皮下免疫和舌下免疫治疗尘螨变应性鼻炎的疗效分析

目的 评价标准化尘螨变应原疫苗皮下免疫治疗(subcutaneous immunotherapy,SCIT)和舌下免疫治疗(sublingual immunotherapy,SLIT)对中-重度持续性变应性鼻炎(allergic rhinitis,AR)的临床效果.方法 98例中-重度持续性AR患者纳入本项开放性对照研究,分别采用SCIT和SLIT治疗方案.所有患者均对屋尘螨和粉尘螨过敏,完成2年的特异性免疫治疗.其中,SCIT组40例,年龄7～57岁,平均(x-±s,以下同)年龄为(19.0±2.7)岁;SLIT组58例,年龄6～ 50岁,平均年龄(17.7±3.2)岁.应用记分法和视觉模拟量表(visual analogue scale,VAS)进行鼻部症状评分.采用治疗前后对照,分别比较SCIT和SLIT两组患者治疗2年后鼻部症状评分的变化,并对两种治疗方法作一疗效比较.应用SAS 9.1.3软件对数据进行统计学分析.结果 免疫治疗2年后,SCIT组和SLIT组患者的喷嚏、流涕、鼻塞和鼻痒症状评分以及鼻部症状总评分(包括记分法和VAS)均明显下降,差异有统计学意义(Z值分别为-3.14、-3.76、-3.09、-3.48、-4.13;-3.63、-3.21、-2.48、-3.56、-3.98,P值均＜0.05).对两组患者治疗2年后的鼻部4个症状评分以及总评分(记分法)与治疗前相应各项评分(基线值)的差值进行比较,组间差异无统计学意义(Z值分别为-0.97、-0.67、-0.36、-0.04、-0.67,P值均＞0.05).然而,对两组患者免疫治疗前后鼻部症状VAS评分的差值进行比较,结果显示:治疗2年后SCIT组患者鼻塞VAS评分的下降更为显著,与SLIT组相比差异有统计学意义(t=-2.21,P=0.032);但两组其余鼻部症状以及症状整体改善程度相似,差异无统计学意义(t值分别为-0.57、-1.93、-1.73、-0.99,P值均＞0.05).结论 尘螨过敏的中-重度持续性AR患者采用SCIT或SLIT进行2年特异性免疫治疗均能获得良好效果.SCIT可能对鼻塞症状的改善尤为显著,但两种治疗方式的总体疗效未见明显差别.

Clinical efficacy of subcutaneous and sublingual immunotherapy in mite-sensitized patients with allergic rhinitis

Objective To investigate the clinical efficacy of subcutaneous immunotherapy(SCIT)and sublingual immunotherapy(SLIT)with standardized house dust mite(HDM)extract for persistent allergic rhinitis(PER).Methods Ninety-eight patients with moderate to severe PER caused by HDM and who completed SCIT(Alutard SQ,ALK-Abelló)or SLIT(Chanllergen-Df drops,Wolwo Pharma)regimen for two years were enrolled in this open-label controlled study.The patients were divided into two groups:SCIT group consisted of 40 patients aged 7 to 57 years old[(19.0 ± 2.7)years,(x-)± s],and SLIT group consisted of 58 patients aged 6 to 50 years old[(17.7 ± 3.2)years].The nasal symptoms(sneezing,rhinorrhea,nasal obstruction and pruritus)were evaluated using a four-point rating scale(from 0 =absent to 3 =severe)as well as 10 cm-visual analogue scale(VAS).Efficacy of SCIT and SLIT was assessed as the mean change from baseline in nasal symptom scores after 2-year course of immunotherapy,and the results were compared.SAS software version 9.1.3 was applied for statistical analysis.Results Both SCIT and SLIT significantly reduced the individual symptom score of sneezing,rhinorrhea,nasal obstruction and pruritus,and the total nasal symptom scores(including 4-point scale and VAS)after 2-year treatment when compared with the baseline(Z value were-3.14,-3.76,-3.09,-3.48,-4.13 ;-3.63,-3.21,-2.48,-3.56,-3.98,respectively,all P ＜ 0.05).There was no significant difference in decreased mean score of the individual and total nasal symptoms(4-point scale)between SCIT and SLIT groups(Z value were-0.97,-0.67,-0.36,-0.04,-0.67,respectively,all P ＞ 0.05).However,a significant reduction of VAS score of nasal obstruction was found in SCIT group after 2-year treatment,compared with SLIT group(t =-2.21,P =0.032).There was no significant difference in decreased VAS score of three other nasal symptoms as well as global rhinitis severity between two immunotherapy groups(t value were-0.57,-1.93,-1.73,-0.99,repectively,all P＞0.05).Conclusions Both SCIT and SLIT demonstrated clinical improvement in moderate to severe PER patients sensitized to HDM after two years treatment.It is suggested that SCIT may relieve nasal obstruction significantly; however,the overall clinical efficacy is consistent with SCIT and SLIT.