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目的 探讨特异性免疫治疗变应性哮喘合并鼻炎的效果,分析特异性免疫治疗期间病情反复的原因。方法 将上海交通大学医学院附属新华医院2006年1月至2010年12月期间收治的102例变应性哮喘合并鼻炎的患儿,分为治疗组和对照组,治疗组78例在哮喘规范化防治基础上联合粉尘螨注射液特异性免疫治疗,而对照组24例以吸入激素等规范化防治为主。评价两组患儿治疗6个月、1年、2年及治疗结束后随访1年哮喘最大呼气流量(PEF)、汉化版儿童哮喘控制测试量表(Ch-CACT)结果和变应性鼻炎的临床症状评分及视觉模拟评分(VAS),比较两组患儿治疗第2年及治疗结束后随访1年哮喘急性发作次数和呼吸道感染情况,并分析特异性免疫治疗期间病情反复的原因。结果 治疗第2年及治疗结束后随访1年哮喘急性发作次数和呼吸道感染次数均较对照组减少,差异具有统计学意义(P<0.01)。治疗组治疗2年及治疗结束后随访1年哮喘PEF测定结果优于对照组,治疗结束后随访1年Ch-CACT较对照组高,差异均具有统计学意义(P<0.05)。治疗6个月、1年、2年及治疗结束后随访1年治疗组变应性鼻炎的临床症状评分和VAS评分优于对照组,差异具有统计学意义(P<0.05)。特异性免疫治疗期间导致病情反复的常见原因为气候因素、呼吸道感染、合并副鼻窦炎及不适当的居室清扫等。结论 特异性免疫治疗能改善哮喘患儿的PEF及Ch-CACT评分,能明显改善变应性鼻炎的临床症状及VAS评分,是一种防治变应性哮喘合并鼻炎持久有效的方法。气候因素、呼吸道感染及合并副鼻窦炎是导致特异性免疫治疗期间病情反复的主要原因。

Effects of dust mite allergen-specific immunotherapy on prevention and cure in children with asthma and allergic rhinitis and the reasons of symptom exacerbation during specific immunotherapy

Objective To evaluate the effects of dust mite allergen-specific immunotherapy combined with standardized management on prevention and cure in children with asthma and allergic rhinitis and analyze the reasons of the asthma and allergic rhinitis symptom exacerbation during specific immunotherapy.Methods One hundred and two children with established diagnosis of allergic asthma and allergic rhinitis to dust mite were enrolled in this study from january 2006 to december 2010,of whom 78 children received the treatment with specific immunotherapy(SIT)combined with standardized management for 2 to 4 year(as the test group)and the other 24 served as the control group with inhaled corticosteroids according to Global Initiative for Asthma(GINA)and Allergic Rhinitis and its Impact on Asthma(ARIA)in the same time.At the beginning,6 months,1 year,2 years of the treament and 1 year after the treament,the clinical symptom and acute episode,pulmonery function(Peak Expiratory Flow,PEF)and Chinese children asthma control test(Ch-CACT)of the asthmatic children,symptem scores and Visual Analogue Scale(VAS)of allergic rhinitis were analyzed,while respiratory tract infection of all the patients were recorded at the second year and after 1 year of the treatment.The reasons of the asthma and allergic rhinitis symptom exacerbation during dust mite allergen-specific immunotherapy were analyzed.The data were analyzed by SPSS15.0.Results Compared with control group,the frequency of acute episode,the frequency of respiratory tract infection in test group were significantly decreased at the 2 years of the treament and 1 year after the treament.The PEFof asthmasic children were obviously improved in the test group at the 2 years of the treament and 1 year after the treament and the Ch-CACT were more higher in the test group than the control group at 1 year after the treament.Compared with control group,the symptem scores and VAS of allergic rhinitis were significantly increased in test group at the 6 months,1 year,2 years of the treament and 1 year after the treament.The common reasons of the asthma and allergic rhinitis symptom exacerbation during specific immunotherapy were climatic factor,respiratory tract infection,nasosinusitis and improper room cleared,etc.Conclusion The dust mite allergen-specific immunotherapy can enhance the PEF and Ch-CACT of the asthmasic children,can obviously improve the symptem scores and VAS of allergic rhinitis and it is a persistent and effective means on prevention and cure in children with allergic rhinitis and asthma.The climatic factor,respiratory tract infection,nasosinusitis are common reasons of the asthma and allergic rhinitis symptom exacerbation during specific immunotherapy.