Analysis of adherence and determinants of sublingual immunotherapy in patients with Artemisia pollen-induced allergic rhinitis
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摘要: 目的 观察蒿属花粉所致季节性变应性鼻炎(allergic rhinitis，AR)患者特异性舌下免疫治疗(sublingual immunotherapy，SLIT)的依从性现状，分析其依从性的影响因素，为有效提高其依从性提供研究支持。方法 对2021年5月至2022年4月在山西医科大学第一医院耳鼻咽喉头颈外科行蒿属花粉SLIT的AR患者进行回顾性电话随访调查治疗现状、统计脱落原因，并提取其病历档案资料的相关信息进行分析。结果 对112例患者进行调查，中止治疗的患者34例(脱落率为30.4%)；发生过不良反应及治疗时间超过6个月的SLIT患者表现出相对较好的依从性(P < 0.05)。脱落患者中断治疗的原因主要有：非花粉期无症状困扰因而停止治疗或感觉治疗无效9例(26.5%)、接种疫苗或怀孕或疫情原因而被迫中断6例(17.6%)。结论 蒿属花粉变应性鼻炎SLIT患者的短期脱落率较高，且不良反应的发生可能是依从性的促进因素，提醒医护人员需要妥善管理患者的不良反应以提高其依从性。Abstract: Objective To monitor adherence to specific sublingual immunotherapy (SLIT) in patients with seasonal allergic rhinitis(AR), analyse factors influencing adherence, and provide research support to effectively improve adherence.Methods Patients with AR who underwent Artemisia pollen SLIT at the Department of Otolaryngology-Head and Neck Surgery, First Hospital of Shanxi Medical University from May 2021 to April 2022 were retrospectively followed up by telephone to investigate the current status of treatment, count the causes of shedding, and extract relevant information from their medical record data for analysis.Results Of the 112 patients surveyed, 34 discontinued treatment(30.3%); patients who experienced adverse reactions and SLIT patients who had been on treatment for more than 6 months showed relatively good adherence(P < 0.05). The main reasons for discontinuation in patients who dropped out were: asymptomatic discomfort during the non-pollen phase and therefore discontinuation of treatment or feeling that treatment was ineffective 9 cases(26.5%), forced discontinuation due to vaccination or pregnancy, or epidemics 6 cases(17.6%).Conclusion Long-term adherence of patients to Artemisia pollen SLIT still needs to be brought to the attention of healthcare professionals, especially in the early stages of treatment when good patient education and good channels of trust and communication between doctors and patients need to be established.
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Key words:
- allergic rhinitis /
- artemisia pollen /
- sublingual immunotherapy /
- adherence
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表 1 不同特征患者的依从性现状
例(%) 项目 总例数(n=112) 依从(n=78) 脱落(n=34) χ2/Z P 性别 男 46(41.1) 31(67.4) 15(32.6) χ2=0.187 0.665 女 66(58.9) 47(71.2) 19(28.8) 年龄/岁 11~18 6(5.4) 6(100.0) 0 Z=10.92 0.027 19~29 43(38.4) 24(55.8) 19(44.2) 30~39 45(40.2) 37(82.2) 8(17.8) 40~49 12(10.7) 8(66.7) 4(33.3) 50~60 6(5.4) 3(50.0) 3(50.0) 居住地为太原 是 79(70.5) 58(73.4) 21(26.6) χ2=1.807 0.179 否 33(29.5) 20(60.6) 13(39.4) 首诊医师是否为过敏科 是 107(95.5) 75(70.1) 32(29.9) χ2=-0.478 0.638 否 5(4.5) 3(60.0) 2(40.0) 合并哮喘 是 24(21.4) 18(75.0) 6(25.0) χ2=0.415 0.520 否 88(78.6) 60(68.2) 28(31.8) 病程 ≤5年 30(26.8) 18(60.0) 12(40.0) Z=1.909 0.385 6~10年 42(37.5) 30(71.4) 12(28.6) >10年 40(35.7) 30(75.0) 10(25.0) 发生不良反应 是 46(41.1) 37(80.4) 9(19.6) χ2=4.30 0.038 否 66(58.9) 41(62.1) 25(37.9) 有家族史 是 70(62.5) 51(72.9) 19(27.1) χ2=0.912 0.340 否 42(37.5) 27(64.3) 15(35.7) 治疗时间 < 6个月 60(53.6) 27(45.0) 33(55.0) χ2=37.120 < 0.001 ≥6个月 52(46.4) 51(98.1) 1(1.9) 
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表 2 患者依从性的logistic回归分析
项目 β SE Wald χ2 P Exp(β) Exp(β)(95%CI) 常数项 -0.638 0.342 3.471 0.063 1.893 治疗时间 4.212 1.052 16.04 < 0.001 0.015 (0.114，0.938) 发生不良反应 1.118 0.538 3.471 0.038 0.327 (0.002，0.116)
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