中国循证儿科杂志 ›› 2018, Vol. 13 ›› Issue (2): 93-96.

• 论著 • 上一篇    下一篇

标准化尘螨特异性皮下免疫治疗尘螨过敏性哮喘伴变应性鼻炎患儿的长期随访研究

黄贇,刘丽娟,尹燕丹,黄剑锋,钱莉玲   

  1. 复旦大学附属儿科医院呼吸科 上海,201102
  • 收稿日期:2017-08-25 修回日期:2018-04-25 出版日期:2018-04-25 发布日期:2018-04-25
  • 通讯作者: 钱莉玲
  • 基金资助:
     

Long-term efficacy of standardized house dust mite specific subcutaneous immunotherapy on children with allergic asthma and rhinitis

 HUANG Yun, LIU Li-juan, YIN Yan-dan, HUANG Jian-feng, QIAN Li-ling   

  1.  Department of Pneumology, Children's Hospital of Fudan University, Shanghai 201102, China
  • Received:2017-08-25 Revised:2018-04-25 Online:2018-04-25 Published:2018-04-25
  • Contact: QIAN LI-ling
  • Supported by:
     

摘要: 目的:探讨标准化尘螨特异性皮下免疫治疗(SCIT)对尘螨过敏性哮喘伴变应性鼻炎患儿远期疗效的影响。 方法:本文为干预效果的长期随访的病例系列报告。对尘螨过敏性哮喘伴变应性鼻炎患儿,开始接受标准化SCIT治疗(T0)至疗程≥30个月治疗结束(T1),在T0、T1、T2(T1后的3年)和T3(T1后的6年),均在哮喘专科门诊或通过电话随访,分别以哮喘症状评分(ASS)、鼻炎症状评分(RSS)、鼻炎与哮喘症状总评分(TSS)、药物评分(TMS)、症状药物总评分(SMS)、视觉模拟量表(VAS)评价和病情改善自我评价量表进行病情估计,ASS、RSS、TSS、TMS评估时点为晚近4周内情况、VAS和病情改善自我评价为患儿或其家长自我感受评估时点为晚近1个月的情况。 结果:2006年4月至2011年6月在哮喘专科门诊诊断为尘螨过敏性哮喘伴变应性鼻炎患儿、且接受了标准化SCIT治疗≥30个月,T1时点56例,男41例,女15例,平均年龄7.1(5~12)岁。均回顾性收集到T0时点病情评估指标ASS、RSS、TSS和VAS,并计算TSS和SMS。随访至T2时点有51例(男38例)和T3时点有45例(男33例)采集到了本文全部病情评估指标。T1时点不同病情评估指标较T0时点差异均有统计学意义。反映病情评估的2个组合指标(TSS和SMS)前后相临时点差异均有统计学意义。病情改善自我评价量表中,变应性鼻炎与哮喘T1时点(18.5% vs 75.0%)、T2时点(31.2% vs 84.0%)、T3时点(39.5% vs 80.0%)比较差异均有统计学意义,病情改善自我评价量表病情评估变应性鼻炎明显差于哮喘。T3时点女生的RSS、TSS、SMS明显低于男生,差异有统计学意义。 结论:标准化SCIT治疗能使尘螨过敏哮喘伴变应性鼻炎患儿的哮喘、鼻炎症状明显减轻,用药减少,VAS评分降低,在停止治疗后的6年仍能维持长期疗效。女性患儿比男性患儿在鼻炎哮喘症状以及症状用药评分方面疗效更加显著。

 

Abstract: Objective:To explore the long-term efficacy of specific subcutaneous immunotherapy (SCIT) with standardized house dust mite on children with asthma and allergic rhinitis. Methods:This paper was a case series report for long-term follow-up of intervention effects. Children with house dust mite allergic asthma and allergic rhinitis received SCIT (T0) to a course of 30 or more months of treatment (T1),at T0, T1, T2 (3 years after T1) and T3 (6 years after T1), either in asthma specialist out-patient or by telephone follow-up. Many indexes were assessed, including asthma symptom scores (ASS), rhinitis symptom score (RSS), total symptom score (TSS), total medication score (TMS), symptom medication score (SMS). Visual analogue scale (VAS) and improvement self-evaluation were also used. ASS, RSS, TSS and TMS were evaluated for nearly 4 weeks. VAS and the condition improved self-evaluation for the children or their parents were used to assess the timing of their own feelings for nearly 1 month. Results:From April 2006 to June 2011, 56 cases ( 41 male cases, average age 7.1 (5~12) years old) were diagnosed as dust mite allergic asthma and allergic rhinitis children in the Asthma specialist outpatient department, and received SCIT treatment ≥ 30 months, meanwhile ASS, RSS, TSS and VAS at T0 were collected retrospectively, and TSS and SMS were calculated. There were 51 cases (38 male cases) at T2 and 45 cases (33 male cases) at T3. All evaluation indexes at T1 were significantly different compared with those at T0. There were significant differences in the 2 composite indexes (TSS and SMS), which reflected the assessment of the illness between any two adjacent time points. In the improvement self-evaluation, the differences of allergic rhinitis and asthma at T1 (18.5% vs 75%), T2 (31.2% vs 84%), T3 (39.5% vs 80%) were statistically significant. In the condition of improving the self-assessment scale,the condition to evaluate allergic rhinitis is obviously worse than asthma. At T3 point, the RSS, TSS, SMS of girls are significantly lower than those of boys and the difference is statistically significant (P<0.05). Conclusion:For children with dust mite allergic asthma and allergic rhinitis, SCIT can improve the asthma and rhinitis symptom markedly, decrease medication and VAS score. The long-term effect can maintain for 6 years after the cessation of treatment. The RSS, TSS and SMS of female children were more effective than those of male children.

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