真菌变应原与哮喘临床特征的相关性研究

发布时间：2018-05-14 12:18

本文选题：变应原 + 支气管哮喘　；参考：《广州医科大学》2017年硕士论文

【摘要】：第一部分呼吸道变应性疾病临床特征及吸入性变应原分布呼吸道变应性疾病主要包括变应性鼻炎和支气管哮喘,在世界范围内发病率逐年升高,是受到广泛关注的健康问题。既往吸入性变应原的研究多针对螨虫、花粉等,相关研究结果显示随各地地理、气候环境的不同,吸入性变应原分布也存在差异,如在我国南方,屋尘螨及蟑螂阳性率较高,而在北方地区,因气候干冷不适合螨虫等生长繁殖,其阳性率相对没有南方的高。近年来空气中真菌孢子也受到临床医师的关注,被认为是重要的变应原,可诱发加重呼吸道变应性疾病,广州属亚热带海洋季风气候,夏季多雨潮湿,全年气温高,有利于真菌及其孢子的生长和繁殖,且真菌种类繁多,而真菌变应原的种类及其在诱发呼吸道变应性疾病中的作用尚不完全明确,深入研究真菌变应原的分布,及与呼吸道变应性疾病的临床特征相关关系具有重要意义,可为呼吸道变应性疾病的临床诊治提供依据。目的:研究采用血清吸入性变应原Ig E检测及皮肤变应原点刺试验的方法对哮喘和/或变应性鼻炎患者进行过敏原检测,以明确真菌变应原分布,并对比分析其与患者临床特征的相关关系。方法:1、收集广州医科大学附属第二医院就诊的变应性鼻炎和/或支气管哮喘患者122例,根据诊断分成为鼻炎组、哮喘并鼻炎组和哮喘组3组。2、所有入组患者进行血清吸入性变应原Ig E检测其中包括总Ig E、螨组合(屋尘螨、粉尘螨)、树花粉组合(柏树花粉、榆树花粉、梧桐花粉、柳树花粉、杨树花粉)及霉菌组合(烟曲霉、分支孢霉、交链孢霉、点青霉、根霉、毛霉)及吸入性变应原点皮肤刺试(包括花粉、刺苋菜、螨、蚕丝、美洲大蠊、屋尘、猫毛、狗毛、飞蛾、垫料、兽羽毛、蜜蜂、德国小蠊及霉菌组(烟曲霉、交链孢霉,支孢霉)。3、收集并比较三组患者的临床特征及其吸入性变应原分布情况。结果:1、哮喘并鼻炎组血清总Ig E水平(330.51±238.81)明显高于鼻炎组(140.20±133.56)及哮喘组(170.08±197.63)(P值均0.01);2、哮喘并鼻炎组血清嗜酸粒细胞水平(0.36±0.25)明显高于哮喘组(0.22±0.19)(P=0.012);3、哮喘组螨变应原阳性比例(30.77%)明显低于鼻炎组(85.11%)和哮喘并鼻炎组(91.3%)(P值均0.01);哮喘组树花变应原阳性比例(23.8%)明显低于鼻炎组(48.94%)和哮喘并鼻炎组(69.57%)(P=0.011;P=0.001);4、鼻炎组与哮喘合并鼻炎组、鼻炎组与哮喘组、哮喘合并鼻炎组与单纯哮喘组间霉菌变应原阳性比例均无显著差异(P=0.8,P=1,P=0.842)结论:1、螨、树花及真菌是变应性呼吸道疾病常见的变应原。2、在合并变应性鼻炎的哮喘患者中,真菌变应原阳性率高。第二部分真菌致敏哮喘患者的临床特征分析支气管哮喘是常见的呼吸道慢性炎症疾病,哮喘的病理基础是由多种细胞参与的气道慢性炎症,变应原的刺激可以诱发特异性体质患者气道的慢性炎症和气道高反应,出现反复发作咳嗽和/或喘息。我们前期的研究显示真菌为常见的吸入性变应原,在合并变应性鼻炎的哮喘患者中真菌变应原阳性率高,近期的研究认为真菌变应原与哮喘的严重程度密切相关。而环境中存在多种真菌及孢子,特应性个体接触后可诱发变态反应性疾病,但真菌致敏的种类及诱发哮喘的临床特征仍不完全清楚,深入研究真菌致敏性哮喘患者的临床特征,明确本地区真菌相关性哮喘的致敏真菌种类,有助于真菌相关性哮喘的诊疗,减轻医疗、经济、家庭负担。目的:研究采用血清吸入性变应原Ig E检测及皮肤变应原点刺试验的方法筛选真菌致敏的支气管哮喘患者,并采用ELISA酶联免疫捕获法检测血清真菌特异性Ig E(s Ig E),并分析本地区哮喘患者真菌致敏的情况及其临床特征。方法:1、收集112例哮喘患者,平均年龄48岁(3-82岁),其中儿童12例,男性49例,女性63例。2、通过血清霉菌Ig E检测包括总Ig E、螨组合(屋尘螨、粉尘螨)、树花粉组合(柏树花粉、榆树花粉、梧桐花粉、柳树花粉、杨树花粉)及霉菌组合(烟曲霉、分支孢霉、交链孢霉、点青霉、根霉、毛霉)及吸入性变应原点皮肤刺试(包括花粉、刺苋菜、螨、蚕丝、美洲大蠊、屋尘、猫毛、狗毛、飞蛾、垫料、兽羽毛、蜜蜂、德国小蠊及霉菌组(烟曲霉、交链孢霉,支孢霉),筛选出伴真菌致敏的哮喘患者,根据真菌致敏情况分为真菌致敏组和不伴真菌致敏组。3、对筛选出的哮喘患者采用ELISA酶联免疫捕获法检测血清真菌s Ig E(烟曲霉、链格孢霉、白色念珠菌、青霉及总毛霉)。4、收集患者临床资料,比较分析真菌致敏组与不伴真菌致敏组哮喘患者的临床特征。结果:1、真菌致敏组及不伴真菌致敏组患者性别、合并变应性鼻炎和/或皮炎比例、血清总Ig E、外周血嗜酸粒细胞计数、FEV1%无明显差异(P0.05)。2、入组的儿童哮喘患者12例中真菌致敏阳性的患儿6例,在儿童患者中伴真菌致敏性哮喘的比例明显高于成人患者(P0.001),真菌致敏组平均年龄明显低于不伴真菌致敏组(P=0.004)。3、真菌致敏组中的重症哮喘患者比例高于后者(P=0.032);且同时存在多种变应原致敏的比例明显高于后者(P0.001);4、14例血清霉菌组合Ig E阳性患者血清SIg E检测阳性11例(78.5%),其中烟曲霉SIg E阳性6例(42.9%)、白色念珠菌s Ig E阳性4例(28.6%)、青霉菌SIg E阳性2例(14.3%)、链格孢霉及总毛霉各1例(7.1%),2例兼有烟曲霉及青霉菌SIg E阳性,1例兼有白念珠菌、毛霉及青霉菌SIg E阳性结论:1、真菌致敏的哮喘患者平均年龄低、儿童多见、重症哮喘比例高,且常存在对多种变应原敏感的情况。2、烟曲霉、白色念珠菌是常见的哮喘致敏真菌变应原。
[Abstract]:The first part is the clinical characteristics of respiratory allergic diseases and inhalation allergen distribution of respiratory allergic diseases mainly including allergic rhinitis and bronchial asthma. The incidence of allergic rhinitis and bronchial asthma is increasing year by year in the world. There are also differences in the distribution of inhalation allergens with different geographical and climatic conditions. In the south of China, the positive rate of house dust mites and cockroaches is higher. In northern China, the positive rate of the positive rate is relatively no higher in the north because of the dry and cold climate, and the positive rate is not high in the south. In recent years, the fungal spores in the air are also concerned by the clinicians. It is considered to be an important allergens which can induce aggravated respiratory allergic diseases. Guangzhou is a subtropical marine monsoon climate. It is rainy and humid in summer and has high temperature throughout the year. It is beneficial to the growth and reproduction of fungi and spores, and there are many kinds of fungi. The species of