舌下特异性免疫治疗进展

对于症状得到控制的轻中度过敏性哮喘和过敏性鼻炎患儿,尤其是单一过敏原过敏的患儿,应用舌下特异性免疫治疗(SLIT)可能是恰当的选择.要得到确切的临床疗效,应该从儿童早期即开始应用SLIT盯,且治疗持续时间要长.使用高剂量的SLIT比低剂量的SLIT更安全有效.SLIT的依从性主要取决于患儿的社会经济因素、家庭因素及治疗过程中不良反应的严重程度,而与患儿的年龄及免疫治疗类型无关.通过长期的临床试验研究发现,不论是过敏性鼻炎还是过敏性哮喘,使用SLIT不会产生任何严重的致命性的不良反应.有关SLIT的新疫苗和新剂型的开发应用以及新的适用范围研究的不断深入,将在过敏患儿中扩大SLIT的使用范围.     

舌下特异性免疫治疗进展

对于症状得到控制的轻中度过敏性哮喘和过敏性鼻炎患儿,尤其是单一过敏原过敏的患儿,应用舌下特异性免疫治疗(SLIT)可能是恰当的选择.要得到确切的临床疗效,应该从儿童早期即开始应用SLIT盯,且治疗持续时间要长.使用高剂量的SLIT比低剂量的SLIT更安全有效.SLIT的依从性主要取决于患儿的社会经济因素、家庭因素及治疗过程中不良反应的严重程度,而与患儿的年龄及免疫治疗类型无关.通过长期的临床试验研究发现,不论是过敏性鼻炎还是过敏性哮喘,使用SLIT不会产生任何严重的致命性的不良反应.有关SLIT的新疫苗和新剂型的开发应用以及新的适用范围研究的不断深入,将在过敏患儿中扩大SLIT的使用范围.     

舌下特异性免疫治疗过敏性鼻炎/过敏性哮喘患儿IL-17和IL-35水平的变化及临床疗效

目的 探讨舌下特异性免疫治疗(SLIT)的机制,并评价SLIT的临床疗效.方法 随机选取2011年1~12月行SLIT治疗的粉尘螨过敏性鼻炎(AR)和/或过敏性哮喘(AS)患儿30例为病例组,另随机选取行体检的30例健康儿童为对照组.检测病例组行SLIT治疗前及治疗1、2年时的1秒钟用力呼气容积(FEV1)或气道阻力与预计值之比、嗜酸性粒细胞(Eos)计数及血清细胞因子IL-17和IL-35水平,与对照组进行比较分析;同时对病例组患儿的鼻炎/哮喘症状进行评分并监测哮喘控制水平.结果 病例组SLIT治疗前、治疗1年时IL-17水平均明显高于对照组(P<0.01);且IL-17水平在治疗前、治疗后1年及治疗后2年呈逐年下降趋势(P<0.01),至治疗2年时与对照组比较差异无统计学意义(P>0.05).血清IL-35水平在治疗前后的变化趋势与IL-17的变化趋势刚好相反.FEV1与预计值之比在治疗前、治疗后1年及治疗后2年呈逐年上升趋势(P<0.01);而气道阻力与预计值之比、Eos计数则呈逐年下降趋势(P<0.01).病例组SLIT治疗2年时的鼻炎症状总评分和哮喘症状总评分改善百分率均较治疗1年时明显增高(P<0.01);SLIT治疗AR 1年时显效率85%,2年时达100%;SLIT治疗AS 1年时控制率为76%,2年时控制率达92%.结论 SLIT是一种有效治疗儿童AR和AS的方法,可能是通过抑制IL-17并促进IL-35的表达水平从而达到治疗目的,且治疗2年的效果较1年更好.     

