CAJ | 학술논문

目的探讨3年期标准化皮下尘螨免疫治疗对变应性鼻炎( allergic rhinitis,AR)患者的临床疗效及安全性.方法对90例经皮肤点刺、血清特异性IgE检测诊断为螨过敏的AR患者,采用标准化特异性变应原剂量递增治疗方案完成3年疗程.分别在治疗前、治疗3年后对鼻塞、鼻涕、鼻痒和喷嚏进行主观症状评分(0～3分),同时达到维持剂量后每4个月记录鼻腔症状的视觉模拟量表(visual analogue scale,VAS)评分及药物评分.观察剂量递增期和剂量维持期的局部及全身不良反应的发生情况以评估治疗的安全性.结果免疫治疗前鼻塞、喷嚏、鼻涕和鼻痒等主观症状评分(中位数[25分位数；75分位数],下同)分别为2[2;3]、2[2;3]、2[2;3]、2[1；2]分；完成3年免疫治疗后各项评分均为0[0;0]分,差异有统计学意义(Z值分别为-8.310、-8.408、- 8.377、-8.287,P值均为0.000).免疫治疗前各种鼻部症状VAS评分及药物评分分别为8.00[7.00;8.85]、2.00[1.50；2.00]分,完成3年免疫治疗后分别为1.00[1.00；1.50]、0[0;0]分,差异有统计学意义(Z值分别为-8.287、-8.248、P值均为0.000),并在维持剂量注射过程中保持稳定(F值分别为2.483、0.296,P值分别为0.086、0.744).64.47％(98例次)的局部不良反应发生在免疫治疗的剂量维持期；全身不良反应发生率为2.54％.结论尘螨标准化特异性变应原免疫治疗AR安全、有效.
목적 탐토3년기표준화피하진만면역치료대변응성비염( allergic rhinitis,AR)환자적림상료효급안전성.방법 대90례경피부점자、혈청특이성IgE검측진단위만과민적AR환자,채용표준화특이성변응원제량체증치료방안완성3년료정.분별재치료전、치료3년후대비새、비체、비양화분체진행주관증상평분(0～3분),동시체도유지제량후매4개월기록비강증상적시각모의량표(visual analogue scale,VAS)평분급약물평분.관찰제량체증기화제량유지기적국부급전신불량반응적발생정황이평고치료적안전성.결과 면역치료전비새、분체、비체화비양등주관증상평분(중위수[25분위수；75분위수],하동)분별위2[2;3]、2[2;3]、2[2;3]、2[1；2]분；완성3년면역치료후각항평분균위0[0;0]분,차이유통계학의의(Z치분별위-8.310、-8.408、- 8.377、-8.287,P치균위0.000).면역치료전각충비부증상VAS평분급약물평분분별위8.00[7.00;8.85]、2.00[1.50；2.00]분,완성3년면역치료후분별위1.00[1.00；1.50]、0[0;0]분,차이유통계학의의(Z치분별위-8.287、-8.248、P치균위0.000),병재유지제량주사과정중보지은정(F치분별위2.483、0.296,P치분별위0.086、0.744).64.47％(98례차)적국부불량반응발생재면역치료적제량유지기；전신불량반응발생솔위2.54％.결론 진만표준화특이성변응원면역치료AR안전、유효.
Objective To evaluate the three-year efficacy and safety with standardized dust mite subcutaneous immunotherapy in patients with allergic rhinitis. Methods Ninety patients who were diagnosed as allergic to mite by skin prick test and serum IgE were include in the standardized allergenspecific dose-escalation regimen.Nasal symptom score (0 - 3 ) were collected before treatment and three years after treatment; VAS( visual analogue scale,0 - 10) of all nasal symptoms and drug use score were collected every four months; frequency of local and systemic reactions were recorded in the duration of dose escalation and maintenance.Results Nasal blocking,sneeze,rhinorrhia and nasal itch were significantly improved after 3 years treatment ( before treatment:2 [ 2 ; 3 ],2 [ 2 ;3 ],2 [ 2 ;3 ],2 [ 1 ; 2 ] ; after treatment:all were 0 [ 0 ;0 ] ; Z value were - 8.310,- 8.408,- 8.377,- 8.287,all P were 0.000 ).VAS of all nasal symptoms and drug use score decreased dramatically after escalation period ( before treatment:8.00 [7.00;8.85],2.00[ 1.50;2.00] ; after treatment:1.00[ 1.00;1.50],0 [0;0] ; Z value were -8.287,- 8.248,P value 0.086,0.744 ),and maintained afterwards ( F value were 2.483,0.296 ; P value were 0.086,0.744).Ninty-eight case times (64.47％ ) local reactions mainly happened in maintenance period;the frequency of systemic reactions was 2.54％. Conclusion The standardized specific allergen immunotherapy for allergic rhinitis is safe and effective.