山东大学耳鼻喉眼学报 ›› 2022, Vol. 36 ›› Issue (1): 75-80.doi: 10.6040/j.issn.1673-3770.0.2021.028

• • 上一篇    下一篇

皮下免疫治疗对单一尘螨和合并霉菌过敏儿童哮喘的临床研究

李孟辉1,3,郅莉莉2,戚凯文3,4,王珊珊3,高倩1,3,步美玲1,3,姜荷云3,4,冯绛楠3,王金荣3   

  1. 1. 山东中医药大学第二临床医学院, 山东 济南 250004;
    2. 淄博市中心医院 变态反应科, 山东 淄博 255036;
    3. 山东第一医科大学附属省立医院 小儿呼吸科, 山东 济南 250021;
    4. 潍坊医学院, 山东 潍坊 261053
  • 发布日期:2022-02-22
  • 通讯作者: 王金荣. E-mail:jrwang60@163.com
  • 基金资助:
    山东省重点研发计划项目(2015GSF118036)

Clinical research of subcutaneous immunotherapy on children with allergic asthma caused by dust mites and combined with mold allergen

LI Menghui1,3, ZHI Lili2, QI Kaiwen3,4, WANG Shanshan3, GAO Qian1,3, BU Meiling1,3,   

  1. 1. Second Clinical Medical College of Shandong University of Traditional Chinese Medicine, Jinan 250004, Shandong, China;
    2. Zibo Central Hospital Allergy Department of, Zibo 255036, Shandong, China;
    3. Shandong Provincial Hospital of Shandong First Medical University Department of Pediatric Respiratory, Jinan 250021, Shandong, China;
    4. Weifang Medical College, Weifang 261053, Shandong, China
  • Published:2022-02-22

摘要: 目的 评价特异性皮下免疫治疗(SCIT)对单一尘螨过敏和尘螨合并霉菌过敏的哮喘儿童的疗效。 方法 纳入6~14岁过敏性哮喘儿童,根据过敏原种类,分为单一尘螨组与尘螨合并霉菌组,给予SCIT。治疗12、24个月时,比较组内和组间的哮喘控制问卷(ACQ)评分、药物评分和肺功能指标[第1秒用力呼气的容积占预计值的百分比(FEV1%)、呼出50%肺活量时最大呼气流量占预计值的百分比(FEF50%)、呼出75%肺活量时最大呼气流量占预计值的百分比(FEF75%)和用力呼气中期流量占预计值的百分比(MMEF%)]。 结果 共纳入118例哮喘儿童,其中单一尘螨组57例,尘螨合并霉菌组61例。治疗12个月时,两组的ACQ评分、药物评分、FEF50%、FEF75%和MMEF%均较治疗前有改善(均P<0.05),而FEV1%虽较治疗前有改善,但差异无统计学意义(P>0.05);治疗24个月时,两组的ACQ评分、药物评分、FEV1%、FEF50%、FEF75%和MMEF%均较治疗12个月有改善(均P<0.05)。治疗12个月和24个月,两组间ACQ评分、药物评分、FEV1%、FEF50%、FEF75%和MMEF%的改善程度差异均无统计学意义(均P>0.05)。 结论 SCIT可改善过敏性哮喘儿童的临床症状,减少哮喘药物的使用,不仅对大气道有改善,还能改善小气道。SCIT对单一尘螨过敏和尘螨合并霉菌过敏的哮喘患儿疗效相当。