fungal allergen and its role in inducing respiratory allergic diseases are not yet finished. A thorough study of the distribution of fungal allergen and the correlation with the clinical characteristics of respiratory allergic diseases is of great significance and can provide a basis for the clinical diagnosis and treatment of respiratory allergic diseases. Objective: To study the use of serum inhaled allergens Ig E and skin allergen pricking test for asthma and / or allergy Patients with rhinitis were detected by anaphylaxis to identify the distribution of fungal allergen and to compare the correlation with the clinical features of the patients. Methods: 1, 122 cases of allergic rhinitis and / or bronchial asthma in the Second Affiliated Hospital of Guangzhou Medical University were collected. According to the diagnosis, the patients were divided into rhinitis, asthma, rhinitis and asthma group, 3 groups of.2, All the patients were tested for serum inhaled allergens Ig E, including total Ig E, mites (house dust mites, dust mites), tree pollen assemblage (cypress pollen, elm pollen, parasol pollen, willow pollen, poplar pollen) and mould combinations (Aspergillus fumigatus, spores branchomyces, Alternaria, Penicillium, Rhizopus, Mucor) and inhaled allergic skin prickle Test (including pollen, prickly amaranth, mites, silk, Periplaneta americana, house dust, cat hair, dog hair, moth, moth, animal feather, bee, Blattella germanica, and mould group (Aspergillus fumigatus, Alternaria, aspergillus).3, collected and compared the clinical features and the distribution of inhaled allergens in three groups of patients. Results: 1, the serum total Ig E level of asthma and rhinitis group (330.51 + 2) 38.81) obviously higher than the rhinitis group (140.20 + 133.56) and asthma group (170.08 + 197.63) (P value 0.01), 2, the serum eosinophil level of asthma and rhinitis group (0.36 + 0.25) was significantly higher than that of the asthma group (0.22 + 0.19) (0.22 + 0.19) (0.22 P=0.012); 3, the positive ratio of mites allergens in asthma group was significantly lower than that of the rhinitis group (85.11%) and the asthma and rhinitis group (P value) The positive proportion of tree flower allergen (23.8%) in asthma group was significantly lower than that of rhinitis group (48.94%) and asthma and rhinitis group (69.57%) (P=0.011; P=0.001); 4, rhinitis group and asthma combined with rhinitis group, rhinitis and asthma group, asthma combined with rhinitis and simple asthma group had no significant difference (P=0.8, P=1, P=0.842): 1, mites, Tree flowers and fungi are the common allergen.2 of allergic respiratory diseases. In the patients with allergic rhinitis, the positive rate of fungal allergen is high. The clinical characteristics of asthma patients with second parts of fungi are the common chronic inflammatory diseases of the respiratory tract. The pathological basis of asthma is the gas of various cells. Chronic inflammation of the tract, allergen stimulation can induce chronic airway inflammation and airway hyperresponsiveness in patients with specific constitution, recurrent coughs and / or wheezing. Our previous study showed that fungi were common inhaled allergens and have high positive rates of fungal allergen in patients with allergic rhinitis. Fungal allergen is closely related to the severity of asthma. There are a variety of fungi and spores in the environment, and allergic diseases can be induced by individual allergic contact. However, the types of fungal sensitization and the clinical characteristics of inducing asthma are still not completely