C-ACT score was significantly higher than that before treatment（ P〈 0. 05）,and the VAS score of asthma and rhinitis was lower than that before treatment（ P〈 0. 05）. The peak expiratory flow rate（ PEF） at 18 and 24 months was significantly higher than that of the baseline（ P〈 0. 05）. There was no significant difference between the baseline and follow-up period of the rest lung function parameters. Serum immunological indexes of dermatophagoides pteronyssinus and dermatophagoides farinae s Ig E in the follow-up of 24 months decreased significantly as compared with that before treatment. There was no significant difference in dermatophagoides pteronyssinus and dermatophagoides farinae s Ig E levels between the two-year treatment and one-year treatment. Conclusions SLIT can significant improve the clinical symptoms of children sensitizing to dust mite with mild or moderate asthma complicated with allergic rhinitis and reduce asthma and allergic rhinitis medication,but it has little effect on pulmonary function. Only with long-term adherence to SLIT can change the body＇s immune

关 键 词：支气管哮喘 变应性鼻炎 舌下特异性免疫治疗 

分 类 号：R725.6[医药卫生—儿科]