中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2012年
10期
726-731
,共6页
李孟荣%王晓宁%姜晗丹%王琼艳%李迎春%林剑%金可%张海邻%李昌崇
李孟榮%王曉寧%薑晗丹%王瓊豔%李迎春%林劍%金可%張海鄰%李昌崇
리맹영%왕효저%강함단%왕경염%리영춘%림검%금가%장해린%리창숭
免疫疗法%哮喘%抗原,尘螨属%安全
免疫療法%哮喘%抗原,塵螨屬%安全
면역요법%효천%항원,진만속%안전
Immunotherapy%Asthma%Antigens,dermatophagoides%Safety
目的 观察尘螨变应原皮下特异性免疫治疗(SCIT)的不良反应、分析可能的危险因素及防范措施.方法 通过对2003年8月至2010年5月温州医学院附属第二医院育英儿童医院呼吸科哮喘及变态反应免疫治疗中心234例SCIT患者回顾性分析,观察局部不良反应(LRs)、全身不良反应(SRs)的症状,体征,发生时间,治疗处理,变应原剂量调整等,分析可能的危险因素,并对预防措施进行评估.结果 (1)234例患者SCIT总注射7679针,LRs发生4973针,占总注射次数的64.8％,所有患者在SCIT过程均发生LRs.SRs共发生235次,占总注射次数的3.1％,累及67例,占治疗例数的28.6％.轻度SRs(EAACI标准Ⅰ级、Ⅱ级)发生212次,累计50例,占治疗例数的21.3％.严重SRs(EAACI标准Ⅲ级、Ⅳ级)发生23次,占总注射次数的0.3％,累及17例,占治疗例数的7.3％.(2)症状主要累及呼吸系统205次(88.4％),皮肤黏膜系统31.5％.(3)肾上腺素处理17次,占总注射次数的0.2％,累及14例,占治疗例数的6％.(4)95.3％的SRs发生在注射后的30 min内,≤10 min发生者19次,后者10次诊断为严重SRs.56例(83.6％)首次发生SRs的剂量为100 000 SQ-U.(5)61例SRs患者经调整变应原注射剂量完成疗程(治疗时间≥2年),其中36例通过变应原剂量经降级或者降级后再升级完成疗程；19例总剂量不变,但调整为分开两次、间隔30 min注射完成疗程；6例升级治疗.6例终止治疗.(6)≤14岁年龄组、维持治疗、哮喘患者、LRs发生次数为发生SRs的可能危险因素.(7) SCIT脱落病例共28例,患者依从比率88.1％.结论 SCIT过程中可能发生严重SRs,以注射次数计SRs发生概率0.3％,但占治疗病例数的7.3％.发生SRs的可能危险因素如高剂量变应原疫苗注射、哮喘患者等.对发生SRs的患者及时对症治疗,通过减少变应原疫苗注射总剂量或总量不变间隔30 min分次注射的方法,可较好避免后续治疗SRs的再次发生.
目的 觀察塵螨變應原皮下特異性免疫治療(SCIT)的不良反應、分析可能的危險因素及防範措施.方法 通過對2003年8月至2010年5月溫州醫學院附屬第二醫院育英兒童醫院呼吸科哮喘及變態反應免疫治療中心234例SCIT患者迴顧性分析,觀察跼部不良反應(LRs)、全身不良反應(SRs)的癥狀,體徵,髮生時間,治療處理,變應原劑量調整等,分析可能的危險因素,併對預防措施進行評估.結果 (1)234例患者SCIT總註射7679針,LRs髮生4973針,佔總註射次數的64.8％,所有患者在SCIT過程均髮生LRs.SRs共髮生235次,佔總註射次數的3.1％,纍及67例,佔治療例數的28.6％.輕度SRs(EAACI標準Ⅰ級、Ⅱ級)髮生212次,纍計50例,佔治療例數的21.3％.嚴重SRs(EAACI標準Ⅲ級、Ⅳ級)髮生23次,佔總註射次數的0.3％,纍及17例,佔治療例數的7.3％.(2)癥狀主要纍及呼吸繫統205次(88.4％),皮膚黏膜繫統31.5％.(3)腎上腺素處理17次,佔總註射次數的0.2％,纍及14例,佔治療例數的6％.(4)95.3％的SRs髮生在註射後的30 min內,≤10 min髮生者19次,後者10次診斷為嚴重SRs.56例(83.6％)首次髮生SRs的劑量為100 000 SQ-U.(5)61例SRs患者經調整變應原註射劑量完成療程(治療時間≥2年),其中36例通過變應原劑量經降級或者降級後再升級完成療程；19例總劑量不變,但調整為分開兩次、間隔30 min註射完成療程；6例升級治療.6例終止治療.(6)≤14歲年齡組、維持治療、哮喘患者、LRs髮生次數為髮生SRs的可能危險因素.(7) SCIT脫落病例共28例,患者依從比率88.1％.結論 SCIT過程中可能髮生嚴重SRs,以註射次數計SRs髮生概率0.3％,但佔治療病例數的7.3％.髮生SRs的可能危險因素如高劑量變應原疫苗註射、哮喘患者等.對髮生SRs的患者及時對癥治療,通過減少變應原疫苗註射總劑量或總量不變間隔30 min分次註射的方法,可較好避免後續治療SRs的再次髮生.
