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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 Sciences), 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 Sciences), 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

Retrospective Study of Mite-Specific Subcutaneous Immunotherapy in Children

  • 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。

     

    Abstract:
      Objective  To explore the clinical efficacy and influencing factors of children receiving mite-specific subcutaneous immunotherapy (SCIT).
      Methods  We retrospectively analyzed the data of children who had received mite SCIT for 3 years at the Desensitization Center of our hospital. We used the daily medication score (DMS) to evaluate the medication use status (the higher the score, the higher the amount of medications given and the less satisfactorily was the primary disease controlled) and we used the visual analogue scale (VAS) to evaluate clinical symptoms (the higher the score, the more severe the symptoms). Evaluation was performed after the first SCIT treatment and after treatment was given for 3 months, 4 months, 12 months, and 3 years. According to whether medication for the primary disease was stopped after 3 years, the patients were divided into two groups, the discontinued medication group (discontinued group) and the continued medication group (continued group). The general data, DMS, VAS and the decline rate of the two groups were compared, and logistic regression was performed to analyze the influencing factors of the outcome.
      Results  A total of 711 children were enrolled in the study, with an average age of 8.38 years at the time of the first visit to the hospital. There were 442 males and 269 females. Skin prick test showed that 445 cases only had mite allergy, and 266 cases had mite allergy combined with other allergies. 360 cases have discontinued the medication for the primary disease after 3 years, and 351 cases had relieved symptoms, but still needed to continue with the medication. At the beginning of SCIT treatment, the DMS and VAS of the discontinued group were lower than those of the continued group (P<0.05). Evaluations from 3 months to 3 years showed that both DMS and VAS continued to decrease compared with those from the beginning, and the decline rate of DMS and VAS of the discontinued group was higher than that of the continued group after 3 years of SCIT (P<0.05). After 3 months of SCIT, the positive rates of nasal and ocular symptoms in the discontinued group were lower than those in the continued group (P<0.05). After 3 years of SCIT, the positive rates of nasal, ocular, and chest symptoms in the discontinued group were lower than those in the continued group (P<0.05). Univariate analysis combined with multivariate logistic regression showed that initial DMS>4 points and initial VAS>3.5 points were protective factors for the discontinuation of the medication for the primary disease at the end of 3 years of SCIT, while the female sex and DMS reduction rate after 12 months of treatment>50% were risk factors for discontinuation.
      Conclusions  Mite SCIT can help relieve clinical symptoms and reduce the use of medication for symptomatic treatment. Symptoms can be improved after 3 months of SCIT, with the fastest improvement shown in nasal and eye symptoms. It is not recommended to discontinue the medication for the primary disease for too much after 1 year of treatment.

     

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