中华耳鼻咽喉头颈外科杂志
中華耳鼻嚥喉頭頸外科雜誌
중화이비인후두경외과잡지
CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY
2015年
8期
641-645
,共5页
谢薇%张汉钟%陈剑%王颖
謝薇%張漢鐘%陳劍%王穎
사미%장한종%진검%왕영
鼻炎,变应性,常年性%注射,皮下%脱敏法,免疫%鼻激发试验
鼻炎,變應性,常年性%註射,皮下%脫敏法,免疫%鼻激髮試驗
비염,변응성,상년성%주사,피하%탈민법,면역%비격발시험
Rhinitis,allergic,perennial%Injections,subcutaneous%Desensitization,immunologic%Nasal provocation test
目的 探讨冲击免疫治疗(rush immunotherapy,RIT)变应性鼻炎(allergic rhinitis,AR)的有效性与安全性.方法 对33例确诊为中-重度持续性AR的患者进行皮下免疫治疗(subcutaneous immunotherapy,SCIT),采用冲击免疫治疗的方法,1周内完成起始阶段治疗,治疗1年后分析患者治疗前后鼻部症状评分、视觉模拟量表评分(visual analogue scale,VAS)、对症用药使用情况、血清总IgE及屋尘螨特异性IgG4、螨变应原皮肤点刺试验、粉尘螨变应原鼻激发试验的情况,并分析不良反应发生情况.以SPSS 17.0软件对数据进行统计学分析.结果 经过1年的免疫治疗,鼻部症状评分、VAS评分分别为(4.97±2.92)、(11.94±7.21)分,较治疗前的(8.91 ±1.84)、(20.64±6.99)分明显降低,差异有统计学意义(t值分别为9.15、7.11,P值均＜0.001).需要使用对症药物的人数明显减少,差异有统计学意义(x2=25.39,P＜0.001).粉尘螨、屋尘螨皮肤指数明显降低,差异有统计学意义(t值分别为5.70、6.29,P值均＜0.001).血清屋尘螨特异性IgG4明显升高(Z=-4.517,P＜0.001).治疗后低浓度鼻激发反应阳性人数较治疗前减少,高浓度鼻激发反应阳性人数较治疗前增多,但差异无统计学意义(x2 =1.93,P=0.38).所有患者都有局部反应,全部治疗过程共进行759次注射,4例患者发生了11次轻度全身不良反应,全身不良反应发生率为1.45％(11/759).无严重的全身不良反应发生.结论 冲击免疫治疗效果肯定,无严重的不良反应,是安全、有效的治疗方法.
目的 探討遲擊免疫治療(rush immunotherapy,RIT)變應性鼻炎(allergic rhinitis,AR)的有效性與安全性.方法 對33例確診為中-重度持續性AR的患者進行皮下免疫治療(subcutaneous immunotherapy,SCIT),採用遲擊免疫治療的方法,1週內完成起始階段治療,治療1年後分析患者治療前後鼻部癥狀評分、視覺模擬量錶評分(visual analogue scale,VAS)、對癥用藥使用情況、血清總IgE及屋塵螨特異性IgG4、螨變應原皮膚點刺試驗、粉塵螨變應原鼻激髮試驗的情況,併分析不良反應髮生情況.以SPSS 17.0軟件對數據進行統計學分析.結果 經過1年的免疫治療,鼻部癥狀評分、VAS評分分彆為(4.97±2.92)、(11.94±7.21)分,較治療前的(8.91 ±1.84)、(20.64±6.99)分明顯降低,差異有統計學意義(t值分彆為9.15、7.11,P值均＜0.001).需要使用對癥藥物的人數明顯減少,差異有統計學意義(x2=25.39,P＜0.001).粉塵螨、屋塵螨皮膚指數明顯降低,差異有統計學意義(t值分彆為5.70、6.29,P值均＜0.001).血清屋塵螨特異性IgG4明顯升高(Z=-4.517,P＜0.001).治療後低濃度鼻激髮反應暘性人數較治療前減少,高濃度鼻激髮反應暘性人數較治療前增多,但差異無統計學意義(x2 =1.93,P=0.38).所有患者都有跼部反應,全部治療過程共進行759次註射,4例患者髮生瞭11次輕度全身不良反應,全身不良反應髮生率為1.45％(11/759).無嚴重的全身不良反應髮生.結論 遲擊免疫治療效果肯定,無嚴重的不良反應,是安全、有效的治療方法.
