太原及周边地区哮喘患者过敏因素临床分析

发布时间：2018-02-27 21:29

本文关键词： 支气管哮喘过敏因素过敏原空气污染脱敏治疗　出处：《山西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过血清过敏原的检测分析哮喘患者过敏原与年龄、性别、体重指数(Body Mass Index,BMI)、过敏性疾病家族史、肺功能、空气污染的关系,探讨太原及周边地区支气管哮喘患者过敏因素的特点,更好地将针对过敏原的特异性免疫治疗应用于临床,提高患者的生活质量。方法:采用免疫印迹方法对2014年11月至2016年10月期间于山西医科大学第一医院呼吸科门诊确诊为急性发作期轻至中度的哮喘患者213例进行血清过敏原(包括食入性和吸入性过敏原)检测,根据其结果分为过敏原阳性组与过敏原阴性组,同时收集两组哮喘患者的一般资料以及肺功能指标:FEV1%Pre、FEV1/FVC%、PD20、PEF等,分析比较过敏原与年龄、性别、BMI、过敏性疾病家族史、肺功能以及空气污染1-3天内使用峰流速仪测得的平均PEF值的关系。在过敏原阳性组中选取60例存在尘螨过敏原的哮喘患者,随机分为给予常规治疗的对照组和给予常规治疗加用针对过敏因素治疗(包括避免接触、脱敏治疗)的观察组,在观察组中脱敏治疗应开始于常规治疗1月哮喘控制之后,然后6个月后评价支气管哮喘常规治疗以及加用针对过敏因素治疗后的临床疗效。结果:1.支气管哮喘患者过敏因素的特点确诊为支气管哮喘患者的血清特异性IgE抗体和总IgE抗体结果显示:过敏原为阳性的总共158例,阳性率74.2%,单一过敏原阳性的患者阳性率为76例(48.1%),2种及以上过敏原阳性的患者阳性率为82例(51.9%);有总IgE100IU/mL的患者8例(5.1%),100—200iu/ml的患者27例(17.1%),200iu/ml的患者123例(77.8%);吸入性过敏原的阳性率(65.8%)高于食入性sige(9.5%)。2.哮喘患者的过敏原阳性率与患者一般条件的关系1)哮喘患者过敏原阳性组的年龄、bmi与过敏原阴性组无明显差异(t=1.609,p=0.109;t=0.915,p=0.361);2)不同年龄段(青年、中年、老年)哮喘患者的过敏原阳性率无差异(变应原阳性率分别为71.0%,78.0%,94.1%,x2=4.683,p=0.096);3)男性患者过敏原阳性率为72.4%,女性患者过敏原阳性率为75.4%,女性患者的过敏原阳性率高于男性患者,两组间差异无统计学意义(x2=0.239,p=0.636);4)哮喘患者过敏原阳性与过敏性疾病家族史有关(x2=92.031,p0.05)。3.哮喘患者过敏原阳性率与肺功能指标的关系哮喘患者过敏原阳性组哮喘患者的pd20、fev1%pre、fev1/fvc%均低于过敏原阴性组,两组结果相比,差异有统计学意义(t=-8.503,p0.05;t=-2.384,p=0.019;t=-2.932,p=0.004)。4.空气污染对哮喘患者的影响过敏原阳性组在经历中至重度空气污染1-3天内使用峰流速仪的平均pef为(196.95±46.89)l/min,过敏原阴性组在相同空气污染期间的平均pef为(213.98±46.12)l/min,过敏原阳性组的平均pef明显低于过敏原阴性组的平均pef,两者间差异有统计学意义(t=-2.349,p=0.021)。5.针对过敏因素治疗的疗效观察分析6个月后接受过敏因素治疗的患者与只接受常规治疗患者的客观pef与主观act的结果:观察组的act评分结果升高值(3.30±1.97)显著大于对照组(2.10±1.35),两组间差异有统计学意义(t=2.755,p0.05);观察组的pef(86.0±5.8)l/min明显高于对照组(80.6±5.4)l/min,两组间差异有统计学意义(t=3.727,p0.05)。结论:1.尘螨、蒿草、矮豚草是太原及周边地区引起哮喘的常见过敏原;2.哮喘患者过敏原阳性可能与过敏性疾病家族史及肺功能有关,而与性别、年龄、BMI无关;3.空气污染可能对过敏原阳性的患者影响更大;4.针对过敏因素采取避免接触及脱敏治疗后,可以更好地改善肺功能、减少急性发作,从而提高患者的生活质量,降低社会和家庭的经济负担。
[Abstract]:Objective: through the analysis of serum allergen detection in patients with asthma allergens with age, sex, body mass index (Body Mass, Index, BMI), family history of allergic diseases, pulmonary function, the relationship of air pollution in Taiyuan and surrounding areas, to explore the characteristics of patients with bronchial asthma allergic factors, will be better for specific immunotherapy the allergens in the clinic, improve the quality of life of patients. Methods: using Western blot methods during November 2014 to October 2016 in the first hospital of Shanxi Medical University, Department of respiration clinic diagnosed as acute exacerbation of mild to moderate asthma patients with 213 cases of serum allergen (including food and inhalant allergens) according to the detection, the result is divided into allergen positive group and negative group allergens, while collecting two groups of asthma patients with general information and lung function index: FEV1%Pre, FEV1/FVC%, PD20, PEF, compare analysis Allergens with age, gender, BMI, family history of allergic diseases, the relationship between the average PEF pulmonary function and air pollution within 1-3 days with the peak flow meter measured values. In allergen positive group 60 cases selected are dust mite allergens in patients with asthma, were randomly divided into routine treatment group and the control give for treatment of allergic factors (including routine treatment and avoid contact with the observation group, desensitization therapy) in the observation group after desensitization treatment should begin with the conventional treatment of asthma control in January, then 6 months after the evaluation of conventional treatment of bronchial asthma and allergic factors for clinical efficacy after