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儿童螨皮下特异性免疫治疗临床疗效的回顾性研究

段庆宁 严敏 刘峰 陈鸣霞 杨玲慧 赵德育

段庆宁, 严敏, 刘峰, 等. 儿童螨皮下特异性免疫治疗临床疗效的回顾性研究[J]. 四川大学学报(医学版), 2021, 52(5): 849-854. doi: 10.12182/20210960205
引用本文: 段庆宁, 严敏, 刘峰, 等. 儿童螨皮下特异性免疫治疗临床疗效的回顾性研究[J]. 四川大学学报(医学版), 2021, 52(5): 849-854. doi: 10.12182/20210960205
DUAN Qing-ning, YAN Min, LIU Feng, et al. Retrospective Study of Mite-Specific Subcutaneous Immunotherapy in Children[J]. JOURNAL OF SICHUAN UNIVERSITY (MEDICAL SCIENCE EDITION), 2021, 52(5): 849-854. doi: 10.12182/20210960205
Citation: DUAN Qing-ning, YAN Min, LIU Feng, et al. Retrospective Study of Mite-Specific Subcutaneous Immunotherapy in Children[J]. JOURNAL OF SICHUAN UNIVERSITY (MEDICAL SCIENCE EDITION), 2021, 52(5): 849-854. doi: 10.12182/20210960205

儿童螨皮下特异性免疫治疗临床疗效的回顾性研究

doi: 10.12182/20210960205
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Retrospective Study of Mite-Specific Subcutaneous Immunotherapy in Children

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  • 摘要:   目的  研究接受螨皮下特异性免疫治疗(subcutaneous immunotherapy, SCIT)儿童的临床疗效及影响因素。  方法  回顾性分析我院脱敏中心接受螨SCIT满3年的儿童资料,应用每日药物评分(daily medication score, DMS)评估用药情况(评分越高,用药品种越多,原发病控制越不理想),应用视觉模拟量表(visual analogue scale, VAS)评估临床症状(分数越高,症状越重)。分别在首次SCIT治疗,治疗3个月、4个月、12个月和3年时进行评估。根据3年后是否停用原发病药物分为停药和未停药两组,比较两组的一般资料、DMS、VAS及其下降率,并进行logistic回归分析结局的影响因素。  结果  共711名儿童入组,初诊时年龄平均8.38岁。男性442例,女性269例。皮肤点刺试验单一螨虫过敏445例,螨虫合并其他过敏266例。有360例在3年后停止了原发病的用药,351例症状缓解,但依然需要用药。SCIT治疗开始时,停药组的DMS和VAS低于未停药组(P<0.05);3个月~3年,DMS和VAS均较开始时持续降低,3年时停药组的DMS和VAS下降率均高于未停药组(P<0.05)。SCIT 3个月时,停药组鼻部和眼部症状阳性率低于未停药组(P<0.05);3年后,停药组鼻部、眼部、胸部症状阳性率均低于未停药组(P<0.05)。单因素分析结合多因素logistic回归发现,初始DMS>4分、初始VAS>3.5分是3年SCIT结束后停用原发病用药的保护因素;女性、治疗12个月时DMS下降率>50%是停药的危险因素。  结论  螨SCIT可缓解临床症状、减少对症治疗的用药。SCIT 3个月后症状即可出现改善,以鼻部和眼部症状改善最快。不建议在治疗1年时过多地停用原发病用药。
  • 图  1  DMS和VAS随SCIT治疗时间变化

    Figure  1.  DMS and VAS changes with the progression of SCIT treatment time

    DMS: Daily medication score; VAS: Visual analogue scale. n=711. * P<0.05, ** P<0.001, vs. initial (0 month).

    图  2  DMS和VAS下降率在两组间的比较

    Figure  2.  Comparison of DMS and VAS decline rates between the two groups

    Data were presented as $\bar x $ (Min-Max). * P<0.05, ** P<0.001. Discontinued group (n=360), continued group (n=351).

    图  3  症状阳性率在两组间的变化

    Figure  3.  Changes in the positive symptom rates in two groups

    * P<0.05, ** P<0.001, vs. continued group at the same time. Discontinued group (n=360), continued group (n=351).

    表  1  停药组和未停药组基础资料比较

    Table  1.   Comparison of basic data between discontinued and continued groups

    ItemDiscontinued group (n=360)Continued group (n=351)P
    Age/yr. 8.56±2.70 8.2±2.24 0.053
    Gender (male/female)/case 255/105 187/164 <0.001
    Skin prick results/case 0.84
     Single allergy to mite 224 221
     Mites and other allergies 136 130
    DMS0/score, $\bar x $ (Min-Max) 3.09 (1-10) 5.57 (1-15) <0.001
    VAS0/score, $\bar x $ (Min- Max) 3.53 (0.7-9.8) 4.31 (1.1-9.8) <0.001
     DMS0: Daily medication score at 0 month; VAS0: Visual analogue scale at 0 month.
    下载: 导出CSV

    表  2  影响SCIT3年后停药的多因素logistic回归分析

    Table  2.   Logistic regression analysis of multi-factors affecting the discontinuation of SCIT after 3 years

    FactorBSEWaldP OR95%CI
    Female −1.281 0.240 28.391 <0.001 0.278 0.173-0.445
    DMS0>4 2.815 0.237 141.002 <0.001 16.686 10.486-26.553
    VAS0>3.5 0.416 0.195 4.560 <0.05 1.516 1.035-2.221
    DMS4 decline rate>16.67% 0.946 0.218 18.876 <0.001 2.575 1.681-3.946
    DMS12 decline rate>50% −1.104 0.196 31.641 <0.001 0.332 0.226-0.487
    VAS12 decline rate>70.08% 0.520 0.218 5.702 <0.05 1.680 1.098-2.579
     B: Partial regression coefficient; SE: Standard error; OR: Odds ratio; CI: Confidence interval.
    下载: 导出CSV
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出版历程
  • 收稿日期:  2021-05-13
  • 修回日期:  2021-08-02
  • 网络出版日期:  2021-09-24
  • 刊出日期:  2021-09-20

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