Abstract:

Objective　To analyze the factors influencing the efficacy of subcutaneous immunotherapy (SCIT) for children with mite-driven allergic asthma.Methods　The clinical data of 42 children with mite-driven allergic asthma who received standardized SCIT for more than 1 year in the pediatric respiratory specialist clinic of Affiliated Hospital of Yangzhou University from July 2018 to May 2022 were retrospectively analyzed. According to the daily dose of inhaled corticosteroids (ICS) 12 months after treatment, they were divided into a ICS discontinuation group [fluticasone propionate (FP) =0 µg] and a ICS maintenance group (FP >0 µg). In the ICS discontinuation group, there were 14 boys and 1 girl, aged (8.7±2.9) years. In the ICS maintenance group, there were 20 girls and 7 girls, aged (9.7±2.2) years. The changes of ICS daily dose and therapeutic effect before and after standardized SCIT were compared between the two groups at the beginning of treatment and 6 months and 12 months after treatment, and the related factors affecting the efficacy of SCIT were discussed. Independent sample t test, Z test, χ² test, and multiple logistic regression analysis were used. Results　After 12 months of treatment, 15 (35.7%) of the 42 children were able to withdraw from ICS use (ICS discontinuation group) and the remaining 27 (64.3%) children needed only a low dose of FP to maintain the asthma symptom control (ICS maintenance group). Six and 12 months after treatment, the daily doses of FP in the ICS discontinuation group and the ICS maintenance group decreased compared with those at the initial treatment (all P<0.05), and there were statistically significant differences between the ICS discontinuation group and the ICS maintenance group at the same treatment time point [50 (0, 100) µg vs. 100 (75, 100) µg, 0 (0, 0) µg vs. 50 (50, 100) µg] (Z=-3.54 and -5.51, both P<0.001). The proportions of overweight, allergic rhinitis, living with smoking members, and multiple allergies in the ICS maintenance group were higher than those in the ICS discontinuation group (all P<0.05). Logistic regression analysis showed that living with smoking members (OR=6.179, 95%CI 1.029-37.118, P=0.047) and multiple allergies (OR=7.772, 95%CI 1.077-56.085, P=0.042) were independent risk factors for non-complete withdrawal of ICS after 12 months of treatment. Conclusions　SCIT can significantly reduce the daily dose of glucocorticoids in children with allergic asthma while ensuring the control of asthma symptoms. Children living with smoking members and children with multiple allergies are at higher risk of continuing glucocorticoids.

Key words:

Allergic asthma,  , Dust mite,  , Subcutaneous immunotherapy,  , Efficacy,  , Influencing factors, Children

摘要：

目的　分析以尘螨过敏为主的哮喘儿童皮下特异性免疫治疗（subcutaneous immunotherapy，SCIT）效果的影响因素。方法　回顾性分析2018年7月至2022年5月在扬州大学附属医院儿童呼吸专科门诊接受标准化SCIT≥1年、以尘螨过敏为主的42例过敏性哮喘儿童的临床资料。按照治疗12个月后吸入性糖皮质激素（inhaled corticosteroids，ICS）的每日使用剂量分为ICS停用组［丙酸氟替卡松（fluticasone propionate，FP）=0 µg］与ICS维持组（FP >0 µg）。ICS停用组中男14例，女1例，年龄（8.7±2.9）岁；ICS维持组中男20例，女7例，年龄（9.7±2.2）岁。于治疗初始、治疗6个月以及12个月时比较两组标准化SCIT前后ICS每日使用剂量的变化、治疗效果，并探讨影响SCIT疗效的相关因素。采用独立样本t检验、Z检验、χ²检验、多因素logistic回归分析。结果　治疗12个月后，42例患儿中共15例（35.7%）患儿可退出ICS的使用（ICS停用组），剩余27例（64.3%）患儿仅需低剂量的FP来维持哮喘症状的控制（ICS维持组）。治疗6个月及12个月时，ICS停用组、ICS维持组的FP每日使用剂量均较治疗初始下降（均P<0.05），同治疗时间点ICS停用组与ICS维持组比较［50（0，100）µg比100（75，100）µg，0（0，0）µg比50（50，100）µg］，差异均有统计学意义（Z=-3.54、-5.51，均P<0.001）。ICS维持组的超重、合并变应性鼻炎、同居室有吸烟成员及多重过敏患儿比例均高于ICS停用组（均P<0.05）；logistic回归分析结果显示，同居室有吸烟成员（OR=6.179，95%CI 1.029～37.118，P=0.047）、多重过敏（OR=7.772，95%CI 1.077～56.085，P=0.042）均是治疗12个月后ICS无法完全退出使用的独立危险因素。结论　SCIT在保证哮喘症状控制的同时，可显著减少过敏性哮喘患儿糖皮质激素的每日使用剂量，同居室有吸烟成员、多重过敏患儿的糖皮质激素维持使用风险更高。

关键词:

过敏性哮喘, 尘螨, 皮下特异性免疫治疗, 疗效, 影响因素, 儿童