奥马珠单抗治疗儿童过敏性疾病的临床研究

目的:探讨奥马珠单抗在患多种过敏性疾病儿童中的治疗效果。方法:回顾性分析2020年9月至2022年9月就诊于南京医科大学附属明基医院儿科过敏性疾病门诊并使用奥马珠单抗治疗患儿的临床资料,分析患儿性别、年龄、过敏性疾病的种类、血清总IgE(TIgE)、皮肤点刺试验结果和(或)血清过敏原特异性IgE(sIgE)水平、奥马珠单抗治疗剂量、治疗效果及药物不良反应情况。结果:接受奥马珠单抗治疗的43例患儿,男/女为24/19;年龄(9.3±2.5)岁。患过敏性疾病种类：支气管哮喘43例(100%),变应性鼻炎43例(100%),过敏性结膜炎5例(11.6%),特应性皮炎18例(41.9%),牛奶蛋白过敏1例(2.3%)。43例患儿血清TIgE[(613.27±616.21)Ku/L]均明显升高。所有患儿过敏原检测均为阳性,其中尘螨过敏占比最高(93%)。治疗后43例哮喘合并变应性鼻炎患儿喘息发作次数减少,鼻炎症状明显减轻;5例过敏性结膜炎患儿眼红、眼痒症状均明显改善;特应性皮炎患儿17例皮肤瘙痒减轻,1例改善不佳;1例牛奶过敏患儿可耐受奶制品。结论:奥马珠单抗对同时存在多种过敏性疾病的患儿有明显治疗效果。     

3085例儿童过敏性疾病吸入性过敏原皮肤点刺试验及临床意义

目的：探讨西安及其周边地区儿童过敏性疾病吸入性过敏原状况及分布,为该地区儿童过敏性疾病的防治提供理论依据。方法：采用丹麦ALK-ABELL公司提供的13种标准化变应原皮肤点刺液,对2006年7月至2011年7月因各种过敏性疾病等原因就诊的来自西安及其周边地区的3085例儿童进行吸入性过敏原皮肤点刺试验（skin prick test, SPT）。结果：3085例患儿中,吸入性SPT阳性1368例,阳性率为44-34%。过敏原阳性率较高的前5位依次为屋尘螨804例（26.06%）、粉尘螨793例（25.71%）、热带螨440例（14.26%）、艾蒿282例（9.14%）、猫毛204例（6.61%）。<4岁组、4岁～组、7～15岁组SPT阳性率依次为28.66%、41.85%、58.61%,组间比较差异有统计学意义（P<0.01）,表现为随年龄增长SPT阳性率增加。男性SPT阳性率较女性高（47.78% vs 38.50%,P<0.05）。在各种不同的过敏性疾病中,以过敏性鼻炎患儿的SPT阳性率最高,达72.41%,其次依次为支气管哮喘（62-25%）、变态反应性皮肤病（45-83%）、过敏性紫癜（36.28%）。结论：西安及其周边地区儿童过敏性疾病吸入性过敏原以屋尘螨、粉尘螨、热带螨、艾蒿、猫毛等为主;SPT阳性率随年龄增长而增加;男性儿童SPT阳性率较女性高;在常见过敏性疾病中,以过敏性鼻炎患儿SPT阳性率最高。     

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目的获取过敏性疾病患儿疾病、生活质量相关资料,并观察孟鲁司特治疗儿童过敏性疾病的疗效。方法 2008年3月至2011年5月北京第二炮兵总医院59例过敏性疾病患儿,分两组:对照组28例,按原发病常规治疗;治疗组31例,在常规治疗基础上加服孟鲁司特(5mg/d,晚睡前服),疗程3～6个月。6个月后,分别对两组及治疗组治疗前后过敏原点刺结果、临床症状、体重、心理行为、学习成绩5项指标进行评估。结果对照组与治疗组临床症状均明显改善;治疗后对照组与治疗组低体重、行为异常、学绩低分发生率分别为53.6%、38.7%,50.0%、25.8%和64.3%、41.9%,其中行为异常发生率组两组间差异有统计学意义(P<0.05)。治疗组治疗前后,低体重(≤P25)、行为异常、学绩低分发生率分别为83.9%、38.7%,74.2%、25.8%和80.6%、41.9%,差异均有统计学意义(P<0.05)。结论儿童过敏性疾病常为心身共患疾病,孟鲁司特治疗儿童过敏性疾病有效,临床综合评估更能反应临床疗效。     