关键词: 特异性免疫治疗, 儿童哮喘, 尘螨, 霉菌

Abstract: Objective To evaluate the efficacy of subcutaneous immunotherapy(SCIT)on children with allergic asthma caused by single dust mite and dust mite with mold respectively. Methods Children aged 6-14 years with allergic asthma were divided into single dust mite allergy group or dust mite with mold allergy group according to allergen species and given SCIT. ACQ score, drug score, lung function indicators(FEV1%, FEF50%, FEF75% and MMEF%)were compared after 12,24 months of treatment within and between groups, respectively. Results A total of 118 asthmatic children were included: 57 in the dust mite group and 61 in the dust mite with mold group. After 12 months of treatment, ACQ score, drug score, FEF50%, FEF75% and MMEF% were significantly improved compared with that before treatment in both groups(all P<0.05). While the FEV1% in both groups were improved compared with that before treatment, but there was no statistical significance(P>0.05). After 24 months of treatment, both groups of ACQ score, drug score, FEV1%,FEF50%,FEF75% and MMEF% have improved significantly of that after 12 months of treatment(all P<0.05). At 12 and 24 months of treatment, there were no significant differences of degree of improvement in ACQ score, drug score, FEV1%, FEF50%, FEF75% and MMEF%(all P>0.05)between two groups. Conclusion The SCIT can significantly improve the clinical symptoms, reduce the use of symptomatic drugs, improve lung function in children with allergic asthma. SCIT not only has a significant effect on single dust mite, but also on dust mite with mold allergen.

Key words: Specific immunotherapy, Children, Asthma, Mold allergen

中图分类号: 

