快速免疫治疗常年性变应性鼻炎

目的：探讨快速免疫治疗常年性变应性鼻炎的新方法及疗效。方法：32例快速免疫组5天半达到维持量,持续治疗一年后评定。36例常规免疫对照组治疗2年后评定。结果：快速免疫组一年总有84．4％,常规免疫组2年总有效率88．9％,两组疗效无显著性差异（P＞0．05）。结论：快速免疫疗法减少了注射次数和缩短了疗程,为治疗常年性变应性鼻炎行之有效的方法。     

特异性免疫治疗在变应性鼻炎中的研究

特异性免疫治疗,特别是皮下特异性免疫治疗在阻止机体产生对新的IgE介导的致敏及阻止变应性鼻炎患者的病情进一步加重方面起到了明显的预防作用。免疫治疗影响了变应性鼻炎的自然进程,改变了机体免疫系统的反应状态。     

将免疫治疗升级为治疗变应性鼻炎的一线选择

自从1911年Noon和Freeman将变应原特异性免疫治疗(简称免疫治疗)引入临床治疗变应性鼻炎(AR)的一个世纪以来,医学界对于免疫治疗分子机制的认识随着IgE的发     

变应性鼻炎特异性免疫治疗

变应性鼻炎特异性免疫治疗已历经一个世纪的历史,经过近百年的大量临床研究,其疗效肯定,但仍有它的局限性和尚待解决的问题,本文就其作用机制、治疗方法、用药途径、疗效和安全性加以综述。     

冲击免疫治疗变应性鼻炎

变应性鼻炎的治疗体系主要由避免接触变应原、药物治疗、特异性免疫治疗和医患宣传教育构成,其中特异性免疫治疗的常规方案总疗程长,起效时间慢,不利于长期贯续治疗.冲击免疫治疗(rush immunotherapy,RIT)在疫苗剂量累加阶段可明显减少注射间隔时间,国外报道其有效性和安全性与常规免疫治疗无异.本文就变应性鼻炎RIT方案进行综述,为建立适合中国变应性鼻炎患者的治疗方案提供依据.     

变应性鼻炎免疫治疗研究进展

变应性鼻炎免疫治疗是针对病因的根本性治疗,疗效肯定、安全性高,包括特异性免疫治疗和非特异性免疫治疗,前者按治疗方式分类可分为皮下免疫治疗、舌下免疫治疗和其他方式的免疫治疗。本文重点综述了近几年对变应性鼻炎免疫治疗相关方面的研究进展。     

特异性免疫治疗在变应性鼻炎中的研究

特异性免疫治疗，特别是皮下特异性免疫治疗在阻止机体产生对新的IgE介导的致敏及阻止变应性鼻炎患者的病情进一步加重方面起到了明显的预防作用。免疫治疗影响了变应性鼻炎的自然进程，改变了机体免疫系统的反应状态。     

变应性鼻炎皮下免疫治疗的不良反应分析

变应原特异性免疫治疗是目前唯一针对变应性鼻炎（AR）病因的治疗方法。变应原皮下免疫治疗（subcutaneous immunotherapy,SCIT）对AR的疗效已有广泛报道。虽然SCIT引发的严重不良反应少见,但不良反应的存在影响了患者治疗的依从性,甚至可威胁患者生命。为此,我们对2009年1月~2013年12月在我科接受SCIT的AR患者进行回顾性分析,总结SCIT的不良反应及其处理。     

免疫疗法合并鼻炎冲剂治疗常年性变应性鼻炎疗效观察

常年性变应性鼻炎90例分单纯中药组（鼻炎冲剂）、单纯免疫疗法组和中西医结合组（鼻炎冲剂结合免疫疗法）进行治疗，治疗前及治疗4月时测定血清IgE、IgG、血浆cAMP、cGMP及鼻分泌物嗜酸细胞。结果表明：单纯中药组、单纯免疫疗法组和中西医结合疗法组有效率分别为71％、75％和97％。中西医结合组疗效优于其它两组（P＜0．05）。三组患者治疗后，IgG升高，而IgE趋于正常。血浆cAMP有不同程度的上升，cGMP下降，中西医结合组尤为明显。本文资料表明：中西医结合免疫疗法是疗效好且巩固的治疗常年性变应性鼻炎的方法。     