목적 탐토충격면역치료(rush immunotherapy,RIT)변응성비염(allergic rhinitis,AR)적유효성여안전성.방법 대33례학진위중-중도지속성AR적환자진행피하면역치료(subcutaneous immunotherapy,SCIT),채용충격면역치료적방법,1주내완성기시계단치료,치료1년후분석환자치료전후비부증상평분、시각모의량표평분(visual analogue scale,VAS)、대증용약사용정황、혈청총IgE급옥진만특이성IgG4、만변응원피부점자시험、분진만변응원비격발시험적정황,병분석불량반응발생정황.이SPSS 17.0연건대수거진행통계학분석.결과 경과1년적면역치료,비부증상평분、VAS평분분별위(4.97±2.92)、(11.94±7.21)분,교치료전적(8.91 ±1.84)、(20.64±6.99)분명현강저,차이유통계학의의(t치분별위9.15、7.11,P치균＜0.001).수요사용대증약물적인수명현감소,차이유통계학의의(x2=25.39,P＜0.001).분진만、옥진만피부지수명현강저,차이유통계학의의(t치분별위5.70、6.29,P치균＜0.001).혈청옥진만특이성IgG4명현승고(Z=-4.517,P＜0.001).치료후저농도비격발반응양성인수교치료전감소,고농도비격발반응양성인수교치료전증다,단차이무통계학의의(x2 =1.93,P=0.38).소유환자도유국부반응,전부치료과정공진행759차주사,4례환자발생료11차경도전신불량반응,전신불량반응발생솔위1.45％(11/759).무엄중적전신불량반응발생.결론 충격면역치료효과긍정,무엄중적불량반응,시안전、유효적치료방법.
Objective To evaluate the efficacy and safety of rush immunotherapy (RIT) for patients with persistent allergic rhinitis (AR).Methods In this study,a total number of thirty three (33) patients who suffered mite allergic rhinitis were included.These patients completed one year subcutaneous immunotherapy (SCIT).Using RIT,the patients underwent the incremental dose phase in a week instead of 15 weeks in a conventional treatment procedure.The symptom scores,visual analog scale (VAS),appropriate medication score,total blood serum IgE,dermatophagoides pteronyssinus specificity IgG4,mite allergy skin prick test (SPT),dermatophagoides farinae nasal provocation test (NPT) and the incidence of adverse reactions were used to evaluate the efficiency and safety of RIT.Results After one year SCIT treatment,the symptom score and VAS scores were significantly decreased,the corresponding medication usage was significantly reduced (8.91 ± 1.84,20.64 ± 6.99 vs.4.97 ± 2.92,11.94 ± 7.21,t value was 9.15,7.11,both P ＜0.001) and the cutaneous reactions to mite allergen were significantly decreased (P ＜0.001) as well.However,dermatophagoides pteronyssinus-specific serum IgG4 increased significantly (Z =-4.517,P ＜ 0.001).The concentration of dermatophagoides farinae nasal provocation test (NPT) was significantly increased.After the treatment,the number of patients who had positive reactions to high concentration nasal provocation test (NPT) increased (x2 =1.93,P =0.38).During the treatment,all the patients experienced local reactions,and specifically there were four patients got general reactions.Conclusion RIT is safe and effective.It shortened the incremental dose phase remarkably.NPT is a good indicator for diagnosing allergic rhinitis and evaluating the efficacy of the treatment.
