Study on influential factors associated with the long-term effect of allergic rhinitis specific immunotherapy
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摘要: 目的:探讨影响变应性鼻炎(AR)特异性免疫治疗(SIT)长期疗效的相关因素。 方法:回顾分析219例AR患者在SIT治疗前及治疗结束后不同时期的随访VAS评分,通过等级Logistic回归分析和配对t检验分析和筛选影响预后的关键因素。结果:①SIT长期疗效与性别、SIT治疗前的VAS评分相关(P<0.05),与家族史、免疫治疗年龄、过敏原总数、总针数、是否合并其他过敏性疾病无关(P＞0.05);②随访终点VAS评分与开始治疗VAS评分比较,随访6个月内总有效率为50.0%,6个月~1年总有效率为51.7%、>1~2年总有效率为47.1%、>2~3年总有效率为54.5%、3年以上总有效率为40.7%,各个观察点均与治疗前VAS评分差异有统计学意义(P<0.05)。结论:除了性别和SIT前VAS评分影响AR患者SIT长期疗效外,遗传因素及其他因素对于AR患者SIT长期疗效无影响;SIT的疗效至少能维持3年;虽然增加SIT针数并不能延长长期疗效,但是可以巩固免疫治疗的疗效。随着时间的推移,SIT的长期疗效有减低趋势,SIT治疗前VAS评分越高,长期疗效越好,并且女性SIT长期疗效优于男性,因此推测环境因素与遗传因素的相互作用即表观遗传学对SIT长期疗效具有影响。Abstract: Objective: To investigate the influential factors associated with the long-term effect of allergic rhinitis (AR) specific immunotherapy (SIT).Method: Retrospective analyzed the following visual analog scale(VAS)before and after the specific immunotherapy of 219 patients with allergic rhinitis. Logistic regression and pair t-test were used to explore the key factors influencing the prognosis. Result: ① The gender and the VAS before specific immunotherapy(P<0.05) were associated with the long-term effect of allergic rhinitis specific immunotherapy,while family history,the age of specific immunotherapy,number of allergens and stitches and with other allergic diseases (P＞0.05) were not associated with the long-term effect of specific immunotherapy;② Compared VAS of different endpoints with VAS before the treatment,there were significant differences. The primary endpoints were the time following no more than half a year (total effective rate:50.0%) ,half a year to 1 year(total effective rate:51.7%) ,1 to 2 year(total effective rate:47.1%),2 to 3 year (total effective rate:54.5%) and over 3 year(total effective rate:40.7%). Conclusion: Apart from the gender and the VAS before specific immunotherapy,genetic and other factors can not significant influence the long-term effect of specific immunotherapy. The effect of specific immunotherapy seems to last for 3 years at least. Increasing stitches can not improve long-term effect of SIT,but it can consolidate the effect. The long-term effect of specific immunotherapy tends to drop off with fluctuations over time and the higher of VAS before SIT,the better effect of long-term SIT. Further more, the long-term effect of SIT of male is worse than female. In consequences,we speculate epigenetics related to the interaction between environmental factors and genetic factors plays an important role in the long-term effect of allergic rhinitis specific immunotherapy.
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Key words:
- rhinitis allergic /
- specific immunotherapy /
- long-term effect /
- influential factor /
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[1] NELSON H S, NOLTE H, CRETICOS P,et al. Efficacy and safety of timothy grass allergy immunotherapy tablet treatment in North American adults[J]. J Allergy Clin Immunol,127:72-80.
[2] 王俊阁,王强,刘卫卫,等. 变应性鼻炎患者变应原特异性免疫治疗引起免疫耐受的机制研究[J].中华耳鼻咽喉头颈外科杂志,2011,18(12):638-641.
[3] BROZEK J L,BOUSQUET J,BAENA-CAGNANI C E,et al. Allergic Rhinitis and its impact on asthma (ARIA) guidelines:2010 revision[J]. J Allergy Clin Immunol,2010,126:466-476.
[4] 邱前辉,苏志文.影响变应性鼻炎脱敏治疗效果的多因素多元回归分析[J].广东医学,1999,20(1):47-48.
[5] GRUBER W, EBER E, MILEDER P, et al. Effect of specific immunotherapy with house dust mite extract on the bronchial responsiveness of paediatric asthma patients[J]. Clin Exp Allergy,1999,29:176-181.
[6] JACOBSEN L, NIGGEMANN B, DREBORG S,et al. Specific immunotherapy has long-term preventive effect of seasonal and perennial asthma:10-year follow-up on the PAT study[J]. Allergy,2007,62:943-948.
[7] PILETTE C,NOURI-ARIA K T,JACOBSON M R,et al. Grass pollen immunotherapy induces an allergen-specific IgA2 antibody response associated with mucosal TGF-beta expression[J].J Immunol,2007,178:4658-4666.
[8] 奚海燕,虞伟,李晓军.表观遗传学与自身免疫病[J].中华风湿病学杂志,2012,16(7):195-498.
[9] KABESCH M. Epigenetics in asthma and allergy[J]. Curr Opin Allergy Clin Immunol,2014,14:58-62.
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