摘要
目的探讨舌下特异性免疫治疗(SLIT)对合并变应性鼻炎(AR)病儿原发性肾病综合征(PNS)复发率的影响。方法将河南科技大学第一附属医院2014年1月至2017年1月收治的194例合并AR的PNS病儿采用随机数字表法分为联合组和常规组,各97例,常规组接受常规治疗,联合组在常规治疗的基础上加用SLIT治疗,均治疗12个月,比较两组临床疗效、PNS复发率和治疗前后鼻症状总分表(TNSS)评分、免疫球蛋白E(IgE)、免疫球蛋白G(IgG)、24h尿蛋白、生活质量及鼻腔灌洗液炎症因子和鼻分泌物嗜酸性粒细胞(EOS)计数的变化。结果治疗后,两组TNSS评分均明显降低,联合组TNSS评分低于常规组[(2.15±0.69)比(7.94±2.55)分,(3.47±1.12)比(8.06±2.61)分,P<0.05],总有效率(98.97%)高于常规组(89.69%)(P<0.05);两组IgE[(131.18±42.99)比(549.53±134.07)U/mL,(219.75±70.24)比(530.25±129.32)U/mL]、24h尿蛋白[(0.85±0.27)比(4.77±1.54)g/24 h,(1.31±0.43)比(4.56±1.43)g/24 h]均明显降低(P<0.05),IgG[(16.73±2.55)比(14.52±1.24)g/L,(15.68±2.04)比(14.31±1.23)g/L]均明显升高(P<0.05),联合组IgE、IgG、24h尿蛋白变化幅度大于常规组,PNS复发率(9.29%)均低于常规组(28.87%)(P<0.05);两组鼻腔灌洗液IL⁃4[(47.75±15.41)比(82.95±26.76)pg/mL,(62.07±19.63)比(81.68±26.69)pg/mL]、IL⁃17[(28.34±9.07)比(41.16±13.28)pg/mL,(34.87±11.24)比(40.72±13.13)pg/mL]水平和鼻分泌物EOS计数[(23.75±7.46)比(64.97±20.33)×103cell/mL,(35.24±11.05)比(63.81±19.94)×103cell/mL]均明显降低(P<0.05),但联合组降低幅度大于常规组(P<0.05);两组病儿PedsQLTM4.0各维度评分均明显升高(P<0.05),联合组升高幅度大于常规组(P<0.05)。结论常规治疗的基础上加用SLIT治疗合并AR的PNS病儿疗效确切,能有效改善病儿鼻炎症状,降低PNS复发率,提高病儿生活质量。
Objective To explore the effects of sublingual immunotherapy(SLIT)on the recurrence rate of primary nephrotic syn⁃drome(PNS)in children patients with allergic rhinitis(AR).Methods Form January 2014 to January 2017.194 cases of children patients with AR and PNS admitted to the First Affiliated Hospital of Henan University of Science and Technology were divided in⁃to combined group and routine group according to the random number table method,with 97 cases in each group.Routine group was given routine treatment,and combined group was treated with SLIT on the basis of routine treatment,and all patients were treated for 12 months.Clinical efficacy,PNS recurrence rate,total nasal symptom score(TNSS),immunoglobulin E(IgE),immunoglobulin G(IgG),24h urinary protein,quality of life,and nasal lavage fluid inflammatory factors and nasal secretion eosinophil(EOS)count before and after treatment were compared between the two groups.Results After treatment,the TNSS score was significantly decreased in the two groups.The TNSS score in combined group was lower than that in routine group[(2.15±0.69)vs.(7.94±2.55)points,(3.47±1.12)vs.(8.06±2.61)points,P<0.05],and the total effective rate was higher than that in routine group(98.97%vs.89.69%)(P<0.05).The levels of IgE[(131.18±42.99)vs.(549.53±134.07)U/mL,(219.75±70.24)vs.(530.25±129.32)U/mL]and 24h urinary protein[(0.85±0.27)vs.(4.77±1.54)g/24h,(1.31±0.43)vs.(4.56±1.43)g/24h]were significantly decreased in the two groups(P<0.05)while the level of IgG[(16.73±2.55)vs.(14.52±1.24)g/L,(15.68±2.04)vs.s(14.31±1.23)g/L]was significantly increased(P<0.05),and the changes of IgE,IgG and 24h urinary protein in combined group were significant than those in routine group,and the PNS recurrence rate was lower than that in routine group(9.29%vs.28.87%)(P<0.05).The lev⁃els of nasal lavage fluid IL⁃4[(47.75±15.41)vs.(82.95±26.76)pg/mL,(62.07±19.63)vs.(81.68±26.69)pg/mL],IL⁃17[(28.34±9.07)vs.(41.16±13.28)pg/mL,(34.87±11.24)vs.(40.72±13.13)pg/mL]and nasal secretion EOS count[(23.75±7.46)vs.(64.97±20.33)×103cell/mL,(35.24±11.05)vs.(63.81±19.94)×103cell/mL]were significantly decreased in the two groups(P<0.05),however,the decreases in combined group were greater than those in routine group(P<0.05).All dimensions scores of Ped⁃sQLTM4.0 scale were significantly increased in the two groups(P<0.05),and the increases in combined group were greater than those in routine group(P<0.05).Conclusion SLIT on the basis of routine treatment with exact efficacy in the treatment of chil⁃dren patients with PNS and AR,can effectively improve the rhinitis symptoms,reduce the PNS recurrence rate,and improve the quality of life of children patients.
作者
潘笑悦
PAN Xiaoyue(Department of Pediatrics,The First Affiliated Hospital of Henan University of Science and Technology,Luoyang,Henan 471000,China)
出处
《安徽医药》
CAS
2020年第1期160-163,共4页
Anhui Medical and Pharmaceutical Journal
关键词
肾病综合征
鼻炎
脱敏法
免疫
鼻灌洗
复发
免疫球蛋白亚类
蛋白尿
嗜酸细胞
Nephrotic syndrome
Rhinitis
Desensitization,immune
Nasal lavage
Recurrence
Immunoglobulin sub⁃units
Proteinuria
Eosinophil