  • R562.2
[1] 中华医学会变态反应分会呼吸过敏学组(筹), 中华医学会呼吸病学分会哮喘学组. 中国过敏性哮喘诊治指南(第一版, 2019年)[J]. 中华内科杂志, 2019, 58(9): 636-655. doi:10.3760/cma.j.issn.0578-1426.2019.09.004. The Respiratory Allergy Group of Chinese Society of Allergy, The Asthma Group of Chinese Thoracic Society, Chinese Medical Association.Chinese guidelines for the diagnosis and treatment of allergic asthma(2019, the first edition)[J]. Chin J Intern Med, 2019, 58(9): 636-655. doi:10.3760/cma.j.issn.0578-1426.2019.09.004.
[2] Twaroch TE, Curin M, Valenta R, et al. Mold allergens in respiratory allergy: from structure to therapy[J]. Allergy Asthma Immunol Res, 2015, 7(3): 205-220. doi:10.4168/aair.2015.7.3.205.
[3] Salo PM, Arbes SJ, Jaramillo R, et al. Prevalence of allergic sensitization in the United States: results from the national health and nutrition examination survey(NHANES)2005-2006[J]. J Allergy Clin Immunol, 2014, 134(2): 350-359. doi:10.1016/j.jaci.2013.12.1071.
[4] Schaller A, Delmas C, De Blay F. Allergic respiratory diseases related to mould in the home[J]. Rev Mal Respir, 2019, 36(7): 889-901. doi:10.1016/j.rmr.2018.10.619.
[5] 赵晨, 王岑岑, 赵晓波, 等. 556例过敏性疾病患儿血清过敏原检测结果分析[J]. 中国临床医生杂志, 2019, 47(1): 102-105. doi:10.3969/j.issn.2095-8552.2019.01.033.
[6] 中华医学会儿科学分会呼吸学组, 《中华儿科杂志》编辑委员会. 儿童支气管哮喘诊断与防治指南(2016年版)[J]. 中华儿科杂志, 2016, 54(3): 167-181. doi:10.3760/cma.j.issn.0578-1310.2016.03.003. The Subspecialty Group of Respiratory Diseases, The Society of Pediatrics, Chinese Medical Association, The Editorial Board, Chinese Journal of Pediatrics.Guideline for the diagnosis and optimal management of asthma in children(2016)[J]. Chin J Pediatr, 2016, 54(3): 167-181. doi:10.3760/cma.j.issn.0578-1310.2016.03.003.
[7] Nguyen JM, Holbrook JT, Wei CY, et al. Validation and psychometric properties of the Asthma Control Questionnaire among children[J]. J Allergy Clin Immunol, 2014, 133(1): 91-97. e1-6. doi:10.1016/j.jaci.2013.06.029.
[8] Pfaar O, Demoly P, Gerth van Wijk R, et al. Recommendations for the standardization of clinical outcomes used in allergen immunotherapy trials for allergic rhinoconjunctivitis: an EAACI Position Paper[J]. Allergy, 2014, 69(7): 854-867. doi:10.1111/all.12383.
[9] 中华医学会儿科学分会呼吸学组肺功能协作组.肺功能系列指南(二):肺容积和通气功能[J].中华实用儿科临床杂志, 2016, 31(10):744-750. doi:10.3760/cma.j.issn.2095-428X.2016.10.006.
[10] Li J, Sun B, Huang Y, et al. A multicentre study assessing the prevalence of sensitizations in patients with asthma and/or rhinitis in China[J]. Allergy, 2009, 64(7): 1083-1092. doi:10.1111/j.1398-9995.2009.01967.x.
[11] 王洁, 常换换, 魏苗, 等. 舌下含服尘螨滴剂治疗单一或多重过敏原儿童变应性鼻炎的疗效观察[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(21): 1646-1650. doi:10.13201/j.issn.1001-1781.2018.21.010. WANG Jie, CHANG Huanhuan, WEI Miao, et al. Effect of sublingual dust mite drops on single or multiple allergens allergic rhinitis in children[J]. J Clin Otorhinolaryngol Head Neck Surg, 2018, 32(21): 1646-1650. doi:10.13201/j.issn.1001-1781.2018.21.010.
