儿童过敏性哮喘舌下脱敏治疗效果的影响因素分析

Analysis of factors influencing therapeutic effect of sublingual desensitization for allergic asthma in children

摘要:

目的 分析儿童过敏性哮喘舌下脱敏治疗效果的影响因素。方法 回顾性分析2018年5月—2021年2月徐州医科大学附属淮安医院就诊的85例过敏性哮喘儿童的临床资料。所有患儿均接受舌下脱敏治疗。治疗1年后，根据治疗效果分为停药组［每日药物总评分（dMS）= 0分］与非停药组（dMS评分> 0分）。比较治疗前、治疗1年后患儿的视觉模拟评分法（VAS）与dMS评分，统计患儿治疗1年内不良反应、儿童过敏性哮喘舌下脱敏治疗效果；采用多因素Logistic逐步回归分析儿童过敏性哮喘舌下脱敏治疗效果的影响因素。结果 治疗1年后患儿VAS评分与dMS评分均低于比治疗前（P <0.05）；治疗1年内，85例患儿中5例（5.88%）发生不良反应，其中1例（1.18%）重度哮喘、1例（1.18%）中度哮喘，1例（1.18%）全身荨麻疹，2例（2.35%）局部荨麻疹。治疗1年后，85例患儿中共64例患儿无须药物控制原发病，停止用药率为75.29%，剩余21例（24.71%）患儿仍需采用药物控制原发病。非停药组男性例数占比、入院时EOS、有生活环境空气污染占比、治疗3个月dMS 评分≤ 3分占比、治疗3个月dMS下降率≤ 16.7%占比、入院时VAS评分≤ 4分占比高于停药组（P <0.05）。多因素Logistic逐步回归分析结果显示，男性［O^R=2.770（95% CI：1.140，6.733）］、有生活环境空气污染［O^R=3.515（95% CI：1.446，8.542）］、治疗3个月dMS评分> 3分［O^R=3.093（95% CI：1.272，7.516）］、入院时VAS评分> 4分［O^R=4.276（95% CI：1.759，10.392）］为儿童过敏性哮喘舌下脱敏非停药的危险因素（P <0.05）。结论 舌下脱敏治疗儿童过敏性哮喘效果确切，安全可靠，且男性、有生活环境空气污染、治疗3个月dMS 评分>3分、入院时VAS评分>4分的患儿继续用药的风险更高。

Abstract:

Objective To analyze the factors influencing the therapeutic effect of sublingual desensitization in children with allergic asthma.Methods The clinical data of 85 children with allergic asthma admitted to the Department of Pediatrics of Huaian Hospital Affiliated to Xuzhou Medical University from May 2018 to February 2021 were retrospectively analyzed. All children received sublingual desensitization treatment. After 1 year of treatment, the children were divided into discontinuation group [daily drug score (dMS) = 0 score] and non-discontinuation group (dMS > 0 score) according to the treatment effect. Visual analog Scale (VAS) scores and DMS scores were compared before and after 1 year of treatment. The adverse reactions within 1 year of treatment were counted, and the therapeutic effect of sublingual desensitization for allergic asthma in children were analyzed. Clinical data of the drug withdrawal group and the non-withdrawal group were compared, and the influencing factors of the therapeutic effect of sublingual desensitization for allergic asthma in children were analyzed by multivariate logistic regression.Results VAS score and dMS score after treatment for 1 year were lower than those before treatment (P < 0.05). Within 1 year of treatment, a total of 5 (5.88%) of the 85 children had adverse reactions, including 1 (1.18%) severe asthma, 1 (1.18%) moderate asthma, 1 (1.18%) systemic urticaria, and 2 (2.35%) local urticaria. After 1 year of treatment, 64 of the 85 children needed to stop medication, with a stopping rate of 75.29%, and the remaining 21 children (24.71%) could be clinically considered to stop medication control. The proportion of male cases, EOS at admission, air pollution in living environment, dMS 3-month score ≤ 3 points, dMS 3-month decline rate ≤ 16.7%, VAS score ≤ 4 points at admission in non-withdrawal group was higher than that in withdrawal group (P < 0.05). logistic regression analysis showed that male [O^R = 2.770, (95% CI: 1.140, 6.733) ], living environment air pollution [O^R = 3.515, 95% CI: 1.446, 8.542) ], dMS score in 3 months > 3 points [O^R = 3.093, 95% CI: 1.272, 7.516) ], VAS score > 4 points at admission [O^R = 4.276 (95% CI: 1.759, 10.392) ] were non-discontinuous risk factors for allergic asthma in children with supraglingual desensitization (P < 0.05).Conclusion Sublingual desensitization is effective, safe and reliable in treating children with allergic asthma. Male children with ambient air pollution, dMS score > 3 at 3 months, and VAS score > 4 at admission were at higher risk of continuing medication.