treatment. Results: the diagnostic characteristics of 1. in patients with bronchial asthma allergic factors for specific IgE antibody in sera of patients with bronchial asthma and total IgE antibody showed that allergen positive for a total of 158 cases, the positive rate was 74.2%, single allergen positive positive patients Rate of 76 cases (48.1%), more than 2 kinds of allergens positive patients with a positive rate of 82 cases (51.9%); a total of 8 patients with IgE100IU/mL (5.1%), 27 cases of patients with 100 - 200iu/ml (17.1%), 123 cases of patients with 200iu/ml (77.8%); inhaled allergens positive rate (65.8%) higher than the ingestion of SiGe (9.5%).2. patients with asthma allergen positive rate in patients with general conditions of 1) of patients with asthma allergen positive group age, BMI had no obvious difference with allergen negative group (t=1.609, p=0.109; t=0.915, p=0.361); 2) in different age groups (young. The middle-aged, elderly) no difference in patients with asthma allergen positive rate (allergens positive rate were 71%, 78%, 94.1%, x2=4.683, p=0.096); 3) male patients with allergen positive rate was 72.4%, female patients with allergen positive rate was 75.4%, female patients with allergen positive rate higher than that of male patients, no statistically significant the difference between the two groups (x2=0.239, P =0.636); 4) on patients with asthma and allergen positive family history of allergic diseases (x2=92.031, P0.05).3. asthma allergen positive rate and lung function index in patients with allergic asthma patients between positive group asthma pd20, fev1%pre, fev1/fvc% were lower than the allergen negative group, compared the results of the two groups was statistically significant. The difference (t=-8.503, P0.05; t=-2.384, p=0.019; t=-2.932, p=0.004).4. effects of air pollution on asthma patients average PEF allergen positive group using the peak flow meter in moderate to severe air pollution within 1-3 days for (196.95 + 46.89) l/min, allergen negative group average PEF during the same as air pollution (213.98 + 46.12) l/min, average PEF allergen positive group was significantly lower than the average PEF allergen negative group, the difference was statistically significant (t=-2.349, p=0.021) efficacy of.5. for treatment of the sensitive factors for 6 months analysis After receiving the treatment of patients with allergic factors only received routine treatment of patients with PEF objective and subjective act results: in the observation group the act score increased value (3.30 + 1.97) was significantly higher than the control group (2.10 + 1.35), the difference was statistically significant between the two groups (t=2.755, P0.05); observation group (PEF 86 + 5.8) l/min was significantly higher than the control group (80.6 + 5.4) l/min, there were statistically significant differences between the two groups (t=3.727, P0.05). Conclusion: the 1. dust mites, wormwood, dwarf ragweed is in Taiyuan and the surrounding areas caused by asthma common allergens in 2. patients with asthma; allergen may be related to family allergic disease history and lung function, and gender, age, independent of BMI; 3. air pollution may be greater for allergen positive patients; 4. for allergic factors taken to avoid contact and desensitization treatment, can better improve lung function and reduce acute episodes, so as to improve the quality of life of patients, Reduce the economic burden of the society and the family.

【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R562.25

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