山东大学耳鼻喉眼学报 ›› 2019, Vol. 33 ›› Issue (1): 114-118.doi: 10.6040/j.issn.1673-3770.0.2018.299

• 论著 • 上一篇    下一篇

变应性鼻炎患者舌下免疫治疗的临床依从性192例分析

曹成,许昱   

  1. 武汉大学人民医院 耳鼻咽喉头颈外科, 湖北 武汉 430000
  • 出版日期:2019-01-20 发布日期:2019-01-28
  • 作者简介:曹成. E-mail:1364623928@qq.com
  • 基金资助:
    国家自然科学基金项目(81371070;81770986);武汉市科技局基金项目(2016060101010037)

Clinical compliance and related factors to sublingual immunotherapy in patients with allergic rhinitis

CAO Cheng, XU Yu   

  1. Department of Otorhinolaryngology Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan 430000, Hubei, China
  • Online:2019-01-20 Published:2019-01-28

摘要: 目的 探讨变应性鼻炎患者舌下免疫治疗的临床依从性。 方法 电话随访武汉大学人民医院2014年4月~2016年5月接受舌下含服免疫治疗(SLIT)的348例尘螨过敏的变应性鼻炎患者,统计SLIT的依从性并调查影响依从性的因素。 结果 348例随访患者仅成功随访192例(55.17%),失访156例(44.83%),失访主要原因是患者所留电话无法拨通或拒绝接听电话。成功随访192例中,男128例、女64例,年龄3~69(17.08±13.71)岁。治疗时间1个月-3年以上(因部分患者未能准确表述具体用药时间,平均用药时间无法求出)。根据年龄分成A组(年龄<14岁)101例和B组(年龄≥14岁)91例,根据用药时间将依从性分为依从性好(时间≥2年)及依从性差(时间<2年)。上述成功随访的患者中,整体依从性好的比例为25.52%(49/192),依从性差的比例为74.48%(143/192),其中男3~55(15.04±11.69)岁,女3~69(21.13±16.27)岁。男性、女性SLIT依从性好的比例分别为30.47%(39/128)、15.63%(10/64),男女依从性比较,差异有统计学意义(χ2=4.945 9, P=0.026);A、B组依从性好的比例分别为31.68%(32/101)、18.68%(17/91),两组依从性比较,差异有统计学意义(χ 2=4.257 4, P=0.039)。整体依从性差的患者143例中自觉免疫治疗效果不明显101例(70.63%)、自觉症状缓解或控制后终止治疗14例(9.79%)、个人因素(如治疗过程影响生活、居住外地、就诊交通不便等)12例(8.39%)、免疫治疗时出现轻度药物不良反应13例(9.09%)、家庭经济状况差2例(1.40%)、其他因素(改用中药治疗)1例(0.70%)。 结论 变应性鼻炎患者SLIT的依从性不理想,与年龄、性别及主观因素有关。

关键词: 变应性鼻炎, 舌下免疫治疗, 依从性, 影响因素

Abstract: Objective To explore the clinical compliance to sublingual immunotherapy(SLIT)in patients with allergic rhinitis(AR). Methods From April 2014 to May 2016, 348 AR patients with dust mite allergy who received SLIT were followed up by telephone. Compliance to SLIT was statistically analyzed and factors influencing compliance were investigated. Results Among 348 patients, only 192 cases(55.17%)were successfully followed-up by telephone, while 156 cases(44.83%)did not return for additional examinations. The main reason for this loss was that patients’ phones were not accessible or they refused to answer the phone. The 192 successful follow-ups included 128 male patients and 64 female patients, with ages ranging from 3 to 69 years(17.08±13.71). The treatment time varied from one month to three years or more(because some patients could not describe accurately the specific medication time, the average medication time could not be calculated). Patients were divided by age into group A(age<14 years)and group B(age≥14 years). Concerning medication time, compliance was categorized into good compliance(time≥2 years)and poor compliance(time<2 years). Among the 192 successful follow-ups, the proportion of overall compliance was 25.52%(49/192), while the proportion of poor compliance was 74.48%(143/192).The age of male patients was 3-55(15.04±11.69)years, and that of female patients was 3-69(21.13±16.27)years. Compliance with SLIT was affected by gender(χ2=4.945 9, P=0.026). The proportion of male compliance was 30.47%(39/128), whereas the proportion of female compliance was 15.63%(10/64). In addition, compliance with SLIT was affected by age(χ2=4.257 4, P=0.039). Proportion of good compliance in groups A and B were 31.68%(32/101)and 18.68%(17/91), respectively. Among 143 patients with poor compliance, the effect of self-conscious immunotherapy was not obvious for 101 of them(70.63%). Reasons for terminating treatment included the following: symptomatic relief or control(14; 9.79%); personal reasons(12; 8.39%)as the treatment process affecting lifestyle, living in rural areas, and inconvenient traffic; mild adverse reactions to drugs during immunotherapy(13; 9.09%), family financial conditions(2; 1.40%), and other reasons(1, 0.70%), such as using Chinese Medicine instead. Conclusion Compliance to SLIT in patients with allergic rhinitis was not optimal, and was affected by age, gender, and subjective factors.

