螨过敏性哮喘患儿标准化特异性免疫治疗3年的有效性观察

Therapeutic efficacy of 3-year subcutaneous immunotherapy in asthmatic children allergic to mite

摘要:

目的：评价皮下注射免疫治疗（SCIT）3年对螨过敏性哮喘患儿的有效性。方法：选择对屋尘螨过敏的哮喘（伴或不伴有过敏性鼻炎）患儿90例（5~14岁），随机分成SCIT联合哮喘规范化治疗组（n=45）与仅哮喘规范化治疗的对照组（n=45），观察两组患儿3年治疗中的症状评分、吸入激素的用量、皮肤变应原点刺试验结果、最大呼气流速、血清总IgE的变化。结果：SCIT治疗组和对照组治疗第1、2、3年的日、夜间症状评分均较其基线期明显下降（P<0.01），且随着治疗时间的延长而逐年下降（P<0.01）。SCIT治疗组、对照组治疗第1、2、3年吸入激素剂量均明显低于其基线期（P<0.01），且随着治疗时间的延长而逐年下降（P<0.01）。治疗组吸入激素平均剂量于第2年、第3年均低于对照组（P<0.05）。3年治疗结束后，因症状缓解而停止吸入激素比例SCIT治疗组较对照组高（29% vs 20%，P<0.05）。第3年末SCIT治疗组血清总IgE水平较其基线期明显下降（P<0.01），亦明显低于对照组（P<0.05）。结论：SCIT治疗对于过敏性哮喘患儿是有效的，并可减少吸入性激素的用量。

Abstract:

OBJECTIVE: To evaluate the therapeutic efficacy of 3-year subcutaneous immunotherapy (SCIT) in asthmatic children allergic to mite. METHODS: Ninety asthmatic children allergic to house dust mite (with or without allergic rhinitis) and aged 5-14 years were randomized into SCIT treatment group (n=45) and control group (n=45). The SCIT treatment group received SCIT combined with standardized treatment for asthma, while the control group received the standardized treatment alone. The therapeutic effects were assessed based on the daytime and nighttime symptom scores, mean daily doses of inhaled corticosteroids (ICS), skin prick test results, peak expiratory flows and total serum IgE at baseline and in the 3-year treatment. RESULTS: In both groups, the daytime and nighttime symptom scores in the first, second, and third years of treatment were significantly lower than the baseline values (P<0.01), and the scores decreased year by year during the 3-year treatment (P<0.01). Also, the mean daily doses of ICS in the first, second, and third years of treatment were significantly lower than the baseline values (P<0.01), and the doses decreased year by year during the 3-year treatment (P<0.01). The mean daily dose was significantly lower in the SCIT treatment group than in the control group in the second and third years of treatment (P<0.05). After 3-year treatment, the SCIT treatment group had a significantly higher proportion of children who discontinued use of ICS due to remission of symptoms compared with the control group (29% vs 20%, P<0.05). At the end of the 3-year treatment, the total serum IgE was significantly lower than the baseline value in the SCIT treatment group (P<0.01), and it was significantly lower in the SCIT treatment group than in the control group (P<0.05). CONCLUSIONS: Three-year SCIT is effective in asthmatic children allergic to house dust mite and allows reduction in the dosage of ICS.