粉尘螨滴剂舌下特异性免疫治疗螨过敏儿童咳嗽变异型哮喘的临床疗效  

Clinical effects of sublingual immunotherapy with dermatophagoides farinae drops on mite-allergic cough variant asthma in children

作　　者：杨姗姗 韩锋 YANG Shan-shan;HAN Feng(Department of Immunology and Rheumatology;Department of Respiratory Medicine,Wuhan Children′s Hospital,Wuhan Maternal and Child Healthcare Hospital,Tongji Medical College,Huazhong University of Science ＆ Technology,Wuhan 430016,Hubei,China)

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院(武汉市妇幼保健院)风湿免疫科,武汉医学硕士430016 [2]华中科技大学同济医学院附属武汉儿童医院(武汉市妇幼保健院)呼吸内科,武汉430016

出　　处：《医学研究生学报》2018年第11期1167-1171,共5页Journal of Medical Postgraduates

基　　金：湖北省卫生计生委科研项目(WJ2017F038)

摘　　要：目的舌下特异性免疫治疗应用于过敏儿童咳嗽变异型哮喘(CVA)相关研究较少。文中探讨粉尘螨滴剂舌下特异性免疫治疗螨过敏儿童CVA的临床疗效。方法回顾性分析2016年1月至2017年1月于华中科技大学同济医学院附属武汉儿童医院就诊的225例CVA患儿,并按照不同治疗方法分为复合治疗组(n=102)和对照组(n=123)。其中对照组仅接受对症药物治疗,复合治疗组则在此基础上增加粉尘螨滴剂舌下特异性免疫治疗,共治疗10个月。治疗期间对所有患儿进行随访,记录相关指标并比较,包括症状积分、肺功能、粉尘螨总Ig E、炎症因子(IL-4、TGF-β和INF-γ)水平检测及有效情况;同时记录可能影响患儿疗效的临床资料以完成相关危险因素分析。结果治疗前,2组患儿日/夜间咳嗽症状评分、肺功能、Ig E、IL-4、TGF-β和INF-γ水平比较差异无统计学意义(P> 0.05);治疗后,复合治疗组患儿日/夜间咳嗽症状评分[(0.87±0.06)/(0.91±0.11)]明显低于对照组[(2.54±0.32)/(2.38±0.42)];肺功能(FEV1/FVC)[(1.98±0.56)/(79.67±9.05)]优于对照组[(1.65±0.37)/(75.87±11.56)],差异均有统计学意义(P<0.05)。复合治疗组治疗有效率明显高于对照组,差异有统计学意义(73.53%vs 54.47%,P<0.05)。单因素及多因素分析后得知,年龄、病程及治疗方式是影响儿童CVA患儿疗效的独立危险因素(P<0.05)。结论粉尘螨滴剂舌下特异性免疫联合治疗可有效改善CVA患儿临床症状及肺功能,可能与血清中IL-4、TGF-β和INF-γ等炎症因子下降相关。年龄、病程及治疗方式是影响患儿疗效的独立危险因素,对临床治疗有一定参考价值。Objective Few studies are reported on the sublingual immunotherapy with dermatophagoides farinae drops （DFD） for mite-allergic cough variant asthma （CVA） in children. This study aimed to investigate the clinical effects of DFD sublingual immunotherapy on mite-allergic CVA in children. Methods We retrospectively analyzed the clinical data on 225 children with mite-allergic CVA treated in Wuhan Children′s Hospital from January 2016 to January 2017. The patients were divided into a control （ n =123） and an experimental group （ n=102） to receive symptomatic treatment and symptomatic treatment combined with DFD sublingual immunotherapy, respectively, both for 10 months. We recorded the relevant indicators, including the symptom scores, lung function parameters, levels of dust mite IgE and inflammatory factors （IL-4, TGF-β and INF-γ）, and related risk factors, and compared the data obtained between the two groups of patients before and after treatment. Results There were no statistically significant differences between the two groups of patients in the baseline daily and nocturnal cough symptom scores, lung function parameters, or levels of serum IgE, IL-4, TGF-β and INF-γ （ P〉0.05）. After treatment, the children in the experimental group showed markedly lower daily and nocturnal cough symptom scores than the control （0.87±0.06 and 0.91± 0.11 vs 2.54±0.32 and 2.38±0.42, P 〈0.05）, better pulmonary function parameters （FEV1/FVC： [1.98±0.56]% / [79.67±9.05]% vs [1.65±0.37] / [75.87±11.56]%, P 〈0.05）, and a higher effectiveness rate （73.53% vs 54.47%, P 〈0.05）. The single- and multi-factor analyses showed that age, disease course and treatment methods were independent risk factors influencing the therapeutic effect on mite-allergic CVA in children （ P 〈0.05）. Conclusion Sublingual immunotherapy with DFD can effectively improve the clinical symptoms and lung function in children with mite-allergic CVA, which may be associated with the decreased levels of ser

关 键 词：儿童咳嗽变异型哮喘 粉尘螨滴剂 IGE 炎症因子 肺功能 

分 类 号：R562.25[医药卫生—呼吸系统]