儿童哮喘吸入性变应原测定和脱敏治疗的疗效观察

发布时间：2018-05-07 19:29

本文选题：哮喘 + 皮肤点刺试验　；参考：《遵义医学院》2012年硕士论文

【摘要】：目的：了解哮喘患儿吸入性变应原皮肤点刺试验的阳性率及遵义地区主要的变应原,观察及评价特异性脱敏治疗儿童过敏性哮喘的临床疗效及安全性。方法：选取2010年5月至2012年3月就诊于遵医附院儿科门诊,临床诊断哮喘,病情处于缓解期的439例哮喘患儿,其中男294例,女145例,0-3岁192例(男136例,女56例),3-6岁144例(男93例,女51例),6-14岁103例(男70例,女33例)。使用由丹麦ALK-ABELLO公司提供的11种常见吸入性过敏原(屋尘螨、粉尘螨、热带螨、猫毛、狗毛、德国大蠊、细链格孢霉、艾蒿、豚草、梯牧草、桦树)进行皮肤点刺试验,生理盐水作为阴性对照,浓度为0.01mg/ml的盐酸组织胺为阳性对照,并同时对同期诊断为慢性咳嗽的189例患儿(以下简称咳嗽组)进行皮肤点刺试验。比较哮喘组不同年龄段皮肤点刺试验阳性率；比较哮喘组与咳嗽组皮肤点刺试验阳性率。439例哮喘患儿中42例接受标准化屋尘螨脱敏治疗,比较患儿治疗前后的每年哮喘发作次数、峰值呼气流速,评价治疗效果和安全性。结果：439例哮喘患儿皮肤点刺阳性率为35.8%,屋尘螨阳性率为72.6%；0-3岁年龄段皮肤点刺阳性率为23.0%,屋尘螨阳性率为72.7%；3-6岁年龄段皮肤点刺阳性率为40.3%,屋尘螨阳性率为67.2%；6-14岁年龄段阳性率为53.4%,屋尘螨阳性率为78.2%。6-14岁及3-6岁年龄段与0-3岁年龄段皮肤点刺阳性率比较,差异均有统计学意义(P0.001)；6-14岁与3-6岁年龄段皮肤点刺阳性率比较,差异有统计学意义(P0.05)；咳嗽组皮肤点刺阳性率为21.7%,屋尘螨阳性率为41.7%,低于哮喘组皮肤点刺总阳性率及屋尘螨阳性率,差异有统计学意义(P0.001)。42例经脱敏治疗1.0年后峰值呼气流速与治疗前比较,差异有统计学意义(P0.001)；治疗前每年哮喘发作次数与治疗后比较,差异有统计学意义(P0.01)。42例患儿共接受957人次脱敏治疗,局部不良反应共有365人次,发生率为38.1%,发生全身不良反应8次,发生率为0.8%。结论：屋尘螨为遵义地区儿童哮喘最常见吸入性变应原。标准化屋尘螨脱敏治疗后患儿的临床症状改善,PEF明显升高,提示屋尘螨变应原特异性免疫治疗效果明显,同时不良反应发生率低,值得临床推广。
[Abstract]:Objective : To investigate the positive rate of skin prick test in children with asthma and the main allergens in compliance area , observe and evaluate the clinical curative effect and safety of specific desensitizing treatment for allergic asthma in children .

Methods : From May 2010 to March 2012 , 439 patients with asthma were diagnosed with asthma and in remission period . Among them , 294 were male , 145 were female , 192 were 0 - 3 years old ( 136 males , 56 females ) , 144 in 3 - 6 years ( male 93 , female 51 ) , aged 6 - 14 years ( male 70 , female 33 ) . The skin prick test was carried out using 11 common allergens ( house dust mites , dust mites , tropical mites , cat hair , dog hair , German cockroach , fine alternaria , wormwood , ragweed , ladder forage , birch ) provided by the Danish ALK - ABELLO company , and normal saline was used as a negative control , and the skin prick test was performed on 189 children with chronic cough ( hereinafter referred to as cough group ) with a concentration of 0.01 mg / ml . The positive rate of skin prick test in different age groups was compared .
To compare the positive rate of skin prick test between asthma group and cough group , 42 of 439 patients with asthma were treated with standardized house dust mite . The number of asthma attack , peak expiratory flow rate before and after treatment were compared , and the efficacy and safety of treatment were evaluated .

Results : The positive rate of skin prick in 439 patients with asthma was 35.8 % , and the positive rate of house dust mites was 72.6 % .
The positive rate of skin prick was 23 . 0 % in 0 - 3 year old age group and 72 . 7 % in house dust mite .
The positive rate of skin prick was 40.3 % in the 3 - 6 year old age group and 67.2 % in house dust mite .
The positive rate of 6 - 14 years old was 53.4 % , and the positive rate of house dust mites was 78.2 % . The positive rate of skin prick in the ages of 6 - 14 and 3 - 6 was significantly higher than that in 0 - 3 years old age group ( P0.001 ) .
The positive rate of skin prick in 6 - 14 years old and 3 - 6 years old was significant ( P0.05 ) .
The positive rate of skin prick in cough group was 21.7 % , the positive rate of house dust mites was 41.7 % , which was lower than that in asthma group ( P 0.001 ) .
There were statistically significant differences in the number of asthma attacks before and after treatment ( P0.01 ) . There were a total of 957 desensitizing treatments in 42 children , with a total of 365 patients with local adverse reactions . The incidence rate was 38 . 1 % . Eight times of systemic adverse reactions occurred , and the incidence rate was 0.8 % .

Conclusion : House dust mites are the most common allergens in children ' s asthma in compliance area . The clinical symptoms and PEF of the children with standardized house dust mites were improved . The results suggested that the effect of allergen - specific immunotherapy in house dust mite was obvious , and the incidence of adverse reactions was low , and it was worthy of clinical popularization .

【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R725.6

【参考文献】