温州市3～6岁健康儿童静脉血细胞参考值范围调查

目的建立温州市儿童静脉血血细胞各参数参考值范围。方法2007年1月至7月温州医学院附属二院检验科随机抽取儿童医院保健中心体检儿童3~6岁的正常儿童895例进行普查,用SYSMEX XE2100型全自动血细胞分析仪检测血常规结果。结果各参数参考范围如下:白细胞计数男性为(3.97~13.09)×109/L,女性为(3.90~12.26)×109/L;红细胞计数男性为(4.35~5.43)×1012/L,女性为(4.02~5.30)×1012/L;血红蛋白浓度男性为114.05~148.43g/L,女性为108.94~145.85g/L;红细胞压积(HCT)男性为0.33~0.43,女性为0.32~0.43;红细胞平均体积(MCV)男性为70.00~86.66 fL,女性为71.90~87.51 fL;红细胞平均血红蛋白含量(MCH)男性为23.91~29.81pg,女性为24.52~30.32pg;红细胞平均血红蛋白浓度(MCHC)男性为323.90~362.31g/L,女性为323.32~362.74g/L;红细胞体积分布亮度(RDW-CV)男性为11.60%~14.68%,女性为11.57%~14.45%;血小板计数男性为(155.22~428.14)×109/L,女性为(157.52~411.73)×109/L。女性红细胞计数和血红蛋白浓度均低于男性(P<0.01),其他各项参数男、女性之间的差异无统计学意义。结论初步建立了温州市3~6岁健康儿童静脉血细胞参考范围。     

糖尿病患儿的龋齿和牙周病

作者研究234例糖尿病患儿的龋齿和牙周病的罹患情况,男性114例,女性120例,年龄5～15岁。糖尿病史1～2周至13年,糖尿病轻型48例,中型145例,重型41例。对照组是303例同龄健康小儿。检查结果糖尿病患儿乳牙和恒牙的患龋率(82.9±2.7%)低于对照组(97.7±0.8%),P<0.001。龋牙数(4.0±0.1)也低于对照组(5.36±0.2),P<0.001。恒牙龋病和糖糖尿病史的关系:糖尿病史1年以内组,患龋率69.0±6.2%,龋牙数     

上海地区儿童过敏性疾病食物过敏原的研究

目的 了解上海地区儿童过敏性疾病主要的食物性过敏原.方法 对上海地区2 928例过敏性疾病患儿和100例健康对照者实施13种食物性过敏原皮肤点刺试验(skin prick tests,SPT),组间比较过敏原SPT阳性率.结果 2 928例过敏性疾病患儿对13种食物性过敏原SPTs阳性率25.1%,显著高于正常对照组的8.0%(P ＜ 0.01).不同年龄组SPT阳性率存在差异,市区与郊区的SPT部分食物性过敏原阳性率亦存在差异.结论 食物性过敏原在儿童过敏性疾病发病中起重要作用,SPTs对过敏性疾病的诊断有一定的临床应用价值.过敏原SPT阳性率与年龄有一定的相关性.     

舌下含服粉尘螨滴剂治疗螨过敏性哮喘患儿的长期疗效

目的 观察舌下特异性免疫治疗(sublingual immunotherapy,SLIT)在治疗期间及停药后1年对过敏性哮喘患儿的疗效.方法 开放、回顾性研究.选择2009年5月至8月在南京医科大学附属南京儿童医院呼吸科就诊的主要对尘螨[粉尘螨和(或)户尘螨]过敏的轻、中度过敏性哮喘患儿80例,年龄4 ～14岁.所有患儿入组时(基线)均已接受抗哮喘药物治疗3个月.分组:(1)SLIT组39例,抗哮喘药物治疗的同时,采用SLIT 2年,停止SLIT后再随访1年,共随访3年;(2)药物组41例,仅采用抗哮喘药物治疗,随访3年.比较SLIT组和药物组在基线,治疗第2年结束时、第3年结束时(停止SLIT 1年时)的哮喘症状评分、用药评分、停药例数、入组前1年、治疗第3年哮喘急性发作频率.结果 (1)症状评分:SLIT 2年结束时,SLIT组患儿哮喘日间症状评分低于药物组(0.18±0.06,0.93±0.12,Z=-4.873,P＜0.05),夜间症状评分差异无统计学意义;停止SLIT 1年时,SLIT组患儿哮喘日间症状评分(0.18±0.06)和夜间症状评分(0.05±0.04)均低于药物组(日间1.46±0.72,夜间0.66±0.14,Z=-5.082,-4.019,P均＜0.05).(2)用药评分和停药例数:SLIT 2年结束时和停止SLIT 1年时,SLIT组用药评分(0.31 ±0.07和0.17±0.06)均低于药物组(0.75±0.12和0.87±0.17,Z=-2.813,-4.106,P均＜0.05);SLIT组停药例数(20例,29例)均多于药物组(10例,13例)(x2 =6.167,14.581,P均＜0.05).(3)入组前1年两组哮喘急性发作频率差异无统计学意义,治疗第3年(停止SLIT 1年)间,SLIT组哮喘急性发作频率小于药物组(0.69±1.20,1.20±1.44,Z=-1.968,P＜0.05).结论 SLIT能明显改善哮喘的症状,减少药物使用和哮喘急性发作,同时在停止SLIT后1年仍能保持疗效.     

