抗IgE单克隆抗体与尘螨皮下免疫治疗在儿童支气管哮喘中的联合应用8例临床分析

Clinical Analysis of 8 Cases of Combined Application of Anti-IgE Monoclonal Antibody and Subcutaneous Immunotherapy of Dust Mites in Children with Bronchial Asthma

摘要: 目的：分析抗IgE单克隆抗体(奥马珠单抗)与尘螨皮下免疫治疗(subcutaneous immunotherapy, SCIT)联合应用对支气管哮喘患儿临床疗效及安全性的影响。方法：回顾性分析 2019年7月至2020年7月就诊于青岛大学附属医院变态反应科门诊接受奥马珠单抗联合SCIT治疗哮喘患儿8例。比较基线期与联合治疗至SCIT初始阶段结束时患儿哮喘症状、肺功能、哮喘药物评分、合并症过敏性鼻炎的改善情况及联合治疗期间不良反应的发生情况。结果：在吸入性糖皮质激素(Inhaled corticosteroids, ICS)减量或维持原剂量的情况下，8例患儿的哮喘控制测试(Asthma Control Questionnaire, ACQ)较治疗前有所改善，差异具有统计学意义(t = 40.60, P < 0.05)，共患病鼻炎视觉模拟评分(Visual analoguescale, VAS)均较治疗前有所改善，差异具有统计学意义(t = 16.82, P < 0.05)。联合治疗后患儿药物评分较基线期下降，差异具有统计学意义(t = 7.51, P < 0.05)联合治疗后，患儿FEV1、PEF、FEF50、FEF75、MMEF均较基线期改善，FEV1较基线期差异具有统计学意义(t = 4.856, P < 0.05)，联合治疗期间患儿均未出现全身不良反应，6例患儿出现局部不良反应，注射30 min内出现局部不良反应的次数仅占2.24% (5/240次)，出现迟发局部不良反应的次数占9.65% (22/240次)均为表现为局部红晕和疼痛。结论：奥马珠单抗联合SCIT治疗可有效改善哮喘患儿症状、减少哮喘药物用量，改善肺功能，合并症过敏性鼻炎(allergic rhinitis, AR)症状也有一定改善，且联合治疗期间奥马珠单抗一定程度减少SCIT不良反应的发生。

Abstract: Objective: The objective is to analyze the effect of anti-IgE monoclonal antibody (Omalizumab) com-bined with subcutaneous immunotherapy (SCIT) on the clinical efficacy and safety of children with bronchial asthma. Methods: A retrospective analysis was performed on 8 children with asthma who received omalizumab combined with SCIT in the Department of Allergy, Affiliated Hospital of Qingdao University from July 2019 to July 2020. The improvement of asthma symptoms, lung function, asthma drug score, comorbidities and the incidence of adverse reactions were compared between baseline and combined treatment. Results: There are 8 cases of Asthma Control Ques-tionnaire (ACQ) with improvement compared with before treatment under the condition of re-ducing the dosage of inhaled corticosteroids (ICS), or maintaining the original dose. The differences were statistically significant (t = 40.60, P < 0.05), and the visual analogscale (VAS) score of comorbidities rhinitis was improved compared with that before treatment, the difference was sta-tistically significant (t = 16.82, P < 0.05). After combined treatment, FEV1, PEF, FEF50, FEF75 and MMEF were improved compared with baseline, and FEV1 was significantly different compared with baseline (t = 4.856, P < 0.05). No systemic adverse reactions occurred during the combined treatment, and local adverse reactions occurred in 6 children. The number of local adverse reac-tions occurred within 30 min of injection accounted for only 2.24% (5/240 times), and the number of delayed local adverse reactions accounted for 9.65% (22/240 times), all of which were manifested as local redness and pain. Conclusion: Omalizumab combined with SCIT can effectively improve the symptoms of asthmatic children, reduce the dosage of asthma drugs, improve lung function, improve allergic rhinitis symptoms, and reduce the incidence of SCIT adverse reactions.