clear. The clinical features of fungal sensitized asthmatics are studied in depth and the local fungi are clearly defined. The types of sensitized fungi associated with asthma contribute to the diagnosis and treatment of fungal related asthma, reduce medical, economic, and family burdens. Objective: To study the screening of bronchial asthma patients with fungal sensitization by using serum inhaled allergen Ig E and skin strain test, and to detect the serum fungi by ELISA enzyme linked immunosorbent assay (ELISA) Specific Ig E (s Ig E) and analysis of the fungal sensitization of the local asthmatic patients and its clinical characteristics. Methods: 1, 112 cases of asthma were collected, the average age of 48 years (3-82 years old), including 12 children, 49 males and 63 females, including total Ig E, mites (dust mites, dust mites), and pollen combination of cypress tree (cypress pollen,) Elm pollen, parasol pollen, willow pollen, poplar pollen) and fungal combinations (Aspergillus fumigatus, spore spporomyces, cyclosporin, Penicillium, Rhizopus, Mucor) and inhaled allergen test skin test (including pollen, amaranth, mites, silkworm, cockroach, house dust, cat hair, dog hair, moth, pads, animal feathers, bee, Blattella germanica and mold group (Aspergillus fumigatus) Aspergillus oryzae, Aspergillus oryzae, screening the asthmatic patients with fungal sensitization, divided into fungal sensitization and non fungal sensitization group.3 according to fungal sensitization, and detected the serum fungal s Ig E (Aspergillus fumigatus, sporomyces, Candida albicans, Penicillium and mucorus total Mucor) by ELISA enzyme linked immunosorbent assay in the patients with asthma. Data, compare and analyze the clinical characteristics of the asthmatic patients in the fungal sensitization group and the non fungal sensitization group. Results: 1, the sex of the fungal sensitizing group and the non fungal sensitization group, the proportion of allergic rhinitis and / or dermatitis, the serum total Ig E, the peripheral eosinophil count, the FEV1% no significant difference (P0.05).2, and the 12 cases of children with asthma in the group In 6 children with fungal sensitization, the proportion of fungal sensitized asthma in children was significantly higher than that in adult patients (P0.001). The average age of the fungal sensitization group was significantly lower than that in the non fungal sensitization group (P=0.004).3, and the proportion of severe asthma in the fungal sensitization group was higher than that of the latter (P=0.032), and the ratio of various allergen sensitization was also found at the same time. The cases were significantly higher than that of the latter (P0.001); 11 cases (78.5%) were positive for SIg E detection in sera Ig E positive patients, including 6 cases (42.9%) of Aspergillus fumigatus SIg E positive, 4 cases of s Ig E positive of Candida albicans (28.6%), 2 cases (14.3%) of Penicillium SIg, 1 (7.1%) and 2 cases of Aspergillus fumigatus and Penicillium, 1, 1, 1 (7.1%), 2 cases of Aspergillus fumigatus and Penicillium, 1, 1, 1, 1, and 1. In addition, the positive conclusion of Candida albicans, Mucor and Penicillium SIg E: 1, the average age of the asthmatic asthmatic patients with fungal sensitization is low, the children are more common, the proportion of severe asthma is high, and there are often.2 sensitive to various allergen, Aspergillus fumigatus and Candida albicans are common allergen allergen sensitized by asthma.

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

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