[12] Khamal R, Isa ZM, Sutan R, et al. WITHDRAWN: indoor particulate matters, microbial count assessments and wheezing symptoms among toddlers in urban day care centers(DCCs)in the district ofseremban, Malaysia[J]. Ann Glob Heal, 2017. doi:10.1016/j.aogh.2016.05.004.
[13] 徐盼盼, 纪东, 程静, 等. 安脱达治疗单一尘螨和多重过敏的变应性鼻炎的疗效分析[J]. 中国中西医结合耳鼻咽喉科杂志, 2017, 25(3): 200-204. doi:10.16542/j.cnki.issn.1007-4856.2017.03.012. XU Panpan, JI Dong, CHEN Jing, et al. Efficacy analysis of Alutard SQ with Dermatophagoides pteronyssinus preparations in monosensitized and polysensitized patients with allergic rhinitis[J]. Chin J Otorhinolaryngol Integr Med, 2017, 25(3): 200-204. doi:10.16542/j.cnki.issn.1007-4856.2017.03.012.
[14] 屠燕怡, 史丽, 赵莉, 等. 尘螨疫苗皮下注射治疗变应性鼻炎的疗效和安全性评估[J]. 山东大学耳鼻喉眼学报, 2016, 30(4): 50-55. doi:10.6040/j.issn.1673-3770.0.2016.292. TU Yanyi, SHI Li, ZHAO Li, et al. Efficacy and safety of subcutaneous immunotherapy with house dust mite extract for allergic rhinitis[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2016, 30(4): 50-55. doi:10.6040/j.issn.1673-3770.0.2016.292.
[15] Smith CJ, Spaeder MC, Sorkness RL, et al. Disparate diagnostic accuracy of lung function tests as predictors of poor asthma control in children[J]. J Asthma, 2020, 57(3): 327-334. doi:10.1080/02770903.2019.1566471.
[16] Jones MH, Howard J, Davis S, et al. Sensitivity of spirometric measurements to detect airway obstruction in infants[J]. Am J Respir Crit Care Med, 2003, 167(9): 1283-1286. doi:10.1164/rccm.200204-339OC.
[17] Siroux V, Boudier A, Dolgopoloff M, et al. Forced midexpiratory flow between 25% and 75% of forced vital capacity is associated with long-term persistence of asthma and poor asthma outcomes[J]. J Allergy Clin Immunol, 2016, 137(6): 1709-1716.e6. doi:10.1016/j.jaci.2015.10.029.
[18] Asamoah F, Kakourou A, Dhami S, et al. Allergen immunotherapy for allergic asthma: a systematic overview of systematic reviews[J]. Clin Transl Allergy, 2017, 7: 25. doi:10.1186/s13601-017-0160-0.
[19] 吴少皎, 陈实, 陈冰, 等. 屋尘螨皮下特异性免疫治疗对儿童过敏性哮喘伴鼻炎肺功能及症状的影响分析[J]. 临床耳鼻咽喉头颈外科杂志, 2017, 31(17): 1352-1355. doi:10.13201/j.issn.1001-1781.2017.17.014. WU Shaojiao, CHEN Shi, CHEN Bing, et al. An analysis of the subcutaneous immunotherapy on the pulmonary function and symptoms of asthma and rhinitis in children[J]. J Clin Otorhinolaryngol Head Neck Surg, 2017, 31(17): 1352-1355. doi:10.13201/j.issn.1001-1781.2017.17.014.
[20] 邓文华, 陈锋. 吸入性糖皮质激素联合长效β2受体激动剂治疗肥胖儿童哮喘的疗效分析[J]. 中国处方药, 2020, 18(4): 72-73.
[21] 容嘉妍, 黄东明, 王桂兰, 等. 屋尘螨皮下特异性免疫治疗儿童哮喘和/或变应性鼻炎致全身不良反应[J]. 中华临床免疫和变态反应杂志, 2020, 14(3): 233-238. doi:10.3969/j.issn.1673-8705.2020.03.010. RONG Jiayan, HUANG Dongming, WANG Guilan, et al. Systemic adverse reactions induced by house dust mite specific immunotherapy among children with asthma and/or allergic rhinitis[J]. Chin J Allergy Clin Immunol, 2020, 14(3): 233-238. doi:10.3969/j.issn.1673-8705.2020.03.010.
[22] Cheng L, Chen J, Fu Q, et al. Chinese society of allergy guidelines for diagnosis and treatment of allergic rhinitis[J]. Allergy Asthma Immunol Res, 2018, 10(4): 300-353. doi:10.4168/aair.2018.10.4.300.
