标准化尘螨过敏原SCIT对儿童AR患者治疗期间的疗效及安全性分析  

The efficacy and safety of standardized dust mite allergen subcutaneous immunotherapy in children with allergic rhinitis during treatment

作　　者：袁璇 谢邵兵 章华[1] 张俊毅[1] 王风君[1] 刘永珍[1] 孟来 钟薇 蒋卫红[1] 谢志海[1] Yuan Xuan;Xie Shaobing;Zhang Hua;Zhang Junyi;Wang Fengjun;Liu Yongzhen;Meng Lai;Zhong Wei;Jiang Weihong;Xie Zhihai(Department of Otorhinolaryngology Head and Neck Surgery,Xiangya Hospital of Central South University,Hunan Province Key Laboratory of Otorhinolaryngology Critical Diseases,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院耳鼻咽喉头颈外科、耳鼻咽喉科重大疾病研究湖南省重点实验室,长沙410008

出　　处：《中华耳鼻咽喉头颈外科杂志》2023年第9期878-884,共7页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：国家自然科学基金(82171118);湖南省自然科学基金(2022JJ30327)。

摘　　要：目的评估标准化尘螨过敏原皮下免疫治疗(subcutaneous immunotherapy,SCIT)对儿童变应性鼻炎(AR)患者治疗期间的疗效和安全性。方法纳入2019年8月至2021年10月于中南大学湘雅医院耳鼻咽喉头颈外科就诊的283例诊断明确为尘螨过敏且完成2~3年SCIT治疗的儿童AR患者,其中男性205例,女性78例,平均年龄10.8岁。记录治疗前及治疗2~3年时不同临床特征儿童AR患者的鼻部症状总评分(total nasal symptoms scores,TNSS)、症状药物总评分(symptom medication score,SMS)、鼻结膜炎相关生活质量评分(rhinoconjunctivitis quality of life questionnaire,RQLQ)和视觉模拟量表(VAS)评分,并比较治疗前后的差异。记录SCIT过程中的不良反应,以评价其安全性。采用SPSS 22.0软件进行统计学分析。结果283例儿童AR患者SCIT治疗期间的总体有效率为89.4%(253/283)。与基线相比,SCIT 2~3年后儿童AR患者的各项症状评分、药物评分和生活质量评分均显著降低(P值均<0.05)。进一步对不同临床特征的儿童AR患者进行分组比较,发现不同年龄段、性别、是否吸烟、是否有AR家族史、不同症状严重程度、单一或多重过敏和是否二次免疫治疗的儿童AR患者均获得良好疗效,且组间差异无统计学意义(P值均>0.05)。SCIT期间共注射12735针次,共发生213(1.67%)针次局部不良反应,以递增期为主,局部风团直径多为5~20 mm;共发生71(0.56%)针次全身不良反应,以递增期为主,多为1级反应,未出现休克等严重全身不良反应。结论标准化尘螨SCIT具有良好的安全性,治疗期间对不同临床特征的儿童AR患者具有确切疗效,可显著改善患儿各项症状,减少对症药物使用,并提高生活质量。Objective To evaluate the efficacy and safety of standardized dust mite allergen subcutaneous immunotherapy(SCIT)in children with allergic rhinitis(AR)during treatment.Methods A total of 283 children with AR diagnosed with definite dust mite allergy and completed 2 to 3 years of SCIT who attended the Department of Otorhinolaryngology Head and Neck Surgery,Xiangya Hospital,Central South University,from August 2019 to October 2021 were included,including 205 males and 78 females,with a mean age of 10.8 years.The total nasal symptoms score(TNSS),symptom medication score(SMS),rhinoconjunctivitis quality of life questionnaire(RQLQ)and visual analogue scale(VAS)before and after 2 to 3 years′treatment were recorded,and the differences before and after treatment were compared.Adverse reactions during SCIT were recorded to evaluate its safety.SPSS 22.0 software was used for statistical analysis.Results The overall effectiveness rate during SCIT in 283 children with AR was 89.4%(253/283).Compared with baseline,all symptom scores,medication scores and quality of life scores were significantly lower after 2 to 3 years of SCIT(all P<0.05).Further group comparisons showed positive efficacy in patients with different clinical characteristics,including age,gender,smoking status,family history of AR,symptom severity,mono-or poly-allergy,and second immunization,with no statistically significant differences between groups(all P>0.05).A total of 12735 injections were administered during the SCIT,and a total of 213(1.67%)injections of local adverse reactions occurred,mainly in the initial treatment phase,and the diameter of the local air mass was mostly 5 to 20 mm;71(0.56%)injections of systemic adverse reactions occurred,mainly in the initial treatment phase,and most of them were grade 1 reactions with no serious systemic adverse reaction such as shock.Conclusion Standardized dust mite SCIT has a good safety profile and definite efficacy in treating AR children with different clinical characteristics.It can significantly improve a

关 键 词：变应性鼻炎 儿童 皮下免疫治疗 疗效 安全性 

分 类 号：R765.21[医药卫生—耳鼻咽喉科]