标准化变应原皮下特异性免疫治疗对单一与多重过敏性哮喘儿童的疗效对比  

The efficacy of standardized allergen subcutaneous specific immunotherapy in children with monosensitized versus polysensitized allergic asthma

作　　者：杨瑾禹 丁圣刚[1,2] 张素丽 朱玉林[1,2] 丁俊丽 霍绍虎[1,2] 邹延峰 Yang Jinyu;Ding Shenggang;Zhang Suli;Zhu Yulin;Ding Jun;Huo Shaohu;Zou Yanfeng(Dept of Pediatrics,The First Afliated Hospital of Anhui Medical University,Hefei 230022;Beijing Children's Hospital,Capital Medical University,China National Clinical Research Center of Respiratory Diseases,Beijing 100045;School of Public Health,Anhui Medical University,Hefei 230032)

机构地区：[1]安徽医科大学第一附属医院儿科,合肥230022 [2]首都医科大学附属北京儿童医院,国家呼吸系统疾病临床研究中心,北京100045 [3]安徽医科大学公共卫生学院,合肥230032

出　　处：《安徽医科大学学报》2023年第7期1200-1204,共5页Acta Universitatis Medicinalis Anhui

基　　金：国家自然科学基金(编号:52273113);2019年安徽省重点研究与开发计划项目(编号:201904a07020042)。

摘　　要：目的探讨标准化变应原皮下特异性免疫治疗(SCIT)对单一尘螨变应原与多重变应原过敏的哮喘儿童的疗效,评估SCIT安全性。方法回顾性分析62例确诊过敏性哮喘且接受标准化变应原SCIT患儿,根据皮肤点刺试验(SPT)结果将患儿分为单一组(仅尘螨结果≥+++)和多重组(尘螨结果≥+++合并其他阳性过敏原),经过标准化变应原SCIT 3年,观察两组患儿治疗前后的肺功能、用药评分及视觉模拟评分(VAS评分)、儿童哮喘控制测试(C-ACT)评分、哮喘控制问卷(ACQ)评分的变化,并对两组疗效进行对比;记录所有患儿治疗期间局部及全身不良反应的发生情况,评估SCIT安全性。结果标准化变应原SCIT治疗能够改善单一组和多重组肺功能指标、用药评分及VAS评分、C-ACT评分、ACQ评分,治疗前后差异均有统计学意义(P<0.05)。两组间进行比较,治疗后单一组肺功能指标[用力呼出50%肺活量时的瞬间呼气流量(FEF50%)、最大呼气中段流量(MMEF)]、用药评分及C-ACT评分、ACQ评分与多重组相比改善明显(P<0.001)。62例患者SCIT治疗注射期间总计接受注射2606次,6例患儿出现共10针次局部不良反应,局部不良反应发生率为0.38%;3例患儿出现3针次轻、中度全身不良反应,全身不良反应发生率为0.12%。结论单一组和多重组哮喘患儿在标准化变应原SCIT下均能获得显著且安全的临床疗效;标准化变应原SCIT下单一组疗效优于多重组。Objective To investigate the efficacy of standardized allergen subcutaneous immunotherapy(SCIT)in children with asthma sensitized to single dust mite allergens versus multiple allergens and to assess the safety of SCIT.Methods 62 children with confirmed allergic asthma who received standardized allergen SCIT were retrospectively analyzed and divided into the monosensitized group(dust mite results≥+++)and the polysensitized group(dust mite results≥+++combined with other positive allergens)according to the results of skin prick test,we observed the changes of pulmonary function,medication score and visual analog scale(VAS)scores,children asthma control test(C-ACT)scores,asthma control questionnaire(ACQ)scores before and after treatment in both groupsand compared the efficacy of the two groups.The incidence of local and systemic adverse effects was recorded during treatment in all children to assess the safety of SCIT.Results Standardized allergen SCIT treatment improved lung function parameters,medication scores and VAS scores,C-ACT scores,ACQ scores in both the monosensitized and polysensitized groups,with statistically significant differences before and after treatment(P<0.05).In comparison between the two groups,lung function parameters[forced expiratory flow at 50%vital capacity(FEF50%),maximum midexpiratory flow(MMEF)],medication scores,C-ACT scores and ACQ scores improved significantly in the monosensitized group compared with the polysensitized group after treatment(P<0.001).62 patients received a total of 2606 injections during the treatment of SCIT,6 children had a total of 10 local adverse reactions and 3 children had 3 mild to moderate systemic adverse reactions,with an incidence of 0.38% for local adverse reactions and 0.12% for systemic adverse reactions.Conclusion The children with asthma in both the monosensitized group and polysensitized group achieved significant and safe clinical outcomes under standardized allergen SCIT.The children in the monosensitized group had more obvious clinical effect

关 键 词：标准化变应原皮下特异性免疫治疗 尘螨 儿童哮喘 单一过敏 多重过敏 

分 类 号：R725.622.5[医药卫生—儿科]