[23] Har D, Lee MJ. Systemic reaction rates with omalizumab, subcutaneous immunotherapy, and combination therapy in children with allergic asthma[J]. Allergy Asthma Proc, 2019, 40(1): 35-40. doi:10.2500/aap.2019.40.4173.
[24] 钟灿, 杨伟忠, 黎月莲, 等. 舌下含服粉尘螨滴剂治疗多重过敏的过敏性哮喘的临床评价[J]. 临床肺科杂志, 2016, 21(7): 1194-1198. doi:10.3969/j.issn.1009-6663.2016.07.008. ZHONG Can, YANG Weizhong, LI Yuelian, et al. Clinical evaluation of sublingual immunotherapy with Dermatophagoides farinae drops in polysensitized patients with allergic asthma[J]. J Clin Pulm Med, 2016, 21(7): 1194-1198. doi:10.3969/j.issn.1009-6663.2016.07.008.
[25] 许晨霞, 张妙莲, 邹泽红, 等. 螨制剂舌下免疫治疗对单一和多重致敏变应性鼻炎的疗效评估[J]. 中华临床免疫和变态反应杂志, 2014, 8(2): 95-100. doi:10.3969/j.issn.1673-8705.2014.02.002. XU Chenxia, ZHANG Miaolian, ZOU Zehong, et al. Clinical evaluation of efficacy of sublingual immunotherapy with Dermatophagoides farinae extract among monosensitized and polysensitized patients with allergic rhinitis[J]. Chin J Allergy Clin Immunol, 2014, 8(2): 95-100. doi:10.3969/j.issn.1673-8705.2014.02.002.
[26] Marogna M, Spadolini I, Massolo A, et al. Effects of sublingual immunotherapy for multiple or single allergens in polysensitized patients[J]. Ann Allergy Asthma Immunol, 2007, 98(3): 274-280. doi:10.1016/S1081-1206(10)60718-1.
[27] von Hertzen LC, Savolainen J, Hannuksela M, et al. Scientific rationale for the Finnish Allergy Programme 2008-2018: emphasis on prevention and endorsing tolerance[J]. Allergy, 2009, 64(5): 678-701. doi:10.1111/j.1398-9995.2009.02024.x.
[28] Agache I, Lau S, Akdis CA, et al. EAACI Guidelines on Allergen Immunotherapy: House dust mite-driven allergic asthma[J]. Allergy, 2019, 74(5): 855-873. doi:10.1111/all.13749.
[1] 庞冲,边赛男,张冰,尹旭,陆颖霞,叶鹏飞,王湛,赵晶,高彦,关凯. 儿童过敏性鼻炎粉尘螨特异性舌下免疫治疗短期疗效评估[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 70-74.
[2] 张贵阳,黄河,冼志,张汉文,谢桂彩. 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[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 60-65.
[3] 钱俊俊,周文成,吴中飞,卜冬云,汪李琴,陆美萍,程雷. 苏皖地区变应性鼻炎患者吸入性变应原谱分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(3): 147-151.
[4] 邱前辉,高俊潇. 特异性免疫治疗对过敏性鼻炎和哮喘的同步控制和远期疗效[J]. 山东大学耳鼻喉眼学报, 2019, 33(1): 33-37.
[5] 洪冬冬,刘元献,邹练强,翁镌凌,邓文娴. 变应性鼻炎患者粉尘螨皮肤点刺试验阳性764例结果分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(1): 119-123.
[6] 许丽平. 碳酸氢钠溶液漱口联合制霉菌素混悬液雾化吸入治疗真菌性咽喉炎32例[J]. 山东大学耳鼻喉眼学报, 2017, 31(2): 121-122.
[7] 屠燕怡,史丽,赵莉,金鹏,訾晓雪,李昂,金义炫,郅莉莉. 尘螨疫苗皮下注射治疗变应性鼻炎的疗效和安全性评估[J]. 山东大学耳鼻喉眼学报, 2016, 30(4): 50-55.
[8] 顾晓,陈彦林. 舌下免疫治疗变应性鼻炎的疗效分析[J]. 山东大学耳鼻喉眼学报, 2016, 30(1): 17-20.
[9] 朱江彬, 孙秀芹, 南兵卫, 郝宗生. 5%碳酸氢钠液与制霉菌素片混合制剂纱条治疗真菌性外耳道炎156例[J]. 山东大学耳鼻喉眼学报, 2015, 29(6): 82-83.
[10] 谢晓红, 胡志邦, 宋盼盼, 戴艳红, 陈峰, 俞晨杰, 高下. 舌下含服粉尘螨滴剂联合鼻用激素治疗变应性鼻炎疗效观察[J]. 山东大学耳鼻喉眼学报, 2014, 28(5): 34-37.
[11] 岳耀光,黄合银,黄丽芳,梁仕才,蒙周君,邓斯敏,张永强,吕显林,李亿华,沈诚. 舌下含服粉尘螨滴剂治疗儿童变应性鼻炎合并腺样体肥大的疗效观察[J]. 山东大学耳鼻喉眼学报, 2014, 28(3): 16-19.
[12] 杨阳1,2,刘吉祥2,宋富存2,程莉雅1. 尘螨变应原皮肤点刺试验结果与其血清sIgE及年龄的相关性[J]. 山东大学耳鼻喉眼学报, 2014, 28(2): 65-67.
[13] 张珂珂,叶萍,杨燕,史丽. 尘螨滴剂治疗变应性鼻炎的临床观察[J]. 山东大学耳鼻喉眼学报, 2009, 23(5): 37-38.
[14] 匡嘉丽 吴军 郭亮 方向佳. 舌下含服脱敏治疗变应性鼻炎疗效观察[J]. 山东大学耳鼻喉眼学报, 2009, 23(4): 49-51.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!