论文部分内容阅读
目的观察屋尘螨特异性免疫治疗(SIT)联合抗哮喘药物控制治疗对哮喘患儿的临床效应、肺功能和免疫学指标的影响。方法选择2005年6月至2008年6月北京儿童医院哮喘专业门诊就诊的44例轻中度哮喘患儿,经病史和体内外过敏原检测证实屋尘螨过敏,27例在吸入糖皮质激素哮喘控制治疗基础上联合应用标准化屋尘螨变应原皮下SIT(SIT组),17例单纯应用吸入性糖皮质激素(inhaled corticosteroids,ICS)控制治疗(ICS组)。比较两组治疗前和治疗中无急性哮喘发作病例的百分率、平均每日ICS剂量、肺功能指标第1秒用力呼气容积占预计值百分比(FEV1%)、呼气峰流速占预计值百分比(PEF%)、平均呼气中期流速占预计值百分比(MMEF%)及免疫学指标血清总IgE、屋尘螨特异性IgE、屋尘螨特异性IgG4、嗜酸细胞阳离子蛋白(eosinophil cationic protein,ECP)变化的差异。结果治疗疗程中SIT组无哮喘急性发作病例的百分率(59.3%)显著高于ICS组(23.5%),差异有统计学意义(χ2=5.371,P=0.02);SIT组平均每日吸入ICS的剂量为(172±92)μg/d,显著低于ICS组(267±112)μg/d,差异有统计学意义(t=2.829,P=0.008);两组治疗前和治疗后肺功能指标(FEV1%、PEF%、MMEF%)差异均无统计学意义;SIT组治疗后血清屋尘螨特异性IgG4浓度范围0.37～18.3mg/L,中位值4.29mg/L,显著高于ICS组治疗后特异性IgG4浓度(其范围0.18～4.03mg/L,中位值0.36mg/L),差异有统计学意义(U=278,W=181,P<0.001);两组治疗前和治疗后血清总IgE、屋尘螨特异性IgE、ECP浓度差异无统计学意义。结论与单纯ICS控制治疗比较,屋尘螨SIT联合抗哮喘药物控制治疗更加改善了尘螨过敏哮喘患儿的临床疗效,表现为无哮喘急性发作病例百分率更高、每日所需ICS控制治疗的剂量更低。SIT治疗2年内的患儿屋尘螨特异性IgG4浓度明显增高,但总IgE、屋尘螨特异性IgE浓度无显著变化。
Objective To observe the effects of house-dust mite-specific immunotherapy (SIT) combined with anti-asthma medication on the clinical effects, pulmonary function and immunological parameters in children with asthma. Methods From June 2005 to June 2008, 44 children with mild-to-moderate asthma admitted to Beijing Children’s Hospital for asthma specialization were diagnosed as house dust mite allergy by history and allergens in vitro and in vivo. Twenty-seven patients were allergic to glucocorticoid asthma Controlled treatment was based on a combination of standardized house dust mite allergen subcutaneous SIT (SIT group) and 17 patients were treated with inhaled corticosteroids (ICS) alone (ICS group). The percentages of patients with no acute asthma attack, mean daily daily dose of ICS, percentage of predicted forced expiratory volume in one second of pulmonary function (FEV1%) and percentage of predicted peak expiratory flow (% (PEF%), mean expiratory flow rate (MMEF%), immunoglobulin IgE, house dust mite specific IgE, house dust mite specific IgG4, eosinophil cationic protein (ECP) Differences in change. Results The percentage of acute exacerbation without asthma was significantly higher in SIT group (59.3%) than in ICS group (23.5%) (χ2 = 5.371, P = 0.02) The difference was statistically significant (t = 2.829, P = 0.008). The difference was statistically significant between the two groups before and after treatment (P <0.01) (FEV1%, PEF%, MMEF%). There was no significant difference in SIT group specific IgG4 concentration between 0.37 ~ 18.3mg / L and 4.29mg / L, which was significantly higher than that of ICS group After treatment, the specific IgG4 concentration (range 0.18-4.03 mg / L, median 0.36 mg / L) was significantly different (U = 278, W = 181, P <0.001) After the serum total IgE, house dust mite specific IgE, ECP concentration difference was not statistically significant. Conclusions Compared with ICS alone, the control efficacy of SIT combined with anti-asthmatic drugs in house dust mites improved the clinical efficacy of dust mite allergic asthma patients, showing a higher percentage of cases without acute asthma attack and daily ICS-controlled treatment Lower doses. The specific IgE concentration of house dust mite in children with SIT was significantly increased within 2 years, but there was no significant change in the total IgE and house dust mite specific IgE concentrations.