Quantitative assessment of the compliance with once-daily sublingual immunotherapy in children (EASY Project: Evaluation of A novel SLIT formulation during a Year)

Compliance is a major determinant for allergy treatment, especially in children. Sublingual immunotherapy (SLIT) is self-managed at home, and no quantitative data on pediatric adherence are available. We studied the compliance in a large real-life setting. A simplified schedule of SLIT was used, consisting of a 10-day updosing phase followed by maintenance treatment in monodose containers to be taken daily (SLITOne). Italian specialists throughout Italy assessed the compliance in children who were newly prescribed SLIT according to guidelines. Parents were contacted with unscheduled telephone interviews at the third and sixth month of therapy and asked to count at that moment the remaining vials. Data from 71 children (38 boys, age range 2-13 yr) were enclosed in the database. Thirty had rhinoconjunctivitis, four asthma and 37 rhinoconjunctivitis + asthma. SLIT was prescribed for: mites in 57 (81%) subjects, grasses in 11 (15%) and 3 (4%) grass + olive mixture. Compliance data were available for all children at 3 months, and for 56 at 6 months. At 3 months, 85% of subjects had a compliance rate >75% (69% of them adhered >90%). At 6 months, 84% had a compliance rate >75% (66% of them adhered >90%). In four cases SLIT was discontinued for economical reasons, and in one case (1.4%) for side effects probably related to therapy. These data obtained in a quite large sample of children and in real-life confirm that the compliance with SLITOne is good, despite the therapy managed at home.     

Allergen specific sublingual immunotherapy in children with asthma and allergic rhinitis

Background

The incidence of asthma and allergic rhinitis (AR) is significantly increased, especially in younger children. Current treatment for children with asthma and allergic rhinitis include allergen avoidance, standard pharmacotherapy, and immunotherapy. Since standard pharmacotherapy is prescribed for symptoms, immunotherapy at present plays an important role in the treatment of allergic diseases. This article presents insights into the up-to-date understanding of immunotherapy in the treatment of children with allergic rhinitis and asthma.

Data sources

PubMed articles published from 1990 to 2014 were reviewed using the MeSH terms "asthma", "allergic rhinitis", "children", and "immune therapy". Additional articles were identified by hand searching of the references in the initial search.

Results

Numerous studies have shown that sublingual application of allergen specific immunotherapy (SLIT) is an adequate, safe and efficient substitution to subcutaneous route of allergens administration (SCIT) in the treatment of IgE-mediated respiratory tract allergies in children. According to the literature, better clinical efficacy is connected with the duration of treatment and mono sensitized patients.

Conclusions

At least 3 years of treatment and stable asthma before the immunotherapy are positive predictors of good clinical efficacy and tolerability of SLIT. SLIT reduces the symptoms of allergic diseases and the use of medicaments, and improves the quality of life of children with the diseases.

     

Sublingual immunotherapy for pediatric allergic rhinitis: The clinical evidence

Allergic rhinitis is estimated to affect 10%-20% of pediatric population and it is caused by the IgE-sensitization to environmental allergens, most importantly grass pollens and house dust mites. Allergic rhinitis can influence patient’s daily activity severely and may precede the development of asthma, especially if it is not diagnosed and treated correctly. In addition to subcutaneous immunotherapy, sublingual immunotherapy (SLIT) represents the only treatment being potentially able to cure allergic respiratory diseases, by modulating the immune system activity. This review clearly summarizes and analyzes the available randomized, double-blinded, placebo-controlled trials, which aimed at evaluating the effectiveness and the safety of grass pollen and house dust mite SLIT for the specific treatment of pediatric allergic rhinitis. Our analysis demonstrates the good evidence supporting the efficacy of SLIT for allergic rhinitis to grass pollens in children, whereas trials regarding pediatric allergic rhinitis to house dust mites present lower quality, although several studies supported its usefulness.     

