發(fā)布時(shí)間：2018-08-29 10:52

【摘要】：目的觀察和評(píng)價(jià)2年粉塵螨滴劑(Dermatophagoides Farinae Drops,DFD)舌下脫敏免疫治療(Sublingual immunotherapy,SLIT)兒童過(guò)敏性哮喘的療效和安全性。方法選取2012年3月-6月福建省福州兒童醫(yī)院哮喘�？崎T(mén)診110例6-14歲非急性發(fā)作期輕-中度過(guò)敏性哮喘兒童,隨機(jī)分成實(shí)驗(yàn)組和對(duì)照組各55例。實(shí)驗(yàn)組按照全球哮喘防治創(chuàng)議(Global INitiative for Asthma,GINA)方案常規(guī)治療和舌下含服DFD,對(duì)照組按照GINA方案常規(guī)治療。通過(guò)2年隨訪,每個(gè)月評(píng)估日、夜間哮喘癥狀(Daytime nighttime asthma symptom,DNAS)評(píng)分、兒童哮喘控制測(cè)試(Children asthma control test,C-ACT)評(píng)分及安全性,每6個(gè)月復(fù)查肺功能第1秒用力呼氣容積(forced expiratory volume in one secon,FEV1)占用力肺活量(forced vital capacity,FVC)的百分比即1秒率(FEV1/FVC,FEV1%)、用力呼氣流量25%(forced expiratory flow25%,FEF25%)、用力呼氣流量50%(forced expiratory flow50%,FEF50%)、呼氣峰流量(peak expiratory flow,PEF),每12個(gè)月復(fù)查特異性免疫球蛋白G4(Specific immunoglobulin G4,s Ig G4)、特異性免疫球蛋白E(Specific Immunoglobulin E,s Ig E)、皮膚點(diǎn)刺檢測(cè)(Skin Prick Test,SPT),并記錄2年期間兩組患兒呼吸道感染次數(shù)、哮喘發(fā)作次數(shù)、兒童誤學(xué)天數(shù)和吸入型糖皮質(zhì)激素(inhaled corticosteroid,IC)劑量。結(jié)果1.治療24個(gè)月實(shí)驗(yàn)組肺功能FEV1%、FEF25%、FEF50%、Ig G4值、C-ACT評(píng)分較對(duì)照組升高(t=-2.146 P=0.005,t=-2.185 P=0.031,t=-3.098 P=0.003,t=-7.583 P=0.0001,t=-2.146 P=0.034),DAS、NAS評(píng)分較對(duì)照組降低(t=2.183 P=0.035,t=2.103 P=0.03),差異有統(tǒng)計(jì)學(xué)意義。2.治療24個(gè)月實(shí)驗(yàn)組粉塵螨皮試等級(jí)變化、s Ig E、肺功能PEF值與對(duì)照組比較無(wú)差異(χ2=0.510 P=0.185,t=-0.183 P=0.855,t=-1.877P=0.063)。3.實(shí)驗(yàn)組治療24個(gè)月后肺功能各指標(biāo)FEV1%、FEF25%、FEF50%較治療前明顯升高(t=-5.973 P=0.0001,t=-2.431 P=0.019,t=-3.957P=0.0001),差異有統(tǒng)計(jì)學(xué)意義。4.對(duì)照組治療24個(gè)月后肺功能FEV1%較治療前明顯升高(t=-6.201P=0.0001),FEF25%、FEF50%與治療前比較差異無(wú)統(tǒng)計(jì)學(xué)意義(t=1.461P=0.150,t=-1.770 P=0.083)。5.實(shí)驗(yàn)組s Ig G4值在治療12個(gè)月和治療24個(gè)月逐年升高,差異有統(tǒng)計(jì)學(xué)意義(F=44.722 P=0.0001)。6.治療24個(gè)月后實(shí)驗(yàn)組呼吸道感染次數(shù)、哮喘發(fā)作次數(shù)、兒童誤學(xué)天數(shù)較對(duì)照組明顯減少(t=-2.409 P=0.020,t=-3.194 P=0.002,t=-2.304P=0.026),差異有統(tǒng)計(jì)學(xué)意義。7.治療24個(gè)月后實(shí)驗(yàn)組IC劑量較對(duì)照組明顯減少(χ2=9.072 P=0.028)。結(jié)論1.DFD SLIT可以改善過(guò)敏性哮喘患兒的肺功能指標(biāo)FEV1%、FEF25%、FEF50%和臨床癥狀如DNAS、C-ACT評(píng)分。2.DFD SLIT可以減少呼吸道感染次數(shù)、哮喘發(fā)作次數(shù)、兒童誤學(xué)天數(shù)和IC劑量。3.DFD SLIT可以產(chǎn)生特異性封閉抗體s Ig G4,并在2年治療中呈現(xiàn)逐年顯著升高,減輕過(guò)敏癥狀。4.DFD是一種安全、有效治療過(guò)敏性哮喘兒童的特異性免疫藥物。
[Abstract]:Objective to observe and evaluate the efficacy and safety of sublingual desensitization immunotherapy (Sublingual immunotherapy,SLIT) for 2 years with dermatophagoides farinae drop (Dermatophagoides Farinae Drops,DFD) in children with allergic asthma. Methods from March to June, 2012, 110 children with mild to moderate allergic asthma aged 6-14 years were randomly divided into two groups: experimental group (n = 55) and control group (n = 55). The experimental group was treated according to global asthma prevention and treatment regimen (Global INitiative for Asthma,GINA) and the sublingual DFD, group was treated with GINA regimen. After 2 years follow-up, each month assessment day, night asthma symptom (Daytime nighttime asthma symptom,DNAS) score, childhood asthma control test (Children asthma control test,C-ACT) score and safety, The percentage of forced expiratory volume (forced expiratory volume in one secon,FEV1) in forced vital capacity (forced vital capacity,FVC) was 1 second (FEV1/FVC,FEV1%), forced expiratory flow (25% (forced expiratory flow25%,FEF25%), forced expiratory flow (50% (forced expiratory flow50%,FEF50%), peak expiratory flow (peak expiratory flow,PEF) every 12 months. The specific immunoglobulin G _ 4 (Specific immunoglobulin G _ 4s Ig G4) and the specific immunoglobulin E (Specific Immunoglobulin Eros Ig E), skin prick were examined for (Skin Prick Test,SPT). The respiratory tract infection times of the two groups were recorded during the 2-year period. Asthma attacks, school days and inhaled glucocorticoid (inhaled corticosteroid,IC) doses in children. Result 1. After 24 months of treatment, the FEV1%,FEF25%,FEF50%,Ig G4 scores and C-ACT scores in the experimental group were significantly higher than those in the control group (t = 2.146, P ~ (0.005), t ~ (-2.185) ~ (0.031) ~ (-3.098), P ~ (0.003) ~ (-7.583) P ~ (0.0001) ~ (0.0001) ~ (2.146) P ~ (0.034), and the DASNAS score was significantly lower than that in the control group (t ~ (2.183) P ~ (0.035) P ~ (2.103) P ~ (0.03). After 24 months of treatment, there was no significant difference in the grade of dermatophagoides farinae and the PEF value of lung function between the experimental group and the control group (蠂 ~ 2 ~ (2) 0. 510 P ~ (0. 185) P ~ (- 0.183) P ~ (-1) P ~ (-1) P ~ + 0.85 ~ (7) P ~ 0. 063). After 24 months of treatment, the FEV1%,FEF25%,FEF50% of lung function in the experimental group was significantly higher than that before treatment (t _ (-5.973) P ~ (0.0001) ~ (0.0001) ~ (-2.431) P ~ (-1) (t ~ (-5.973) P ~ (0.000) ~ (-2.431) ~ (0.019) ~ (3.957) P ~ (-1). After 24 months of treatment, the pulmonary function of the control group was significantly higher than that before treatment (t=-6.201P=0.0001). There was no significant difference in 50% of FEF25 and before treatment (t = 1.461) or 0.150 ~ (-1.770) P0. 083) .5. The value of Ig G4 in the experimental group increased year by year after 12 months of treatment and 24 months of treatment, and the difference was statistically significant (FF4 44.722 P0. 0001) .6. After 24 months of treatment, the number of respiratory tract infection, the number of asthma attacks and the number of days of school error in children in the experimental group were significantly lower than those in the control group (t _ (2.409) P ~ (0.020) P ~ (-3.194) P ~ (-1). The difference was statistically significant (t ~ (2) -2.304 P ~ (+) P ~ (0.026). After 24 months of treatment, the dose of IC in the experimental group was significantly lower than that in the control group (蠂 ~ 2 / 9.072 P ~ (0.028). Conclusion 1.DFD SLIT can improve the pulmonary function index FEV1%,FEF25%,FEF50% and clinical symptoms such as DNAS,C-ACT score. 2. DFD SLIT can reduce the number of respiratory tract infections and asthma attacks in children with allergic asthma. The days of school error in children and the dosage of IC. 3. DFD SLIT could produce specific blocking antibody s Ig G4, and increased significantly year by year during 2 years treatment. 4. DFD is a safe and effective specific immunotherapy for children with allergic asthma.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R725.6

