舌下免疫治疗与皮下免疫治疗对过敏性鼻炎合并哮喘患者的疗效与安全性：系统评价与荟萃分析

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中文摘要

引言： 过敏性鼻炎（AR）和哮喘是常见的慢性呼吸系统疾病，二者常同时存在。过敏原免疫治疗（AIT）是一种可改变疾病进程的治疗方法；然而，在合并AR和哮喘的患者中，皮下免疫治疗（SCIT）与舌下免疫治疗（SLIT）的比较疗效和安全性仍不确定。
方法： 检索了PubMed/MEDLINE、Scopus、Web of Science、Embase和Cochrane对照试验中心注册库，检索时间自建库至2026年3月。直接比较SCIT与SLIT在AR合并哮喘患者中的研究符合纳入标准。结局包括症状评分、药物使用、报告的哮喘急性发作或加重事件、视觉模拟量表（VAS）评分、免疫学标志物和不良事件。
结果： 系统评价共纳入9项研究，其中7项纳入荟萃分析。与SCIT相比，SLIT与更少报告的哮喘急性发作或加重事件相关（比值比[OR]，0.28；95%置信区间[CI]，0.09-0.89；中等确定性证据）。SCIT与VAS评分改善更大相关（均数差[MD]，1.80；95%CI，0.82-2.78；低确定性证据）。在鼻炎总症状评分（TRSS；MD，0.44；95%CI，-0.14至1.02；极低确定性证据）、总药物评分（TMS；MD，-0.48；95%CI，-1.12至0.16；低确定性证据）或哮喘总症状评分（TASS；MD，-0.24；95%CI，-1.03至0.55；极低确定性证据）方面，未观察到统计学显著差异。在全身反应（OR，0.28；95%CI，0.05-1.43）、皮肤反应（OR，0.72；95%CI，0.41-1.28）、恶心或呕吐（OR，1.25；95%CI，0.23-6.94）或退出率（OR，0.72；95%CI，0.21-2.51）方面，未发现统计学显著差异。
结论： 有限的比较证据提示，与SCIT相比，SLIT可能与更少报告的哮喘加重事件相关，而SCIT可能与VAS评分改善更大相关。然而，这些发现基于少量临床异质性研究，且使用了非标准化的结局定义。在鼻炎症状、药物使用、哮喘症状评分或大多数安全性结局方面，未观察到明显差异。需要进一步开展高质量的头对头随机对照试验。

英文摘要

INTRODUCTION: Allergic rhinitis (AR) and asthma are common chronic respiratory disorders that frequently coexist. Allergen immunotherapy (AIT) is a disease-modifying treatment; however, the comparative efficacy and safety of subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) remain uncertain in patients with concomitant AR and asthma.
METHODS: PubMed/MEDLINE, Scopus, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception to March 2026. Studies directly comparing SCIT and SLIT in patients with AR and concomitant asthma were eligible. Outcomes included symptom scores, medication use, reported asthma exacerbations or worsening events, visual analog scale (VAS) scores, immunological markers, and adverse events.
RESULTS: Nine studies were included in the systematic review, seven of which contributed to the meta-analysis. SLIT was associated with fewer reported asthma exacerbations or worsening events than SCIT (odds ratio [OR], 0.28; 95% confidence interval [CI], 0.09-0.89; moderate-certainty evidence). SCIT was associated with greater improvement in VAS scores (mean difference [MD], 1.80; 95% CI, 0.82-2.78; low-certainty evidence). No statistically significant differences were observed in the total rhinitis symptom score (TRSS; MD, 0.44; 95% CI, -0.14 to 1.02; very-low-certainty evidence), total medication score (TMS; MD, -0.48; 95% CI, -1.12 to 0.16; low-certainty evidence), or total asthma symptom score (TASS; MD, -0.24; 95% CI, -1.03 to 0.55; very-low-certainty evidence). No statistically significant differences were found in systemic reactions (OR, 0.28; 95% CI, 0.05-1.43), skin reactions (OR, 0.72; 95% CI, 0.41-1.28), nausea or vomiting (OR, 1.25; 95% CI, 0.23-6.94), or withdrawal rates (OR, 0.72; 95% CI, 0.21-2.51).
CONCLUSION: Limited comparative evidence suggests that SLIT may be associated with fewer reported asthma-worsening events than SCIT, whereas SCIT may be associated with greater improvement in VAS scores. However, these findings were based on a small number of clinically heterogeneous studies using nonstandardized outcome definitions. No clear differences were observed in rhinitis symptoms, medication use, asthma symptom scores, or most safety outcomes. Further high-quality head-to-head randomized controlled trials are needed.