随访方式对哮喘儿童舌下含服粉尘螨滴剂依从性的影响

目的评价不同随访方式对哮喘儿童舌下脱敏治疗依从性的影响。方法将112例哮喘(缓解期)合并鼻炎的儿童在接受脱敏治疗后均选择随访,按自愿方式进行分组:69例接受电话随访者为电话随访组,43例不愿接受电话随访者为医院现场随访组。两组患儿在接受脱敏治疗后均告知脱敏常识,纪录联系电话、起始时间、取药时间和数量,每次取药时随访询问效果并纪录;电话随访组加入电话随访,并及时将疗效、不良反应反馈给专科医师。两组均进行为期1年的观察。结果电话随访组坚持1年治疗59例(85.5%),医院随访组坚持1年治疗16例(37.2%)。两组患儿依从性在第6个月、第9个月和12个月,差异都具有统计学意义(χ2=23.71、25.38、27.93,P均<0.001)。随访过程中,未发现舌下脱敏治疗的严重不良事件。结论电话随访方便、快捷,能有效提高患儿舌下脱敏治疗的依从性。     

New visions in specific immunotherapy in children: an iPAC summary and future trends

Specific immunotherapy is indicated for confirmed immunoglobulin E-mediated airway diseases using standardized allergen products with documented clinical efficacy and safety. For decades the subcutaneous route of administration (SCIT) has been the gold standard. Recently, the sublingual immunotherapy (SLIT) has also been investigated in children. SCIT, especially with grass and birch pollens but also house dust mites, is an effective treatment in children with allergic rhinitis and asthma when a significant part of their symptoms are caused by these allergens. A long-term effect up to 12 yr after discontinuation of SCIT with timothy allergen has been shown. Efficacy and safety of SLIT in pollen allergic rhinoconjunctivitis have been demonstrated in adults. The evidence in children is a little less convincing, and more data is needed. The clinical relevance, long-term results and the size of the effect, as well as the dose, the treatment regimen and duration has not been sufficiently elaborated. It is demonstrated that SCIT has the potential for preventing the development of asthma in children with allergic rhinoconjunctivitis. Also one randomized study indicates a preventive effect of SLIT in children on the development of asthma. At present, there are no studies who clearly demonstrates either a long-term effect or a preventive effect on the development of asthma of SLIT in children. The areas with lack of evidence should be addressed in well performed prospective, randomized long-term studies both with SCIT and SLIT. This review was initiated by iPAC (international Pediatric Allergy and Asthma Consortium) and aims to review current knowledge related to specific immunotherapy in childhood, and to identify needs for future research in this field.     

Spezifische Immuntherapie im Kindesalter

Background

Subcutaneous (SCIT) and sublingual (SLIT) immunotherapy are the two routes for administering allergen-specific immunotherapy for inhalative allergens.

Immunotherapy

The only route of administration for children with bee or wasp venom allergy is SCIT and it is also the primary route of administration for children with asthmatic complaints. Both SCIT and SLIT were shown to be effective in controlling symptoms and in reducing rescue medication in patients with allergic rhinoconjunctivitis sensitized to grass pollens. There is evidence from clinical trials that SLIT with specific grass pollen allergens administered as tablets (e.g. Grazax and Oralair) or drops (Infecto-SLIT forte) is effective and safe in children. A recently published meta-analysis compared both forms of administration and showed a trend toward favoring SCIT for symptom and medication scores. Moreover, local adverse events after SLIT, such as oral pruritus, burning sensation, lip or tongue swelling and gastrointestinal symptoms are pronounced during the first months of administration, which might reduce patient compliance and adherence to specific immunotherapy. Finally, SCIT but not SLIT showed a reduced risk of developing asthma and new sensitization during treatment and 7 years after discontinuation of therapy indicating long-term preventive effects of SCIT.

Conclusions

Although there is evidence of effectiveness of both SCIT and SLIT with grass pollen extracts in patients with allergic rhinoconjunctivitis, SCIT is the primary mode of administration in children. Further research is needed to establish the clinical effectiveness of SCIT versus SLIT in a head-to-head trial in children.     