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 邵玉芳;郭小銘;李轉(zhuǎn)芬;;不同點(diǎn)刺陽(yáng)性級(jí)別兒童過(guò)敏性哮喘患者的肺功能比較[J];齊齊哈爾醫(yī)學(xué)院學(xué)報(bào);2013年10期

2 陳久艷;徐吉成;;安脫達(dá)標(biāo)準(zhǔn)化塵螨疫苗治療兒童過(guò)敏性哮喘32例療效觀察[J];蘇州大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2009年06期

3 王曉玲;趙一鳴;;舌下脫敏療法在兒童過(guò)敏性哮喘中的應(yīng)用[J];兒科藥學(xué)雜志;2009年06期

4 ;抗生素與兒童過(guò)敏性哮喘[J];中國(guó)處方藥;2012年01期

5 郭萬(wàn)里;;寵物飼養(yǎng)及居住條件與學(xué)齡前兒童過(guò)敏性哮喘的關(guān)系[J];中國(guó)優(yōu)生優(yōu)育;2013年03期

6 秦長(zhǎng)云;兒童過(guò)敏性哮喘長(zhǎng)期脫敏治療的效果及其免疫學(xué)變化[J];右江民族醫(yī)學(xué)院學(xué)報(bào);1999年05期

7 廖翠芳;王靜;;兒童過(guò)敏性哮喘的舌下特異性免疫治療的療效與安全性分析[J];現(xiàn)代預(yù)防醫(yī)學(xué);2011年01期

8 胡琴;連金媚;吳愛(ài)玲;;不同藥物防治兒童過(guò)敏性哮喘發(fā)作的療效對(duì)比[J];社區(qū)醫(yī)學(xué)雜志;2012年11期

9 李慧香;尹麗娟;王淑玲;孫宗芝;;吸入糖皮質(zhì)激素治療兒童過(guò)敏性哮喘療程的研究[J];臨床薈萃;2007年14期

10 徐嘯晨;褚燕琦;王曉玲;;兒童過(guò)敏性哮喘書(shū)面藥物咨詢服務(wù)1例介紹[J];兒科藥學(xué)雜志;2011年01期

相關(guān)會(huì)議論文 前8條

1 王曉玲;;舌下脫敏療法在兒童過(guò)敏性哮喘中的應(yīng)用[A];第二十屆全國(guó)兒科藥學(xué)學(xué)術(shù)會(huì)議暨首屆全國(guó)兒科中青年藥師論文報(bào)告會(huì)論文集[C];2009年

