尘螨变应原免疫治疗联合药物治疗对哮喘合并变应性鼻炎患儿临床疗效及气道高反应性的影响

doi:10.3969/j.issn.1006-7795.2016.05.002

摘要/Abstract

摘要： 目的了解哮喘合并变应性鼻炎患儿经尘螨变应原免疫治疗联合药物治疗后的临床疗效及对气道高反应性的影响。方法选择2012年2月至2012年11月就诊于首都医科大学附属北京儿童医院确诊尘螨致敏的轻、中度哮喘合并变应性鼻炎患儿26例，采用病例自身对照研究，对其进行尘螨特异性免疫治疗联合哮喘及鼻炎药物治疗。结果 26例患儿3年按期监测气道反应性，患儿症状用药计分（Symptom and Medication Score，SMS）由治疗前的6.1±2.3显著减低为1年时的3.3±1.5，2年时的2.2±1.6和3年时的1.1±1.3（P<0.05），自主哮喘控制评估（Children Asthma Control Test，C-ACT）由治疗前的22.2±3.3显著增高至1年时的24.7±2.6，并维持至2年时25.0±1.5和3年时的25.2±1.8（P<0.05），视觉模拟评分（Visual Analog Scale，VAS）哮喘症状由治疗前的2.8±2.5显著下降为治疗1年时的1.1±1.7，2年时1.1±1.03和3年时的0.6±1.09（P<0.05），变应性鼻炎症状的VAS由治疗前的4.7±2.0显著下降为1年时的1.7±1.9，2年时的1.9±1.7和3年时的1.2±1.3（P<0.05），而肺功能指标无明显改善（P>0.05）；气道反应性特征中，气道阻力由1年时的8.176±2.634下降为2年时的7.461±2.464和3年时的6.957±2.440（P<0.05）；传导率（respiratory conductance，Grs）由1年时的0.135±0.045升高为2年时的0.151±0.062和3年时的0.163±0.067（P<0.05），最小诱发累积剂量或反应阈值（minimum dose of bronchoconstrictor or the amount of the cumulative dose at the inflection point where the reciprocal of Rrs（Grs）decreases linearly，Dmin）由1年的7.110±10.865升高为2年时的9.558±9.487和3年时的19.640±12.379（P<0.05）。结论变应原免疫治疗哮喘合并变应性鼻炎患儿的疗效显著，气道反应性及气道敏感性降低。

关键词: 哮喘, 变应性鼻炎, 儿童, 变应原免疫治疗, 气道高反应性

Abstract: Objective To understand the clinical efficacy in children with asthma and allergic rhinitis who received the dust mite allergy immunotherapy(AIT), and to discuss the influence of dust mite allergy immunotherapy on airway hyperresponsiveness. Methods A total of 26 cases with mild or moderate persistent asthma complicated with allergic rhinitis who received the dust mite specific immunotherapy combined with drug therapy between February 2012 and November 2012 in Beijing Children's Hospital were enrolled in the case-self-control study. Results Totally 26 cases completed treatment for three years and monitoring airway hyperresponsiveness. The average daily Symptom and Medication Score (SMS) at one, two and three years after the dust mite allergy immunotherapy were 3.3±1.5, 2.2±1.6,1.1±1.3 respectively, which were significantly lower than at the baseline values (6.1±2.3) (P<0.05), ACT/C-ACT assessment at one, two and three years after AIT were 24.7±2.6, 25.0±1.5, 25.2±1.8 respectively, which were higher than that at the baseline (22.2±3.3) (P<0.05); Asthma Visual Analog Scale (VAS) at one, two and three years after AIT were 1.1±1.7, 1.1±1.03, 0.6±1.09 respectively, which were significantly lower than that at the baseline (2.8±2.5) (P<0.05). Allergic rhinitis VAS score at one and two and three year after AIT were 1.7±1.9, 1.9±1.7, 1.2±1.3 respectively, which were significantly lower than at the baseline (4.7±2.0) (P<0.05). However, the pulmonary function index was not significantly different after the treatment. Respiratory resistance (RrS) at two and three year after AIT were 7.461±2.464, 6.957±2.440, which were significantly lower than at one year(8.176±2.634)(P<0.05); Respiratory conductance (Grs) at two and three year after AIT were 0.151±0.062, 0.163±0.067, which were higher than that at one year (0.135±0.045) (P<0.05); Minimum dose of bronchoconstrictor or the amount of the cumulative dose at the inflection point where the reciprocal of Rrs (Grs) decreases linearly (Dmin) at two and three year after AIT were 9.558±9.487, 19.640±12.379, which were higher than that at one year (7.110±10.865) (P<0.05). Conclusion The dust mite allergy immunotherapy could improve symptoms significantly, reduced asthma controller medication, improved airway hyperresponsiveness but did not significantly improve the spirometric parameters.

Key words: asthma, allergic rhinitis, children, allergy immunotherapy, airway hyperresponsiveness

中图分类号:

皇惠杰, 刘晓颖, 侯晓玲, 苗青, 向莉. 尘螨变应原免疫治疗联合药物治疗对哮喘合并变应性鼻炎患儿临床疗效及气道高反应性的影响[J]. 首都医科大学学报, 2016, 37(5): 568-573.

Huang Huijie, Liu Xiaoying, Hou Xiaoling, Miao Qing, Xiang Li. Effects of dust mite allergy immunotherapy on clinical efficacy and airway hyperresponsiveness in allergic asthma and rhinitis children sensitized to dust mite[J]. Journal of Capital Medical University, 2016, 37(5): 568-573.

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