Key words: Allergic rhinitis, Sublingual immunotherapy, Compliance, Influence factors

中图分类号: 

  • R765.21
[1] 中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组,中华医学会耳鼻咽喉头颈外科学分会鼻科学组.变应性鼻炎诊断和治疗指南(2015年,天津)[J].中华耳鼻咽喉头颈外科杂志,2016,51(1):6-24. doi:10.1186/1939-4551-7-6. Subspecialty Group of Rhinology, Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery, Subspecialty Group of Rhinology, Society of Otorhinolaryngology Head and Neck Surgery, Chinese Medical Association. Chinese guidelines for diagnosis and treatment of allergic rhinitis[J]. Chinese Journal of Otorhinolaryngology & Head and Neck Surgery, 2016, 51(1): 6-24. doi:10.1186/1939-4551-7-6.
[2] 文春秀, 谢小娟, 甘金梅, 等. 粉尘螨滴剂通过改善机体免疫功能治疗过敏性鼻炎[J]. 中国免疫学杂志, 2016, 32(2): 244-246. doi:10.3969/j.issn.1000-484X.2016.02.022. WEN Chunxiu, XIE Xiaojuan, GAN Jinmei, et al. Dust mite drops by improving immune function in treating allergic rhinitis[J]. Chinese Journal of Immunology, 2016, 32(2): 244-246. doi:10.3969/j.issn.1000-484X.2016.02.022.
[3] Zhang Y, Zhang L. Prevalence of allergic rhinitis in china[J]. Allergy Asthma Immunol Res, 2014, 6(2): 105-113. doi:10.4168/aair.2014.6.2.105.
[4] Jutel M, Agache I, Bonini S, et al. International consensus on allergy immunotherapy[J]. J Allergy Clin Immunol, 2015, 136(3): 556-568. doi:10.1016/j.jaci.2015.04.047.
[5] Burks AW, Calderon MA, Casale T, et al. Update on allergy immunotherapy: american academy of allergy, asthma & Immunology/European academy of allergy and clinical Immunology/PRACTALL consensus report[J]. J Allergy Clin Immunol, 2013, 131(5): 1288-1296.e3. doi:10.1016/j.jaci.2013.01.049.
[6] Osterberg L, Blaschke T. Adherence to medication[J]. N Engl J Med, 2005, 353(5): 487-497. doi:10.1056/NEJMra050100.
[7] Malling HJ. Comparison of the clinical efficacy and safety of subcutaneous and sublingual immunotherapy: methodological approaches and experimental results[J]. Curr Opin Allergy Clin Immunol, 2004, 4(6): 539-542.
[8] Canonica GW, Cox L, Pawankar R, et al. Sublingual immunotherapy: World Allergy Organization position paper 2013 update[J]. World Allergy Organization Journal, 2014, 7(1): 1-52. doi:10.1186/1939-4551-7-6.
[9] Pajno GB, Barberio G, De Luca F, et al. Prevention of new sensitizations in asthmatic children monosensitized to house dust mite by specific immunotherapy. A six-year follow-up study[J]. Clin Exp Allergy, 2001, 31(9): 1392-1397.
[10] 张小鹏. 粉尘螨滴剂与抗益生菌疗法治疗过敏性鼻炎的临床观察对比研究[J]. 世界最新医学信息文摘(电子版), 2013, 13(31): 59-59,62. doi:10.3969/j.issn.1671-3141.2013.31.046.
[11] 陈建军, 孔维佳, 项济生, 等. 舌下含服免疫治疗依从性分析及对策[J]. 临床耳鼻咽喉头颈外科杂志, 2010, 24(5): 203-206. doi:10.3969/j.issn.1001-1781.2010.05.004. CHEN Jianjun, KONG Weijia, XIANG Jisheng, et al. Compliance analysis of sublingual immunotherapy and countermeasures[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2010, 24(5): 203-206. doi:10.3969/j.issn.1001-1781.2010.05.004.