2 陳偉;曹蘭芳;孔憲明;王利民;趙瑜;;自然殺傷細(xì)胞在兒童過(guò)敏性哮喘和/或鼻炎中的變化研究[A];中華醫(yī)學(xué)會(huì)2011年全國(guó)變態(tài)反應(yīng)學(xué)術(shù)會(huì)議論文集[C];2011年

3 趙仕勇;;特異性免疫治療對(duì)兒童過(guò)敏性哮喘的臨床療效和免疫學(xué)調(diào)控[A];中華醫(yī)學(xué)會(huì)第十三屆全國(guó)兒科呼吸學(xué)術(shù)會(huì)議論文匯編[C];2012年

4 張春林;;兒童過(guò)敏性哮喘患者口服粉塵螨滴劑臨床療效觀察[A];中華醫(yī)學(xué)會(huì)2010年全國(guó)變態(tài)反應(yīng)學(xué)術(shù)會(huì)議暨中歐變態(tài)反應(yīng)高峰論壇參會(huì)指南/論文匯編[C];2010年

5 武其文;蔡鵬程;陳治中;吳曉慧;胡麗華;;基于家系的Tim-1基因啟動(dòng)子多態(tài)性與兒童過(guò)敏性哮喘的關(guān)聯(lián)研究[A];中華醫(yī)學(xué)會(huì)第八次全國(guó)檢驗(yàn)醫(yī)學(xué)學(xué)術(shù)會(huì)議暨中華醫(yī)學(xué)會(huì)檢驗(yàn)分會(huì)成立30周年慶典大會(huì)資料匯編[C];2009年

6 李安生;唐蓉芳;;特異性免疫療法(SIT)治療兒童過(guò)敏性哮喘的臨床研究[A];第一屆全國(guó)變態(tài)反應(yīng)學(xué)術(shù)研討會(huì)論文匯編[C];2001年

7 姜毅;李溫慈;徐海濱;邵山鷹;;舌下變應(yīng)原特異性免疫療法對(duì)兒童過(guò)敏性哮喘臨床療效及肺功能的影響[A];2011年浙江省醫(yī)學(xué)會(huì)兒科學(xué)分會(huì)學(xué)術(shù)年會(huì)暨兒內(nèi)科疾病診治新進(jìn)展國(guó)家級(jí)學(xué)習(xí)班論文匯編[C];2011年

8 姜毅;李溫慈;徐海濱;邵山鷹;;舌下變應(yīng)原特異性免疫療法對(duì)兒童過(guò)敏性哮喘臨床療效及PPAR-γ及IL-4的影響[A];2011年浙江省醫(yī)學(xué)會(huì)兒科學(xué)分會(huì)學(xué)術(shù)年會(huì)暨兒內(nèi)科疾病診治新進(jìn)展國(guó)家級(jí)學(xué)習(xí)班論文匯編[C];2011年

相關(guān)重要報(bào)紙文章 前1條

1 范曉艷;omalizumab治療兒童過(guò)敏性哮喘安全有效[N];醫(yī)藥經(jīng)濟(jì)報(bào);2003年

相關(guān)碩士學(xué)位論文 前5條

1 閻冰;T-bet和GATA3在兒童過(guò)敏性哮喘脫敏治療中的變化[D];鄭州大學(xué);2007年

2 劉艷琳;粉塵螨滴劑舌下免疫治療兒童過(guò)敏性哮喘的臨床研究[D];福建醫(yī)科大學(xué);2014年

3 孔珍珍;兒童過(guò)敏性哮喘特異性免疫治療過(guò)程中Foxp3和IL-27 mRNA表達(dá)水平的變化[D];鄭州大學(xué);2011年

4 王芳;兒童過(guò)敏性哮喘特異性免疫治療過(guò)程中IL-10、TGF-β1和CD4~+CD25~+ T細(xì)胞的變化[D];鄭州大學(xué);2009年

5 張靖華;兒童過(guò)敏性哮喘特異性免疫治療過(guò)程中IFN-γ/IL-4比值、FOXP3和CD4~+CD25~+ T細(xì)胞的變化[D];鄭州大學(xué);2010年

，

本文編號(hào)：2210981