摘要
目的探讨度普利尤单抗治疗支气管哮喘(哮喘)合并特应性皮炎(AD)等2型炎症共病患儿的临床疗效及安全性。方法采用回顾性分析的方法,对2021年4月1日至2022年9月1日在天津医科大学第二医院儿科哮喘及过敏专病门诊接受度普利尤单抗治疗≥16周的哮喘合并AD、过敏性鼻炎(AR)2型炎症共病患儿病历资料进行分析。通过比较治疗16周前后临床症状的改善,吸入性糖皮质激素(ICS)用量、肺功能、呼出气一氧化氮(FeNO)、血清总免疫球蛋白E(T-IgE)、外周血嗜酸性粒细胞(EOS)计数等的变化及治疗期间不良反应的发生情况来评估度普利尤单抗治疗哮喘合并AD、AR的疗效及安全性;并分析AD、AR与哮喘疗效之间的相关性。定量指标符合正态分布的采用配对t检验比较,非正态分布的则采用秩和检验比较,不同指标间的相关关系采用Spearman秩相关检验。结果1.纳入10例哮喘合并AD、AR患儿病历资料分析,其中男8例,女2例,年龄4~14岁,中位年龄为9岁;3例患儿在接受度普利尤单抗治疗前已进行皮下注射免疫治疗(SCIT),1例患儿应用奥马珠单抗疗效不佳转换为度普利尤单抗治疗。2.哮喘的改善:10例患儿治疗16周后,哮喘症状控制良好,均未出现哮喘急性发作,儿童哮喘控制测试、哮喘控制问卷均较基线显著改善(均P<0.05);第1秒用力呼气容积占预计值百分比较基线显著提升(P<0.05);ICS剂量(均换算为二丙酸倍氯米松)及FeNO水平均较基线显著下降,ICS剂量由基线400.00(200.00,400.00)μg/d下降至0(0,125.00)μg/d,FeNO由基线38.00(18.25,56.75)×10^(-9)降至11.00(9.00,19.25)×10^(-9)(均P<0.05);3例患儿治疗前后均完成血清T-IgE检测,基线水平分别为>5000 kU/L、3546 kU/L、1000 kU/L,治疗16周后降至2759 kU/L、1432 kU/L、655 kU/L,余治疗16周后未检测血清T-IgE。3.哮喘共患病的改善:度普利尤单抗治疗16周期间,AD评分、源自患者的湿疹评价评分在各随�
Objective To investigate the clinical efficacy and safety of Dupilumab on the treatment of asthma combined with atopic dermatitis(AD)and other type 2 inflammatory co-morbidities in children.Methods Clinical data of children with asthma combined with AD,allergic rhinitis(AR)type 2 inflammatory co-morbidities who received Dupilumab treatment for 16 weeks or longer in the Pediatric Asthma and Allergy Clinic of the Second Hospital of Tianjin Medical University from April 1,2021 to September 1,2022 were retrospectively analyzed.The efficacy and safety of Dupilumab on the treatment of asthma combined with AD and AR in children were assessed by comparing clinical symptoms before and after 16 weeks of treatment,changes in the dosage of inhaled corticosteroids(ICS),lung function,fractional exhaled nitric oxide(FeNO),and peripheral blood eosinophil(EOS)count,and the incidence of adverse events,respectively.The correlation between the efficacy on AD,AR and asthma was assessed.Quantitative indicators that were normally distributed were compared by the paired samples t-test;otherwise,they were compared by rank-sum test.The correlation between different indicators was compared by Spearman rank correlation test.Results(1)Ten children with asthma combined with AD,AR were recruited,including 8 males and 2 females,with the mean age of 9(4-14)years.Three children were previously treated with subcutaneous immunotherapy(SCIT)prior to Dupilumab treatment,and 1 child was transferred to Dupilumab treatment because of a poor responsiveness to Omalizumab.(2)Improvement of asthma:after 16 weeks of treatment,asthma symptoms were well controlled in the 10 children,and none of them had acute asthma attacks.The childhood asthma control test for children and asthma control questionnaire findings were significantly improved from baseline(all P<0.05).Forced expiratory volume in the first second to the predicted value was significantly improved from baseline(P<0.05).The dosage of ICS[all converted to Beclomethasone Dipropionate,0(0,125.00)μg/d vs
作者
胡建
许丽
王雪艳
刘长山
Hu Jian;Xu Li;Wang Xueyan;Liu Changshan(Department of Pediatrics,the Second Hospital of Tianjin Medical University,Tianjin 300211,China;Children′s Respiratory and Asthma Research Center,the Second Hospital of Tianjin Medical University,Tianjin 300211,China)
出处
《中华实用儿科临床杂志》
CAS
CSCD
北大核心
2023年第7期521-527,共7页
Chinese Journal of Applied Clinical Pediatrics
基金
天津市科技计划(22KPHDRC00280)。
