粉尘螨滴剂舌下含服免疫治疗对不同年龄段变应性鼻炎患者的临床效果评估

目的 探究粉尘螨滴剂舌下含服免疫治疗对不同年龄段变应性鼻炎(AR)患者的临床效果。 方法 将2016年3月~8月收治的240例AR患者根据年龄分为6组,学龄前组为3~6岁,学龄期组为7~12岁,青春期组为13~20岁,青年期组为21~40岁,中年期组为41~60岁,老年期组为60岁以上,每组40例。均采用舌下含服粉尘螨滴剂变应原特异性免疫治疗+药物治疗,其中粉尘螨滴剂的脱敏治疗分为递增及维持剂量2个阶段。脱敏治疗同时根据患者情况联合控制症状药物治疗。6个月后比较各组症状评分、药物评分、体征评分及视觉模拟量表(VAS)评分,并统计各组有效率及不良事件发生率。 结果 治疗6个月后各组症状评分、药物评分、体征评分及VAS评分均有显著改善,学龄前组、学龄期组、青春期组、青年期组、中年期组、老年期症状评分分别为(3.20±0.79)、(3.58±0.81)、(3.92±0.70)、(4.25±0.72)、(4.59±0.75)、(4.96±0.80)分,药物评分分别为(0.84±0.32)、(0.98±0.30)、(1.14±0.41)、(1.33±0.44)、(1.52±0.40)、(1.72±0.48)分,体征评分分别为(0.18±0.02)、(0.21±0.05)、(0.24±0.06)、(0.27±0.07)、(0.31±0.06)、(0.35±0.07)分,VAS评分分别为(1.82±0.39)、(2.08±0.51)、(2.31±0.50)、(2.54±0.53)、(2.78±0.52)、(3.00±0.46)分,年龄越低的组,各项评分改善效果越显著,差异均有统计学意义(F分别为28.111、28.111、48.241、32.607,P均<0.001);学龄前组、学龄期组、青春期组、青年期组、中年期组、老年期组治疗有效率分别为95.00%、95.00%、90.00%、87.50%、87.50%、82.50%,各组比较差异无统计学意义(χ2=20.293,P=0.161);青年期组、中年期组及老年期组不良事件发生率(30.00%、25.00%、25.00%)低于学龄前组、学龄期组及青春期组(7.50%、5.00%、7.50%),差异均有统计学意义(χ2分别为6.646、4.501、4.501,8.658、6.275、6.275,6.646、4.501、4.501,P分别为0.010、0.034、0.034,0.003、0.012、0.012,0.010、0.034、0.034)。 结论 AR患者应用粉尘螨滴剂舌下含服免疫治疗效果均较好,且随患者年龄增长,效价相对降低,安全性相对升高。

Evaluation of clinical effects of sublingual immunotherapy with Dermatophagoides farinae drops in patients of different age groups with allergic rhinitis

ObjectiveTo explore the clinical effects of sublingual immunotherapy with Dermatophagoides farinae drops in patients of different age groups with allergic rhinitis(AR). Methods A total of 240 patients with AR admitted to the hospital from March to August 2016 were divided into six groups based on their age(3-6 years old, preschool group; 7-12 years old, school group; 13-20 years old, puberty group; 21-40 years old, adolescent group; 41-60 years old, middle-age group; older than 60 years, old-age group), with 40 patients in each group. The patients were treated with sublingual administration of Dermatophagoides farinae drops. The desensitization therapy of Dermatophagoides farinae drops included two stages: increasing dose and maintenance dose. The desensitization therapy was combined with symptomatic drug treatment based on the patient's condition. Scores of symptoms, drugs, physical signs, and visual analog scale(VAS)were compared between the two groups after 6 months. The effective and incidence rates of adverse events were statistically analyzed in each group. Results After 6 months of treatment, the scores of symptoms(3.20±0.79, 3.58±0.81, 3.92±0.70, 4.25±0.72, 4.59±0.75, and 4.96±0.80 points), drugs(0.84±0.32, 0.98±0.30, 1.14±0.41, 1.33±0.44, 1.52±0.40, and 1.72±0.48 points), physical signs(0.18±0.02, 0.21±0.05, 0.24±0.06, 0.27±0.07, 0.31±0.06, and 0.35±0.07 points), and VAS(1.82±0.39, 2.08±0.51, 2.31±0.50, 2.54±0.53, 2.78±0.52, and 3.00±0.46 points)significantly improved in the preschool, school, puberty, adolescent, middle-age, and old-age groups. The lower the age of the patient, more obvious were effects of score improvement(F=28.111, 28.111, 48.241, 32.607; P<0.001). The effective rates of efficacy in the preschool, school, puberty, adolescent, middle-age, and old-age groups were 95.00%, 95.00%, 90.00%, 87.50%, 87.50%, and 82.50%, respectively(χ2=20.293, P=0.161). The incidence rates of adverse events in the adolescent, middle-age, and old-age groups(30.00%, 25.00%, and 25.00%, respectively)were lower than those in the preschool, school, and puberty groups(7.50%, 5.00%, and 7.50%, respectively)(χ2=6.646, 4.501, 4.501, 8.658, 6.275, 6.275, 6.646, 4.501, 4.501; P=0.010, 0.034, 0.034, 0.003, 0.012, 0.012, 0.010, 0.034, 0.034). Conclusion Sublingual immunotherapy with Dermatophagoides farinae drops is effective in treating patients with AR. The titer lowers with age, while the safety increases.