皮下免疫和舌下免疫治疗尘螨变应性鼻炎的临床研究
发布时间：2019-01-04 08:32
【摘要】： 目的:观察标准化尘螨变应原疫苗皮下免疫疗法(subcutaneousimmunotherapy,SCIT)和舌下免疫疗法(sublingual immunotherapy,SLIT)治疗中-重度持续性变应性鼻炎(allergicrhinitis,AR)的疗效、安全性及依从性。 方法:AR患者160例分为两组,分别采用SCIT和SLIT的治疗方案。其中,SCIT组81例,年龄7～62岁,平均年龄(21.5±14.6)岁;SLIT组79例,年龄6～53岁,平均年龄(15.1±10.3)岁。所有患者均为中-重度持续性AR,对屋尘满(Derp)和粉尘螨(Derf)过敏。随访6个月至2年,观察免疫治疗过程中的局部和全身不良反应发生情况,同时评价患者的依从性及影响因素。对治疗满1年的患者比较治疗前后鼻部症状评分及视觉模拟量表(visual analogue scale,VAS)评分,并检测治疗前后血清总IgE、特异性IgE和嗜酸粒细胞阳离子蛋白(eosinophil cationic protein,ECP)水平。 结果:①临床效果:治疗1年后,SCIT组和SLIT组鼻部症状评分及VSA评分均较治疗前明显下降(P0.05)。②血液检测:治疗1年后与治疗前比较,SCIT组和SLIT组血清ECP水平明显下降(P0.05);血清总IgE和尘螨特异性IgE水平无明显变化(P0.05)。③局部不良反应:SCIT组所有患者在免疫治疗的不同阶段均出现过局部反应,占注射总次数的62.9%,表现为注射部位周围局部轻度肿胀。SLIT组有4例(5.1%)出现局部反应,表现为口腔局部轻度瘙痒不适。两组患者的局部不良反应均属轻度,可耐受并自行缓解。④全身不良反应:SCIT组有11例患者(13.6%)发生全身反应,共18例次(占注射总次数0.9%),大多数为速发性反应,多见于维持治疗阶段,临床表现主要是胸闷和呼吸困难、哮喘发作、荨麻疹。SLIT组也有11例患者(13.9%)发生全身反应,包括胃肠道反应、荨麻疹和鼻炎症状加重等,主要发生在剂量递增阶段。两组全身不良反应的发生率无统计学差异(P0.05)。SCIT组有1例为非致命性严重全身反应(严重哮喘),两组患者其余的全身反应均属于轻到中度,未发生过敏性休克。⑤依从性:160例患者对免疫治疗的总体依从性为83.1%,其中SCIT组和SLIT组的依从性分别为86.4%和79.8%,两者之间差异无统计学意义(P0.05)。患者不依从(提前退出治疗)的首要原因均为自觉疗效不满意,SCIT组和SLIT组分别占6.2%和10.1%。 结论:尘螨AR患者采用皮下注射或舌下含服途径进行特异性免疫治疗均有良好的疗效、安全性及依从性,两种治疗方式的全身不良反应发生率和患者依从性无明显差异。
[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 卤14.6) years old, and 79 cases in the SLIT group were 653 years old with an average age of 15.1 卤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.
【学位授予单位】：南京医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R765.21
本文编号：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 卤14.6) years old, and 79 cases in the SLIT group were 653 years old with an average age of 15.1 卤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.
【学位授予单位】：南京医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R765.21
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