变应性鼻炎的舌下免疫治疗疗效分析

中文摘要

目的：评估分析遵义地区标准化粉尘螨滴剂舌下免疫治疗对变应性鼻炎的疗效。

方法：收集2016年12月至2018年2月就诊于遵义医学院附属医院的对粉尘螨过敏,皮肤点刺实验（Skin Prick Test,SPT）阳性并进行规律标准化粉尘螨滴剂舌下免疫治疗的变应性鼻炎患者。计算缓解率，明确治疗是否有效。为明确年龄与疗效的关系，在治疗前后分别进行变应性鼻炎症状评分。故根据治疗方案不同将患者分为14岁以下治疗方案组（A组）和14岁及以上治疗方案组（B组）两组；将A组按照学龄前组（年龄＜6岁）和学龄后组6岁≤年龄＜14岁）划分为2组，B组按照未成年人组（14岁≤年龄＜18岁）和成年人组（年龄≥18岁）划分为2组，分别计算各组人群在治疗前和治疗2个月后的症状总评分以及治疗前后症状总评分的差值，对两种方案的不同年龄组治疗前后症状总评分的差值进行t检验。再采用卡方检验对各组患者在不同症状上的缓解率进行假设检验，比较治疗前后各维度之间的症状是否有缓解。最后，为明确舌下免疫治疗的维持治疗疗效，计算规律用药时间达到4个月及以上的患者各阶段的症状缓解率。

结果：在321例患者中，根据纳入排除标准纳入237例患者，237例患者总缓解率为86.08%(204/237)。

A组患者，150人，经过2个月治疗，学龄前组（23人）和学龄后组（127人）症状总评分差值分别为-3.13±3.334、-3.57±2.626，P＜0.01，差异具有统计学意义，学龄后组的症状总体改善情况较学龄前组更好；仅鼻涕症状，学龄前组缓解率为39.13%，学龄后组缓解率为67.72%，P＜0.05，不同年龄组的患者治疗前后缓解率具有统计学差异，且学龄后组的缓解率明显高于学龄前组。

B组患者，87人，经过2个月的治疗，未成年人组（38人）和成年人组（49人）

症状总评分差值分别为-2.66±2.474、-3.90±2.785，＜0.01,差异有统计学意义，成年人组的症状总体改善情况较未成年人组更好。仅鼻痒症状，未成年人组和成年人组缓解率分别为34.21%、65.31%，P＜0.05，不同年龄的患者治疗前后缓解率具有统计学差异，且成年人组缓解率明显高于未成年人组。

规律用药时间达到4个月以上的患者77人，SLIT治疗后3.10±1.119个月，缓解率为83.12%（64/77）；SLIT治疗后6.39±1.800个月，缓解率为85.71%（66/77）；治疗时间达6个月的患者比治疗时间达3个月的患者症状缓解率提高2.49%。

结论：标准化粉尘螨滴剂舌下免疫治疗对遵义地区变应性鼻炎的治疗总体有效，14岁以下患者学龄后组的症状总体改善情况较学龄前组更好，14岁及以上的患者，成年人的总体症状改善情况好于未成年人，年龄越大，改善情况越好；年龄对于14岁以下患者的鼻塞症状、14岁及以上患者的鼻痒症状的缓解率有一定影响，年龄越大，缓解率越高。舌下免疫治疗3个月有效率83.12%，治疗6个月有效率85.71%，维持治疗对变应性鼻炎患者的症状有持续改善的作用。年龄与SLIT治疗效果呈正相关。

关键词：变应性鼻炎；舌下免疫治疗；疗效分析

analysis

Abstract

Objective:To evaluate the efficacy of sublingual allergen immunotherapy with standardized D.farinae drops in the treatment of allergic rhinitis in Zunyi City.

Methods:321p atients who were suffered from allergic rhinitis and were allergic to dust mites and positive to SPT(Skin prick test)were enrolled in Zunyi Medical College Affiliated Hospital from December2016to February2018.Before and after sublingual allergen immunotherapy with standardized D.farinae drops,symptom scores were evaluated.According to different treatment options,patients were divided into two group,group A(under14years old)and group B(14years old and above).Group A was divided into two groups according to school age(the preschool age is under6years old and the post-school age is6years old and above).Group B was divided into two groups,the juveniles(under18years old)and adults(aged18years and above).The total scores of symptoms and the differences between pre-treatment and post-treatment were calculated. T-test was performed on the differences between the scores of two groups in different age groups before and after the treatment.The chi-square test was applied to test the remission rate of different groups in different symptoms to compare whether the symptoms before and after treatment were relieved.Finally,to calculate the rate of symptom relief of patients with a regular treatment for4months and above in differrent phases.

Results:237patients were included according to the inclusion exclusion criteria,204Of the237patients were relieved of symptoms,with a remission rate of86.08%.

In group A,there were150patients.After2months of treatment,differences in total rhinitis symptom scores of preschool and post-school age patients respectively were -3.13±3.334and-3.57±2.626,significant differences were detected between groups and within group comparisons based on the differences in total rhinitis symptom scores(P＜0.01).There was a statistical difference between preschool and post-school age children,and the overall symptom improvement of post-school age children was better than that of preschool age children.For the symptom of nasal mucus,the remission rates of preschool