Five‐grass pollen 300IR SLIT tablets: efficacy and safety in children and adolescents

Halken S, Agertoft L, Seidenberg J, Bauer C‐P, Payot F, Martin‐Muñoz MF, Bartkowiak‐Emeryk M, Vereda A, Jean‐Alphonse S, Melac M, Le Gall M, Wahn U. Five‐grass pollen 300IR SLIT tablets: efficacy and safety in children and adolescents.
Pediatr Allergy Immunol 2010: 21: 970–976.
© 2010 John Wiley & Sons A/S The efficacy and safety of five‐grass pollen 300IR sublingual immunotherapy (SLIT) tablets (Stallergènes SA, France) have previously been demonstrated in paediatric patients. This report presents additional data concerning efficacy at pollen peak, efficacy and safety according to age, nasal and ocular symptoms, use of rescue medication, satisfaction with treatment and compliance. Children (5–11 yr) and adolescents (12–17 yr) with grass pollen–allergic rhinoconjunctivitis were included in a multinational, randomized, double‐blind, placebo‐controlled study and received either a 300IR five‐grass pollen tablet or placebo daily in a pre‐ (4 months) and co‐seasonal protocol. The severity of six symptoms (sneezing, rhinorrhoea, nasal congestion, nasal and ocular pruritis, and tearing) was scored, and rescue medication use was recorded daily during the pollen season. Patient satisfaction was recorded at the season end. A total of 161 children and 117 adolescents were evaluated (n = 267). 300IR SLIT was effective over the whole season (p = 0.0010) and at the pollen peak (p = 0.0009). The adjusted mean difference between 300IR and placebo groups was significant for both nasal (p = 0.0183) and ocular (p < 0.0001) symptoms. Rescue medication use was statistically lower in the SLIT group during the pollen season and at the pollen peak (both p < 0.05). More patients in the SLIT group were satisfied with their treatment compared to placebo (83.2% vs. 68.1%, p = 0.0030), and compliance was high (SLIT 93.9% of patients were compliant, placebo 94.8% of patients were compliant). SLIT was well tolerated by children and adolescents. 300IR five‐grass pollen tablets are effective and safe during the pollen season and at the pollen peak in children and adolescents with grass pollen rhinoconjunctivitis.     

粉尘螨滴剂舌下特异性免疫治疗对儿童咳嗽变异性哮喘的有效性

目的：探讨粉尘螨滴剂舌下特异性免疫（SLIT）治疗对儿童咳嗽变异性哮喘的有效性及安全性。方法：将确诊为咳嗽变异性哮喘并且粉尘螨变应原皮肤点刺试验呈阳性反应的106例4～14岁患儿随机分为SLIT组（n=53）和常规治疗组（n=53）。常规治疗组按照儿童哮喘规范化治疗方案治疗,SLIT组在常规规范化治疗的基础上,加用舌下含服粉尘螨滴剂。观察两组患儿治疗后咳嗽哮喘症状评分改善情况及临床症状开始改善的时间,同时检测血嗜酸性粒细胞（EOS）水平以及最大呼气峰流速(PEF)的变化。记录两组不良反应发生情况。结果：治疗25周后,SLIT组的症状评分降低值、PEF升高幅度及血EOS比例下降程度均显著高于常规治疗组,差异均有统计学意义（P＜0.05）;SLIT组症状改善时间较常规治疗组短,差异亦有统计学意义（P＜0.05）。SLIT组的有效率显著高于常规治疗组,差异有统计学意义（85% vs 68%,P＜0.05）。SLIT组部分患儿出现红、肿、瘙痒等局部反应,均于次日自行消失。结论：粉尘螨滴剂舌下免疫对儿童咳嗽变异性哮喘具有良好的效果,且安全性高。     

尘螨过敏性支气管哮喘的舌下免疫治疗研究进展

在尘螨过敏性哮喘的治疗方法中,螨变应原舌下免疫疗法日益受到关注.其机制尚不十分明确,但可以调节Th1/Th2失衡,促进Th1反应.治疗过程中可降低IgE,升高IgG4,抑制过敏反应的发生.口腔黏膜中的朗格汉斯细胞对提高机体耐受性也发挥着一定的作用.近年来越来越多的研究证明舌下免疫疗法具备有效性、安全性及其良好的依从性....