30例常年性变应性鼻炎特异性免疫治疗的临床研究

目的：观察特异性免疫治疗常年性变应性鼻炎的临床疗效、安全性及可能机制。方法：回顾分析30例接受3年特异性免疫治疗的常年性变应性鼻炎患者（治疗组）的资料。2006年对其进行调查随访;取同期30例常年性变应性鼻炎患者为对照组,症状发作时服用抗组胺药物及鼻用激素联合治疗;10例健康人为健康组,观察治疗后临床疗效及免疫学指标（静脉血IL-2、IL-4、IL-5水平）的变化情况。结果：①变应性鼻炎免疫治疗临床疗效评定：治疗组治疗结束时总有效率90．00％,对照组总有效率86．67％,2组疗效比较差异无统计学意义（P〉0．05）。免疫治疗后平均症状、体征积分为（3．88±2．71）分,与治疗前（11．10±1．53）比较,差异有统计学意义（P〈0．01）。②血清IL-2、IL-4、IL-5测定：对照组患者存在免疫功能异常,表现为IL-2水平低下,IL-4、IL-5水平升高,与健康组比较差异有统计学意义（P〈0．01）;治疗组与对照组比较差异有统计学意义（P〈0．01）,治疗组与健康组比较差异无统计学意义（P〉0．05）。③对30例变应性鼻炎患者进行脱敏治疗3530次,发生全身反应4例,共6例次,总发生率为0．17％（6／3530）;局部反应发生12例,共54例次,总发生率为1．53％（54／3530）。局部及全身反应均较轻。结论：特异性免疫是治疗变应性鼻炎的有效方法,值得推广应用。     

Treatment of perennial allergic rhinitis with ascorbic acid solution

The object of our study was to assess the therapeutic effects of Ascorbic Acid (AA) solution in patients suffering from perennial allergic rhinitis. Sixty patients were included in a two week randomized study. Synthetic AA Solution was found to decrease symptoms in 74% of patients, parallely there was a decrease of the pH of nasal secretion to normal limits.     

鼻内应用Rhinocort治疗常年性变应性鼻炎

目的探讨鼻内应用雷诺考特(Rhinocort)治疗常年性变应性鼻炎的临床效果. 方法 60例常年性变应性鼻炎随机分组,实验组30例应用Rhinocort鼻喷雾剂治疗,对照组30例施以鼻腔微波热凝治疗.于治疗结束后1月和1年分别进行近期和远期疗效评定. 结果两组的近、远期疗效分别为93.3%、96.7%和70.0%、63.3%,χ2检验两组疗效差异均无显著性意义(P＞0.05). 结论 Rhinocort鼻喷雾剂鼻内应用治疗常年性变应性鼻炎使用方便,起效快速,定量准确,全身生物利用度低,安全性和有效性好,是目前治疗常年性变应性鼻炎的好方法.     

血清IL-4、IFN-γ与持续性变应性鼻炎的相关性

目的探讨T辅助细胞亚群失衡介导的免疫反应在常年性变应性鼻炎中的作用。方法24例常年性变应性鼻炎患者和17例健康志愿者,应用酶联免疫试剂盒检测血清白细胞介素-4(IL-4)、γ-干扰素(IFN-γ)水平并进行比较分析。结果常年性变应性鼻炎组血清IL-4含量[37．8±18．36]pg/L明显高于对照组[1．74±3．35] pg/L；IFN-γ含量[0．72±3．35]pg/L明显低于对照组[43．60±22．87]pg/L,其差异有显著性意义(P＜0．01)。常年性变应性鼻炎组血清IFN-γ/IL-4比值明显下调。结论T辅助细胞亚群比例失衡,Th2功能亢进是常年性变应性鼻炎发病的重要原因。     

Treatment of perennial secretory rhinitis

Patients with a history of nonallergic perennial secretory rhinitis of many years' duration were selected for a comparative study investigating the effects of the topical application of ipratropium (an anticholinergic drug) and budesonide (a glucocorticoid). According to the patient's daily registration of nasal symptoms, there was a significant effect of budesonide on nasal secretion and sneezes. Since budesonide proved superior to ipratropium, it is concluded that the secretion in this type of rhinitis might be regulated by mechanisms other than cholinergic.     

Olfactory dysfunction in seasonal and perennial allergic rhinitis

Although the pathogenesis of sudden hearing loss (SHL) is not as yet known, the clinical picture and the frequent association with vascular risk factors make an ischaemic event likely. This study aimed to assess the effect of an extracorporeal procedure (H.E.L.P.) in removing LDL-cholesterol, fibrinogen and lipoprotein (a) from the plasma, on the recovery of hearing SHL. This procedure using the HELP-system was compared with the usual standard treatment with prednisolone, dextranes and pentoxifyllin. We undertook a single centre, prospective, randomized study in which 18 patients were assigned to H.E.L.P.-apheresis and 9 patients were assigned to standard treatment (2:1 randomization). Audiometric and laboratory testing was performed at baseline, 24 h and 6 weeks after start of treatment. Primary endpoint was the improvement of the average pure-tone threshold between 0,125 and 8 kHz after 24 h. Twenty-four hours after H.E.L.P. treatment average pure-tone threshold recovered by 10.4 dB and by 26.4 dB after 6 weeks. The recovery of hearing of the standard treated patients was 5.8 dB and 16.8 dB after 24 h and 6 weeks respectively. LDL-cholesterol, fibrinogen and lipoprotein (a) were significantly reduced in the HELP treated patients compared with standard therapy, resulting in a significant improve in plasma viscosity, erythrocyte aggregation and resistance to oxidative stress of LDL particles. Our results suggest that the clinical outcome of SHL after a single extracorporeal LDL-apheresis is superior or at least equal to the more expensive standard treatment with prednisolone, dextranes and pentoxifyllin. Re-establishment of vascular endothelial function and improved blood rheology may be the underlying cause. These results must be confirmed in larger-scale trials.     

