皮下免疫治疗儿童变应性鼻炎的早期疗效与安全性分析  

Short-term efficacy and safety analysis of subcutaneous immunotherapy for children with allergic rhinitis

作　　者：胡宇琴 莫丽华 王贤诚 智敏 钟建文 刘大波 罗向前 HU Yuqin;MO Lihua;WANG Xiancheng;ZHI Min;ZHONG Jianwen;LIU Dabo;LUO Xiangqian(Department of Pediatric Otolaryngology,Shenzhen Hospital of Southern Medical University,Shenzhen,Guangdong,518101,China;Department of Pediatric,Shenzhen Hospital of Southern Medical University,Shenzhen,Guangdong,518101,China)

机构地区：[1]南方医科大学深圳医院儿童耳鼻咽喉科,广东深圳518101 [2]南方医科大学深圳医院儿科,广东深圳518101

出　　处：《中国耳鼻咽喉头颈外科》2025年第1期27-32,共6页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：广东省自然科学基金-青年提升项目(2023A1515030299);深圳市科创委基础研究(面上项目)(JCYJ20230807142209020);南方医科大学深圳医院(腾飞计划)(22H3ATF04)。

摘　　要：目的探讨皮下免疫治疗(subcutaneous immunotherapy,SCIT)对儿童变应性鼻炎(AR)早期疗效、安全性及相关影响因素。方法回顾性分析2020年8月~2024年5月于南方医科大学深圳医院接受SCIT的147例AR儿童的病例资料。收集患者的临床特征及实验室数据,对比首诊及治疗后3、6、12个月的视觉模拟量表(VAS)评分、总症状评分(TSS)、总用药评分(TMS)及综合症状药物评分(CSMS),并统计治疗期间发生的局部不良反应(local adverse reactions,LRs)和全身不良反应(systemic adverse reactions,SRs)的发生率。结果共纳入147例5~18岁的AR患儿。治疗后3、6、12个月的VAS、TSS、TMS及CSMS较基线评分均显著下降(P均<0.001),早期起效时间为治疗后3个月;有效组中维生素D3(VitD3)水平显著高于无效组(P<0.001),血清VitD3含量与和临床症状呈负相关(R=-0.3,P=0.026)。147例患儿的注射总次数为3201次,52例(35.4%)出现LRs,注射次数为69次(2.2%);21例(14.3%)出现SRs,注射次数为34次(1.1%),未出现Ⅲ、Ⅳ级SRs。在Logistics回归分析中,体质量指数(BMI)是导致LRs发生的危险因素(OR:2.220,95%CI:1.009-4.887,P=0.048)。结论SCIT对于AR患儿是一种有效且安全的治疗方法,SCIT对儿童AR早期疗效显著,且安全性良好,VitD3缺乏可影响SCIT的早期疗效,超重肥胖儿童更易发生局部不良反应。OBJECTIVE To explore the short-term efficacy,safety and related influencing factors of subcutaneous immunotherapy(SCIT)in children with allergic rhinitis(AR).METHODS Retrospective analyzed the clinical data of 147 children with AR who underwent SCIT at Shenzhen Hospital of Southern Medical University from August 2020 to May 2024.The clinical characteristics and laboratory parameters were collected,the visual analogue scale(VAS),total symptom score(TSS),total medication score(TMS)and combined symptom medication score(CSMS)were compared at the baseline and 3,6 and 12 months after treatment.The incidence of local adverse reactions(LRs)and systemic adverse reactions(SRs)during treatment was also documented.RESULTS A total of 147 children with AR aged 5-18 years were included in the study.A significant reduction was observed in VAS,TSS,TMS and CSMS at months 3,6 and 12 of follow up compared with baseline(all P<0.001),and the short-term onset time was months 3 after treatment.The level of VitD3 in the effective group was significantly higher than that in the ineffective group(P<0.001).Serum VitD3 level was negatively correlated with clinical symptom(R=-0.3,P=0.026).The total number of injections in 147 children was 3201.LRs occurred in 52 children(35.4%),the number of injections was 69(2.2%).SRs occurred in 21 children(14.3%),and the number of injections was 34(1.1%).No grade III or IV SRs occurred.In the logistic regression analysis,body mass index(BMI)was a risk factor for LRs(OR:2.220,95%CI:1.009-4.887,P=0.048).CONCLUSION SCIT demonstrates significant early efficacy and a favorable safety profile safety in children with AR.Serum Vitamin D3 deficiency can affect the short-term efficacy of SCIT.Overweight and obese children are prone to develop local adverse reactions.

关 键 词：鼻炎 变应性 常年性 儿童 免疫疗法 治疗结果 药物相关的副作用和不良反应 皮下特异性免疫治疗 早期疗效 

分 类 号：R765.21[医药卫生—耳鼻咽喉科]