[12] 桂晓钟, 陈涌, 赵军, 等. 变应性鼻炎皮下注射和舌下含服特异性免疫治疗依从性对比[J]. 中国耳鼻咽喉头颈外科, 2010, 17(12): 631-633. GU Xiaozhong, CHEN Yong, ZHAO Jun, et al. A comparative study of the compliance between subcutaneous immunotherapy and sublingual immunotherapy in patients with allergic rhinitis[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2010, 17(12): 631-633.
[13] Kiel MA, Röder E, Gerth van Wijk R, et al. Real-life compliance and persistence among users of subcutaneous and sublingual allergen immunotherapy[J]. J Allergy Clin Immunol, 2013, 132(2): 353-360.e2. doi:10.1016/j.jaci.2013.03.013.
[14] Senna G, Lombardi C, Canonica GW, et al. How adherent to sublingual immunotherapy prescriptions are patients? The manufacturers' viewpoint[J]. J Allergy Clin Immunol, 2010, 126(3): 668-669. doi:10.1016/j.jaci.2010.06.045.
[15] Trebuchon F, Lhéritier-Barrand M, David M, et al. Characteristics and management of sublingual allergen immunotherapy in children with allergic rhinitis and asthma induced by house dust mite allergens[J]. Clin Transl Allergy, 2014, 4: 15. doi:10.1186/2045-7022-4-15.
[16] Wang L, Yin J, Fadel R, et al. House dust mite sublingual immunotherapy is safe and appears to be effective in moderate, persistent asthma[J]. Allergy, 2014, 69(9): 1181-1188. doi:10.1111/all.12188.
[17] Barberi S, Ciprandi G, Verduci E, et al. Effect of high-dose sublingual immunotherapy on respiratory infections in children allergic to house dust mite[J]. Asia Pac Allergy, 2015, 5(3): 163-169. doi:10.5415/apallergy.2015.5.3.163.
[18] Berto P, Bassi M, Incorvaia C, et al. Cost effectiveness of sublingual immunotherapy in children with allergic rhinitis and asthma[J]. Eur Ann Allergy Clin Immunol, 2005, 37(8): 303-308.
[19] Wilson DR, Lima MT, Durham SR. Sublingual immunotherapy for allergic rhinitis: systematic review and meta-analysis[J]. Allergy, 2005, 60(1): 4-12. doi:10.1111/j.1398-9995.2005.00699.x.
[20] 李祖望, 许昱, 陶泽璋, 等. 标准化尘螨变应原疫苗舌下免疫治疗变应性鼻炎的临床研究[J]. 中国耳鼻咽喉头颈外科, 2010, 17(1): 3-6. doi:10.16066/j.1672-7002.2010.01.014. LI Zuwang, XU Yu, TAO Zezhang, et al. Sublingual immunotherapy with a standardized dermatophagoides farinae extract for allergic rhinitis[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2010, 17(1): 3-6. doi:10.16066/j.1672-7002.2010.01.014.
[21] 宋薇薇, 林小平, 高军, 等. 变应性鼻炎变应原特异性舌下含服免疫治疗1年疗效及安全性分析[J]. 中国耳鼻咽喉头颈外科, 2010, 17(12): 634-636. doi:10.16066/j.1672-7002.2010.12.011. SONG Weiwei, LIN Xiaoping, GAO Jun, et al. Efficacy and safety of sublingual immunotherapy for one year in treatments of patients with allergic rhinitis[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2010, 17(12): 634-636. doi:10.16066/j.1672-7002.2010.12.011.
[22] Novembre E, Galli E, Landi F, et al. Coseasonal sublingual immunotherapy reduces the development of asthma in children with allergic rhinoconjunctivitis[J]. J Allergy Clin Immunol, 2004, 114(4): 851-857. doi:10.1016/j.jaci.2004.07.012.
[23] Eberle PF. Sublingual immunotherapy: time to reconsider compliance and adherence[J]. World Allergy Organ J, 2015, 8(S1): A68. doi:10.1186/1939-4551-8-s1-a68.
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