变应原特异性免疫治疗在变应性鼻炎伴哮喘治疗中的临床疗效  

Clinical Efficacy of Allergen Specific Immunotherapy in the Treatment of Allergic Rhinitis with Asthma

作　　者：卢蓉蓉 张兰 郑洁 蒋路云[2] LU Rongrong;ZHANG Lan;ZHENG Jie(Clinical Medical College,Chengdu University of Traditional Chinese Medicine,Sichuan 610075,China)

机构地区：[1]成都中医药大学临床医学院,610075 [2]成都中医药大学附属医院耳鼻咽喉科,610072

出　　处：《医学研究杂志》2023年第4期138-147,共10页Journal of Medical Research

摘　　要：目的 系统评价变应原特异性免疫治疗在变应性鼻炎伴哮喘治疗中的临床疗效,为临床治疗提供循证依据。方法计算机检索PubMed、Cochrane Library、EMBASE、Web of Science、中国知网(CNKI)、万方数据知识服务平台、维普网等数据库,收集公开发表的所有关于变应原特异性免疫治疗治疗变应性鼻炎伴哮喘的随机对照试验,文献检索起止时间从建库至2022年4月30日。按纳入标准筛选文献并对纳入文献进行严格质量评价后提取资料,应用Rev Man 5.4软件进行Meta分析。结果 共纳入16篇随机对照研究,共计1904例患者。变应原特异性免疫治疗1130例,常规药物治疗774例。Meta分析结果显示,在儿童鼻炎症状评分(RR=-1.75,95%CI:-2.45~-1.05,P<0.001)、成人鼻炎症状评分(RR=-2.35,95%CI:-3.82~-0.88,P=0.002)、儿童哮喘症状评分(RR=-1.35,95%CI:-1.68~-1.01,P<0.001)、成人哮喘症状评分(RR=-1.22,95%CI:-1.34~-1.10,P<0.001)、患儿第1秒用力呼气容积实测值占预计值百分率(FEV1%)(RR=0.42,95%CI:0.32~0.52,P<0.001)、患儿用力肺活量(forced vital capacity, FVC)方面,变应原特异性免疫治疗组与常规药物组比较,差异均有统计学意义(RR=0.30,95%CI:0.20~0.39,P<0.001)。两组血清白细胞介素(interleukin, IL-4)方面比较,差异无统计学意义(RR=-4.70,95%CI:-9.98~0.57,P=0.08)。结论 变应原特异性免疫治疗在变应性鼻炎伴哮喘治疗中的临床疗效优于常规药物治疗。但考虑到本研究纳入文献质量普遍较低,未来仍需进行更高质量的随机对照试验深入研究,进一步证实特异性免疫治疗在变应性鼻炎伴哮喘治疗中的临床疗效。Objective To systematically evaluate the clinical efficacy of allergen specific immunotherapy(ASIT)for allergic rhinitis with asthma,and to provide evidenced-based evidence for clinical treatment.Methods Retrieved from PubMed,Cochrane Library,EMBASE,Web of Science,CNKI,Wangfang data,VIP database and so on.Randomized controlled trials about ASIT for allergic rhinitis with asthma were collected during database inception to April 30,2022.Extract data after the literatures were screened according to the inclusion criteria and strictly evaluated qualities,Mata-analysis was performed by using Rev Man 5.4software.Results Sixteen randomized controlled trials were identified,a total of 1904 cases were included,of which 1130 were treated with ASIT(ASIT group)and 774 were treated with routine drug therapy(routine group).Meta-analysis showed that there were significant differences in the scores of rhinitis symptoms in children(RR=-1.75,95%CI:-2.45--1.05,P<0.001),the scores of adult rhinitis symptom(RR=-2.35,95%CI:-3.82--0.88,P<0.001),the asthma symptom scores of children(RR=-1.35,95%CI:-1.68--1.01,P<0.001),the asthma symptom scores of adult(RR=-1.22,95%CI:-1.34--1.10,P<0.001),the percentage of forced expiratory volume measured in the first second to the predicted value(FEV1%)of children(RR=0.42,95%CI:0.32-0.52,P<0.001),the forced vital capacity(FVC)of children(RR=0.30,95%CI:0.20-0.39,P<0.001)between ASIT group and routine group;there was significant difference in serum interleukin(IL-4)between the two groups(RR=-4.70,95%CI:-9.98-0.57,P=0.08).Conclusion The clinical efficacy of ASIT in the treatment of allergic rhinitis with asthma is superior to routine drug therapy.However,considering that the qualities of the included literatures of this study are generally not high,further research of high qualities of randomized controlled trials are still needed in the future to further confirm the clinical efficacy of ASIT for allergic rhinitis with asthma.

关 键 词：变应性鼻炎伴哮喘 变应原特异性免疫治疗 临床疗效 META分析 

分 类 号：R765[医药卫生—耳鼻咽喉科]