皮下免疫和舌下免疫治療塵螨變應(yīng)性鼻炎的臨床研究
發(fā)布時間：2019-01-04 08:32
【摘要】： 目的:觀察標(biāo)準(zhǔn)化塵螨變應(yīng)原疫苗皮下免疫療法(subcutaneousimmunotherapy,SCIT)和舌下免疫療法(sublingual immunotherapy,SLIT)治療中-重度持續(xù)性變應(yīng)性鼻炎(allergicrhinitis,AR)的療效、安全性及依從性。 方法:AR患者160例分為兩組,分別采用SCIT和SLIT的治療方案。其中,SCIT組81例,年齡7～62歲,平均年齡(21.5±14.6)歲;SLIT組79例,年齡6～53歲,平均年齡(15.1±10.3)歲。所有患者均為中-重度持續(xù)性AR,對屋塵滿(Derp)和粉塵螨(Derf)過敏。隨訪6個月至2年,觀察免疫治療過程中的局部和全身不良反應(yīng)發(fā)生情況,同時評價患者的依從性及影響因素。對治療滿1年的患者比較治療前后鼻部癥狀評分及視覺模擬量表(visual analogue scale,VAS)評分,并檢測治療前后血清總IgE、特異性IgE和嗜酸粒細(xì)胞陽離子蛋白(eosinophil cationic protein,ECP)水平。 結(jié)果:①臨床效果:治療1年后,SCIT組和SLIT組鼻部癥狀評分及VSA評分均較治療前明顯下降(P0.05)。②血液檢測:治療1年后與治療前比較,SCIT組和SLIT組血清ECP水平明顯下降(P0.05);血清總IgE和塵螨特異性IgE水平無明顯變化(P0.05)。③局部不良反應(yīng):SCIT組所有患者在免疫治療的不同階段均出現(xiàn)過局部反應(yīng),占注射總次數(shù)的62.9%,表現(xiàn)為注射部位周圍局部輕度腫脹。SLIT組有4例(5.1%)出現(xiàn)局部反應(yīng),表現(xiàn)為口腔局部輕度瘙癢不適。兩組患者的局部不良反應(yīng)均屬輕度,可耐受并自行緩解。④全身不良反應(yīng):SCIT組有11例患者(13.6%)發(fā)生全身反應(yīng),共18例次(占注射總次數(shù)0.9%),大多數(shù)為速發(fā)性反應(yīng),多見于維持治療階段,臨床表現(xiàn)主要是胸悶和呼吸困難、哮喘發(fā)作、蕁麻疹。SLIT組也有11例患者(13.9%)發(fā)生全身反應(yīng),包括胃腸道反應(yīng)、蕁麻疹和鼻炎癥狀加重等,主要發(fā)生在劑量遞增階段。兩組全身不良反應(yīng)的發(fā)生率無統(tǒng)計學(xué)差異(P0.05)。SCIT組有1例為非致命性嚴(yán)重全身反應(yīng)(嚴(yán)重哮喘),兩組患者其余的全身反應(yīng)均屬于輕到中度,未發(fā)生過敏性休克。⑤依從性:160例患者對免疫治療的總體依從性為83.1%,其中SCIT組和SLIT組的依從性分別為86.4%和79.8%,兩者之間差異無統(tǒng)計學(xué)意義(P0.05)�；颊卟灰缽�(提前退出治療)的首要原因均為自覺療效不滿意,SCIT組和SLIT組分別占6.2%和10.1%。 結(jié)論:塵螨AR患者采用皮下注射或舌下含服途徑進行特異性免疫治療均有良好的療效、安全性及依從性,兩種治療方式的全身不良反應(yīng)發(fā)生率和患者依從性無明顯差異。
[Abstract]:Objective: to observe the efficacy, safety and compliance of subcutaneous immunotherapy (subcutaneousimmunotherapy,SCIT) and sublingual immunotherapy (sublingual immunotherapy,SLIT) in the treatment of moderate to severe persistent allergic rhinitis (allergicrhinitis,AR). Methods: 160 patients with AR were divided into two groups and treated with SCIT and SLIT respectively. In the SCIT group, 81 cases were aged 762 years, the average age was (21.5 鹵14.6) years old, and 79 cases in the SLIT group were 653 years old with an average age of 15.1 鹵10.3 years. All patients were moderately-severe persistent AR, allergic to house dust-filled (Derp) and dust mites (Derf). Patients were followed up for 6 months to 2 years to observe the occurrence of local and systemic adverse reactions in the course of immunotherapy, and to evaluate the compliance and influencing factors of the patients. The scores of nasal symptoms and visual analogue scale (visual analogue scale,VAS) were compared before and after treatment for one year. The serum levels of total IgE, specific IgE and eosinophil cationic protein (eosinophil cationic protein,ECP were measured before and after treatment. Results: 1 Clinical effect: after 1 year of treatment, nasal symptom score and VSA score in SCIT group and SLIT group were significantly lower than those before treatment (P0.05). The level of serum ECP in SCIT group and SLIT group was significantly decreased (P0.05). There was no significant change in serum total IgE and dust mite-specific IgE levels (P0.05). 3 Local adverse reactions occurred in all patients in SCIT group at different stages of immunotherapy, accounting for 62.9% of the total number of injections. In SLIT group, 4 cases (5.1%) showed local reaction, which showed mild itching discomfort in oral cavity. The local adverse reactions in both groups were mild, tolerable and self-relieved. 4 systemic adverse reactions occurred in 11 patients (13.6%) in the SCIT group, 18 times (0.9% of the total injection times). The main clinical manifestations were chest tightness and dyspnea, asthma attack and urticaria. In SLIT group, 11 patients (13.9%) had systemic reactions, including gastrointestinal reactions. Urticaria and rhinitis symptoms are aggravated, mainly in the dose increasing stage. There was no significant difference in the incidence of systemic adverse reactions between the two groups (P0.05 in). SCIT group, 1 case was non-fatal severe systemic reaction (severe asthma), and the rest of systemic reactions in both groups were mild to moderate. No anaphylactic shock. 