本文選題：變應(yīng)性鼻炎 + 特異性免疫治療��； 參考：《寧波大學(xué)》2017年碩士論文

【摘要】：目的:1.觀察變應(yīng)性鼻炎患者皮下特異性免疫治療(SCIT)的臨床療效。2.觀察變應(yīng)性鼻炎患者特異性免疫劑量累加階段唾液sIgG4、血清免疫學(xué)指標(biāo)(sIgG4、血嗜酸性粒細(xì)胞,總IgE、sIgE)、鼻聲反射的變化。3.分析唾液sIgG4與血清sIgG4的相關(guān)性。方法:1.隨機(jī)從2015年8月至2016年6月就診于寧波大學(xué)附屬醫(yī)院以塵螨過敏為主并自愿接受SCIT治療的患者中隨機(jī)選取42例,在治療前及劑量累加階段完成后分別進(jìn)行癥狀VAS評分,血清、唾液及鼻聲檢測,觀察并記錄42例患者治療前后VAS評分、血嗜酸性粒細(xì)胞(絕對值、百分比),血總IgE、sIgE、sIgG4濃度,唾液sIgG4濃度和鼻腔總?cè)莘e以及鼻腔最小截面積的變化。隨訪并記錄患者不良反應(yīng)。2.通過療效評定公式得出患者劑量累加階段結(jié)束后(17周)的療效,統(tǒng)計分析比較治療前后癥狀VAS評分,血清各指標(biāo)及唾液sIgG4濃度變化及鼻聲檢測(鼻腔總?cè)莘e、最小截面積)的變化。3.分析治療前后唾液sIgG4與血清sIgG4的相關(guān)性。結(jié)果:1.42例AR患者共有41例完成劑量累加階段治療,治療后主要癥狀(鼻癢、鼻塞、噴嚏、流涕)VAS評分、伴隨癥狀(眼癢)VAS評分,療效評定:顯效21.95%(9/41),有效56.10%(23/41),無效21.95%(9/41),總有效率78.05%(32/41)。2.與治療前比較,血清sIgG4濃度、唾液sIgG4濃度、鼻腔總?cè)莘e、最小截面積均有統(tǒng)計學(xué)差異(p0.05)。3.與治療前比較,治療后血清嗜酸性粒細(xì)胞絕對值、百分比,總IgE,sIgE差異均無統(tǒng)計學(xué)意義(p0.05)。4.治療前血清sIgG4與唾液sIgG4呈正相關(guān)(R=0.734,P0.05),劑量累加階段完成后血清sIgG4與唾液sIgG4相關(guān)性不明顯(R=0.304,P0.05)。結(jié)論:1.經(jīng)過17W皮下特異性免疫治療,患者鼻部及眼部伴隨癥狀VAS評分均有降低。2.SCIT可使AR患者血清、唾液s IgG4濃度升高,s IgG4可作為客觀評估免疫治療臨床療效的一個重要的免疫學(xué)指標(biāo)。3.鼻腔總?cè)莘e、最小截面積與治療前比較有明顯的增大,免疫治療在早期可以明顯改善鼻通氣功能。4.血清sIgG4與唾液sIgG4的相關(guān)關(guān)系需通過擴(kuò)大樣本量,延長隨訪時間等進(jìn)一步深入研究。
[Abstract]:Purpose 1. To observe the clinical effect of subcutaneous specific immunotherapy in patients with allergic rhinitis. To observe the changes of salivary Siga _ 4, serum immunological index, serum eosinophil, total IgE sIgE, nasal acoustic reflex in patients with allergic rhinitis. The correlation between salivary sIgG4 and serum sIgG4 was analyzed. Method 1: 1. From August 2015 to June 2016, 42 patients with dust mite hypersensitivity were randomly selected from the affiliated Hospital of Ningbo University and accepted SCIT treatment voluntarily. The symptom VAS score and serum were evaluated before and after the dose-accumulation stage. Saliva and nasal acoustic examination were performed to observe and record the changes of VAS score, eosinophilic granulocyte (absolute value, percentage of eosinophils), total IgES IgEN sIgG4 concentration, salivary sIgG4 concentration, nasal total volume and minimal nasal area before and after treatment in 42 patients. Follow up and record adverse reactions. 2. 2. According to the formula of curative effect evaluation, the curative effect was obtained after the end of the patients' dose accumulation stage. The VAS score of symptoms, the changes of serum indexes, saliva sIgG4 concentration and nasal acoustic examination (total volume of nasal cavity) before and after treatment were statistically analyzed and compared. Minimum cross-sectional area). To analyze the correlation between salivary sIgG4 and serum sIgG4 before and after treatment. Results 41 of 41 patients with AR completed the dose-accumulation stage treatment. The main symptoms after treatment (nasal itch, nasal congestion, sneezing, snot) VAS scores, accompanying symptoms (EVAS score, curative effect evaluation: 21.95595 / 41C, effective 56.1010n23 / 41a, no effect 21.9599 / 41a), total effective rate 78.05 / 32 / 41a 路2. 5%. The total effective rate was 78.05 鹵32 / 41 / 41g / L, and the total effective rate was 78.05 / 32 / 41 / 41g / L, and the total effective rate was 78.05 鹵32 / 41 / 41g / L, respectively. Compared with before treatment, the serum sIgG4 concentration, saliva sIgG4 concentration, total volume of nasal cavity and minimum cross section area were all significantly different (P < 0.05). There was no significant difference in serum eosinophil absolute value, percentage and total IgE between before and after treatment. There was a positive correlation between serum sIgG4 and salivary sIgG4 before treatment, and there was no significant correlation between serum sIgG4 and salivary sIgG4 after the completion of dose-accumulation stage. Conclusion 1. After 17 W subcutaneous specific immunotherapy, the VAS scores of nasal and ocular associated symptoms were decreased. 2. SCIT could make the serum of AR patients. Saliva s IgG4 concentration increased and s IgG4 could be used as an important immunological index to objectively evaluate the clinical efficacy of immunotherapy. The total volume and minimum sectional area of nasal cavity were significantly increased compared with those before treatment. Immunotherapy could significantly improve nasal ventilation function at the early stage. The relationship between serum sIgG4 and salivary sIgG4 should be further studied by enlarging sample size and prolonging follow-up time.
【學(xué)位授予單位】：寧波大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R765.21

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