Long-term effect of submucous turbinectomy in patients with perennial allergic rhinitis

OBJECTIVES: The long-term effect of submucous turbinectomy for patients with perennial allergic rhinitis was assessed. STUDY DESIGN: A cohort study of 45 patients with severe perennial allergic rhinitis who underwent submucous turbinectomy and were followed up after surgery for more than 3 years was performed. We investigated quality of life in 30 of 45 patients who had passed over 5 years after the surgery. METHODS: Nasal symptoms were assessed with a standard symptom score by diary cards. Nasal congestion was evaluated by rhinometry. Nasal challenge tests in vivo were performed to evaluate allergic reactions. These examinations were performed before surgery and at 1 year, more than 3 years, and more than 5 years after submucous turbinectomy. We determined the symptom scores and the quality of life using card questionnaires in 30 patients at the time point of more than 5 years after surgery. RESULTS: The mean [+/- SD] total nasal symptom score (maximum 9) was significantly lower at 1 year after surgery (7.5+/-1.6 vs. 1.8+/-1.8, P <.0001) compared with before surgery. A significant improvement in nasal symptoms was noted at the 3-year (2.8+/-2.3, P <.0001) and 5-year (3.3+/-1.6, P <.0001) time points. A significant increase in total nasal airflow value was noted at each time point after surgery, with a gradual reduction in the total nasal symptom score as well (before surgery, 269.4+/-249.5 cm3/s; 1 y after surgery, 450.1+/-197.7 cm3/s; more than 3 y after surgery, 385.1+/-182.3 cm3/s). The nasal challenge test score was also reduced 1 year after surgery (2.1+/-1.0 vs. 0.6+/-0.7, P <.0001). However, there was no further significant increase at the 3-year time point (0.4+/-0.7, P <.0001) after surgery. In regard to postoperative quality of life, according to the results of the card questionnaire, 50% of the patients had not been receiving antiallergic treatments in the postoperative period. CONCLUSION: Our results suggest that submucous turbinectomy is a useful strategy for the longterm management of nasal allergic reaction and contributes to the improvement in quality of life.     

三线减张鼻中隔矫正联合射频消融治疗持续性变应性鼻炎

目的　探讨三线减张鼻中隔矫正联合低温等离子射频消融治疗伴有鼻中隔偏曲的中-重度持续性变应性鼻炎（persistent allergic rhinit is,PAR）的疗效。方法 分别采用三线减张鼻中隔矫正术（对照组32例）和三线减张鼻中隔矫正联合低温等离子射频消融（观察组36例）治疗伴有鼻中隔偏曲的PAR,术后随访1年,根据症状和体征记分评定其疗效：≥66%为显效,65%～26%为有效,≤25%为无效。结果　对照组总有效率59.4%,观察组总有效率91.7%。观察组总有效率显著高于对照组（P＜0.05）。结论  对伴有鼻中隔偏曲的PAR,三线减张鼻中隔矫正联合低温等离子射频消融治疗PAR的疗效明显优于单纯三线减张鼻中隔矫正术。     

等离子低温消融术在常年性变应性鼻炎治疗中的应用

目的 观察等离子低温消融术治疗常年性变应性鼻炎的疗效.方法 30例常年性变应性鼻炎患者行下鼻甲及鼻丘等离子低温消融术,其中18例加行鼻中隔矫正术,术后随访半年,观察疗效,并用视觉模拟评分表法（VAS）比较手术前后鼻塞症状的改善程度.结果 本组病例显效率73.3%（22/30）,有效率23.3%（7/30）,无效率3.3%（1/30）;手术前后鼻塞症状的VAS值差异有统计学意义（P＜0.001）.结论 等离子低温消融术治疗常年性变应性鼻炎是安全、有效的.     

钬激光治疗变应性鼻炎

目的探讨使用钬激光治疗变应性鼻炎的疗效。方法选择变应性鼻炎50例,自愿接受钬激光手术,通过破坏鼻丘、鼻中隔前上方黏膜的筛前神经分支和下鼻甲前方黏膜,从而降低筛前神经分支的敏感性,抑制腺体分泌,使变应性鼻炎症状改善。结果 50例随访1-2年,全部病例鼻通气正常,变应性鼻炎症状消失,显效35例,有效10例,无效5例。结论钬激光治疗变应性鼻炎方法简单、安全有效。