5 Compliance: the overall compliance of 160 patients with immunotherapy was 83.1, in which the compliance of SCIT group and SLIT group was 86.4% and 79.8%, respectively. There was no significant difference between the two groups (P0.05). The main cause of patients' noncompliance (early withdrawal from treatment) was self-conscious efficacy dissatisfactory, SCIT group and SLIT group accounted for 6.2% and 10.1%, respectively. Conclusion: the specific immunotherapy with subcutaneous injection or sublingual administration for AR patients has good efficacy, safety and compliance. There is no significant difference in the incidence of systemic adverse reactions and compliance between the two treatments.
【學(xué)位授予單位】：南京醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R765.21
本文編號：2400042
[Abstract]:Objective: to observe the efficacy, safety and compliance of subcutaneous immunotherapy (subcutaneousimmunotherapy,SCIT) and sublingual immunotherapy (sublingual immunotherapy,SLIT) in the treatment of moderate to severe persistent allergic rhinitis (allergicrhinitis,AR). Methods: 160 patients with AR were divided into two groups and treated with SCIT and SLIT respectively. In the SCIT group, 81 cases were aged 762 years, the average age was (21.5 鹵14.6) years old, and 79 cases in the SLIT group were 653 years old with an average age of 15.1 鹵10.3 years. All patients were moderately-severe persistent AR, allergic to house dust-filled (Derp) and dust mites (Derf). Patients were followed up for 6 months to 2 years to observe the occurrence of local and systemic adverse reactions in the course of immunotherapy, and to evaluate the compliance and influencing factors of the patients. The scores of nasal symptoms and visual analogue scale (visual analogue scale,VAS) were compared before and after treatment for one year. The serum levels of total IgE, specific IgE and eosinophil cationic protein (eosinophil cationic protein,ECP were measured before and after treatment. Results: 1 Clinical effect: after 1 year of treatment, nasal symptom score and VSA score in SCIT group and SLIT group were significantly lower than those before treatment (P0.05). The level of serum ECP in SCIT group and SLIT group was significantly decreased (P0.05). There was no significant change in serum total IgE and dust mite-specific IgE levels (P0.05). 3 Local adverse reactions occurred in all patients in SCIT group at different stages of immunotherapy, accounting for 62.9% of the total number of injections. In SLIT group, 4 cases (5.1%) showed local reaction, which showed mild itching discomfort in oral cavity. The local adverse reactions in both groups were mild, tolerable and self-relieved. 4 systemic adverse reactions occurred in 11 patients (13.6%) in the SCIT group, 18 times (0.9% of the total injection times). The main clinical manifestations were chest tightness and dyspnea, asthma attack and urticaria. In SLIT group, 11 patients (13.9%) had systemic reactions, including gastrointestinal reactions. Urticaria and rhinitis symptoms are aggravated, mainly in the dose increasing stage. There was no significant difference in the incidence of systemic adverse reactions between the two groups (P0.05 in). SCIT group, 1 case was non-fatal severe systemic reaction (severe asthma), and the rest of systemic reactions in both groups were mild to moderate. No anaphylactic shock. 5 Compliance: the overall compliance of 160 patients with immunotherapy was 83.1, in which the compliance of SCIT group and SLIT group was 86.4% and 79.8%, respectively. There was no significant difference between the two groups (P0.05). The main cause of patients' noncompliance (early withdrawal from treatment) was self-conscious efficacy dissatisfactory, SCIT group and SLIT group accounted for 6.2% and 10.1%, respectively. Conclusion: the specific immunotherapy with subcutaneous injection or sublingual administration for AR patients has good efficacy, safety and compliance. There is no significant difference in the incidence of systemic adverse reactions and compliance between the two treatments.
【學(xué)位授予單位】：南京醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R765.21
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