医学生毕业论文.doc

变应性鼻炎常规免疫治疗和集群免疫治疗的疗效及安全性对比分析 学生：XXX 导师：XXX （温州医学院附属第二医院耳鼻咽喉科，温州 325027） [摘要] 目的 比较常规免疫方案和集群免疫方案用于标准化尘螨变应原治疗持续性过敏性鼻炎的疗效和安全性。 方法 60例中重度持续性螨过敏变应性鼻炎患者，均符合免疫治疗入选标准，以安脱达屋尘螨疫苗行特异性免疫治疗，其中32例患者接受常规免疫治疗，28例患者接受集群免疫治疗，两组均持续治疗1年。通过两组鼻结膜症状与体征总评分评价临床疗效，同时观察局部不良反应和全身不良反应发生率以评价治疗的安全性。结果 集群免疫治疗在6周左右达到维持剂量，剂量累加阶段疗程较常规治疗组缩短60％以上，在观察6周后，临床疗效较常规治疗组明显（P0.05），但局部和全身不良反应发生率在剂量累加阶段和剂量维持阶段与常规免疫治疗相比均无显著差异(P0.05)。结论 对中重度持续性螨过敏变应性鼻炎而言，集群免疫治疗是一种快速、有效、安全的治疗方法。 ?[关键词] 　变应性鼻炎；集群免疫治疗；常规免疫治疗；疗效；安全性 [ABSTRACT] OBJECTIVE To compare the efficacy and safety of subcutaneous immunotherapy with Dermatophagoides pteronyssinus standardized extract given in conventional and cluster immunotherapy schedules for persistent allergic rhinitis. METHODS Sixty patients with moderate to severe allergic rhinitis caused by dust mites , in accordance with the immunotherapy inclusion criteria,were allocated to receive conventional immunotherapy schedule (n = 32) or cluster immunotherapy schedule (n = 28), and both groups continued treatment for 1 year. Total scores of Nasal conjunctival symptoms and signs were assessed to evaluate the clinical efficacy, and also the incidence of local and systemic adverse reactions were registered. to evaluate the safety. RESULTS The cluster schedule reduced the time to maintenance dose by more than 60%,and resulted in a more significant improvement than conventional schedule after 6 weeks of observation (P0.05),but the incidence of local and systemic adverse reactions during the incremental-dose phase and maintenance-dose phase compared with conventional immunotherapy were not significantly different (P0.05). CONCLUSION The cluster immunotherapy is efficacious and safe to treat patients clinically sensitive to dust mites. [Key words] Allergic Rhinitis; Cluster immunotherapy; Conventional immunotherapy; Clinical efficacy; Safety 变应性鼻炎（Allergic rhinitis,AR）是一种主要由IgE介导的I型变态反应性疾病，其发病率高，是现代社会面临的一个重要健康问题。特异性免疫治疗（Specific immunotherapy，SIT）应用于治疗AR已有近80年的历史，Noon和Freema