珠三角地区变应性鼻炎和/或支气管哮喘患者皮下特异性免疫治疗依从性的真实世界研究  

Real World Study on Compliance of Subcutaneous Specific Immunotherapy in Patients with Allergic Rhinitis and/or Bronchial Asthma in the Pearl River Delta Region

作　　者：江育蔺 王心悦 唐隽[4] 鲍燕敏[5] 王桂兰 白珺[8] 廖振鹏[9] 黎雅婷 JIANG Yu-lin;WANG Xin-yue;TANG Jun;BAO Yan-min;WANG Gui-lan;BAI Jun;LIAO Zhen-peng;LI Ya-ting(Department of Pediatrics,The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Department of Allergy,The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Department of Otorhinolaryngology Head and Neck Surgery,The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Department of Otorhinolaryngology Head and Neck Surgery,Foshan First People's Hospital,Foshan 528000,China;Department of Respiratory Medicine,Shenzhen Children's Hospital,Shenzhen 518038,China;The Second Clinical Medical School of Southern Medical University,Zhongshan 528403,China;Department of Pediatrics,Boai Hospital of Zhongshan,Zhongshan 528403,China;Foshan Maternity&Child Healthcare Hospital,Foshan 528000,China;Department of Otorhinolaryngology Head and Neck Surgery,The Fifth Affiliated Hospital of Sun Yat sen University,Zhuhai 519000,China)

机构地区：[1]中山大学附属第三医院儿科,广东广州510630 [2]中山大学附属第三医院变态反应过敏科,广东广州510630 [3]中山大学附属第三医院耳鼻咽喉头颈外科,广东广州510630 [4]佛山市第一人民医院耳鼻咽喉头颈外科,广东佛山528000 [5]深圳市儿童医院呼吸内科,广东深圳518038 [6]南方医科大学第二临床医学院,广东中山528403 [7]中山市博爱医院儿科,广东中山528403 [8]佛山市妇幼保健院儿科,广东佛山528000 [9]中山大学附属第五医院耳鼻咽喉头颈外科,广东珠海519000

出　　处：《中山大学学报（医学科学版）》2022年第1期18-26,共9页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省医学科学技术研究基金(A2020232);广州市产学研协同创新重大专项民生科技研究项目(201704020179,财务编号A3116)。

摘　　要：【目的】了解珠三角地区变应性鼻炎(AR)和/或支气管哮喘患者(BA)中止皮下变应原免疫治疗(SCIT)的原因,为提高患者SCIT的依从性提供参考依据。【方法】本研究是一项回顾性、多中心、大样本的真实世界研究,收集和分析2015年1月到2020年12月在珠三角地区6家三甲医院接受SCIT的AR和/或BA患者的临床资料,并对中止治疗患者的进行电话随访。【结果】纳入1244例接受SCIT的患者,中止治疗427例(脱落率为34.3%);儿童、已婚、过敏家族史阳性、总IgE(tIgE)>200 U/mL的患者表现出相对良好的SCIT依从性(P值均<0.05),而单纯AR患者依从性较AR合并BA组低(P<0.05),治疗前症状评分和药物评分高的患者脱落率低(P值均<0.001)。对279例(65.3%)脱落患者进行电话随访,中止治疗的前3位原因分别是:治疗未达预期效果(115例,41.2%)、学习生活因素(74例,26.5%)、不良反应(29例,10.4%)。脱落患者人数随时间推移而逐渐减少,在治疗第1年因"不良反应"中止治疗的患者比例较第2、3年高(P<0.05)。【结论】治疗未达预期效果是SCIT患者依从性不佳的首要原因,患者中止治疗集中在开始治疗的早期,家庭成员监管有助于提高SCIT的依从性,提示需要采取个体化措施减少SCIT脱落。【Objective】To investigate the causes of discontinuation of subcutaneous allergen immunotherapy(SCIT)in patients with allergic rhinitis(AR)and/or bronchial asthma(BA)in the Pearl River Delta region,and to improve the compliance of these patients.【Methods】It was a retrospective,multi-center real world study.Patients with AR and/or BA receiving SCIT in six hospitals in the Pearl River Delta region from January 2015 to December 2020 were recruited.The clinical data of all patients were collected,and the patients with abscission were followed up by telephone.【Results】In this study,1244 patients who received SCIT were included.A total of 427 patients stopped SCIT before 3 years(34.3%).Children,married patients and patients with positive family history of allergy and total immunoglobulin E(tIgE)>200 U/mL showed relatively good compliance(P<0.05),while more patients of AR alone stopped SCIT before 3 years than patients of AR complicated with BA(P<0.05).Patients with high symptom score and drug score before treatment had better compliance(P<0.001).A total of 279 cases(65.3%)of the non-adherence group were followed by telephone.The first three reasons for discontinuing treatment were the treatment did not achieve the expected effect(115 cases,41.2%),factors pertaining to learning and daily life(74 cases,26.5%)and adverse reactions(29 cases,10.4%).The number of patients stopping SCIT decreased gradually with time;the proportion of patients who discontinued treatment due to adverse reactions in the first year of treatment was higher than that in the second and third years(P<0.05).【Conclusion】Failure to achieve the expected effect was the primary reason for poor compliance of patients receiving SCIT and discontinuation mainly occurred on the early stage of the treatment.The supervision from family members is helpful to improve the compliance,suggesting that individualized measures need to be taken to reduce the loss of SCIT.

关 键 词：皮下特异性免疫治疗 依从性 变应性鼻炎 支气管哮喘 珠三角地区 

分 类 号：R186[医药卫生—流行病学]