목적 관찰진만변응원피하특이성면역치료(SCIT)적불량반응、분석가능적위험인소급방범조시.방법 통과대2003년8월지2010년5월온주의학원부속제이의원육영인동의원호흡과효천급변태반응면역치료중심234례SCIT환자회고성분석,관찰국부불량반응(LRs)、전신불량반응(SRs)적증상,체정,발생시간,치료처리,변응원제량조정등,분석가능적위험인소,병대예방조시진행평고.결과 (1)234례환자SCIT총주사7679침,LRs발생4973침,점총주사차수적64.8％,소유환자재SCIT과정균발생LRs.SRs공발생235차,점총주사차수적3.1％,루급67례,점치료례수적28.6％.경도SRs(EAACI표준Ⅰ급、Ⅱ급)발생212차,루계50례,점치료례수적21.3％.엄중SRs(EAACI표준Ⅲ급、Ⅳ급)발생23차,점총주사차수적0.3％,루급17례,점치료례수적7.3％.(2)증상주요루급호흡계통205차(88.4％),피부점막계통31.5％.(3)신상선소처리17차,점총주사차수적0.2％,루급14례,점치료례수적6％.(4)95.3％적SRs발생재주사후적30 min내,≤10 min발생자19차,후자10차진단위엄중SRs.56례(83.6％)수차발생SRs적제량위100 000 SQ-U.(5)61례SRs환자경조정변응원주사제량완성료정(치료시간≥2년),기중36례통과변응원제량경강급혹자강급후재승급완성료정；19례총제량불변,단조정위분개량차、간격30 min주사완성료정；6례승급치료.6례종지치료.(6)≤14세년령조、유지치료、효천환자、LRs발생차수위발생SRs적가능위험인소.(7) SCIT탈락병례공28례,환자의종비솔88.1％.결론 SCIT과정중가능발생엄중SRs,이주사차수계SRs발생개솔0.3％,단점치료병례수적7.3％.발생SRs적가능위험인소여고제량변응원역묘주사、효천환자등.대발생SRs적환자급시대증치료,통과감소변응원역묘주사총제량혹총량불변간격30 min분차주사적방법,가교호피면후속치료SRs적재차발생.
Objective To investigate the incidence of local reactions (LRs) and systemic reactions (SRs) of subcutaneous immunotherapy (SCIT) and to analyze the potential risk factors of such reactions in Chinese population.Method This is a retrospective study on 234 dust mite sensitized patients with allergic rhinitis and asthma who received allergen immunotherapy in our hospital from 2003 to 2010.Chart review was conducted to capture clinical data of reactions to immunotherapy.Parameters included signs and symptoms,the onset of reaction,and interventions in treating such reactions,particularly,the administration of epinephrine (EPI) and adjustment of vaccine dosage due to LRs and SRs.Result The 234 patients received a total of 7679 injections.Among them,4973 LRs (64.8％) and 235 SRs (3.1％) were observed in 67 patients (28.6％ of all patients).SRs included respiratory symptoms (205 events,88.4％) and cutaneous symptoms (31.5％).Of the total of 235 SR events,212 (90.2％) were presented as mild SRs and 23 (9.8％) were in severe SR category (grade Ⅲ and grade Ⅳ,EAACI grading system).Overall,severe SRs accounted for 0.3％ of total injections.Seventeen of the 23 SR events required epinephrine treatment (0.2％ of total injections).Of the 67 patients,61 completed the course of treatment after dose adjustment ; 36 patients had their doses decreased prior to further advancing to target dose.Nineteen subjects tolerated splitting two injections at 30 minutes interval.Six patients advanced the dose based on protocol and another 6 had to stop immunotherapy.Most of the SRs (77.4％) occurred during the maintenance phase of immunotherapy.The levels of TIgE,SIgE D1 and SIgE D2 were found to be significantly higher in patients with SRs comparing to patients without SRs (P ＜ 0.05).SRs more commonly occurred in patients with age less than 14 years than their older counterparts (95.5％ vs.85.6％,OR =3.58,95％ CI =1.040-12.322,P ＜0.01).The incidence of SRs were significantly higher in asthma patients who received SCIT than non-asthma patients (OR =2,95 ％ CI =1.136-4.624).Conclusion Our study suggests that risk factors of SRs include maintenance phase (higher allergen vaccine doses),patients with asthma,age of less than 14 years,higher levels of TIgE,and SIgE D1 and SIgE D2.Effective management includes proper dose adjustment,splitting doses into 2 injections at 30 min apart,and strictly following immunotherapy indications.
