特应性斑贴试验在诊断特应性皮炎患儿食物过敏中的应用

发布时间：2018-06-07 04:52

本文选题：斑贴试验 + 特应性　；参考：《重庆医科大学》2010年硕士论文

【摘要】： 研究背景特应性皮炎(atopic dermatitis, AD)是一种具有遗传趋向的慢性、复发性、炎症性皮肤病,大多起病于婴幼儿时期。目前一致的观点认为食物抗原在婴幼儿和儿童AD的发病中起着重要作用。及时准确地发现致敏食物并加以避免是有效治疗儿童AD和防止AD病情反复的关键。目前国内用于筛查食物过敏原的主要手段和方法包括:病史,皮肤点刺试验(SPT)和血清特异性IgE(sIgE)检查。病史对大部份病例不可靠,而SPT和sIgE主要针对速发型食物过敏反应,很难识别出真正参与AD发病的迟发型过敏反应的食物抗原。1996年,特应性斑贴试验(atopy patch test, APT)作为一种新型的诊断迟发型食物过敏反应的工具被Isolauri和Turjanmaa首次应用于AD患儿。此后,许多研究均表明APT在识别参与迟发型过敏反应的抗原中具有明显的优势,但迄今国内尚无相关研究的报道。目的探讨APT在诊断AD患儿食物过敏中的效能和临床应用的价值。方法以我国儿童食物过敏中常见的5种食物——鸡蛋、牛奶、大豆、小麦和花生为抗原,以开放性食物激发试验为金标准,同时采用APT和SPT对AD患儿进行诊断性检查。比较APT和SPT诊断AD患儿食物过敏的敏感性、特异性、阳性预测值、阴性预测值和ROC曲线下面积。结果 1.经食物激发试验证实,本实验AD组患儿的食物过敏发生率为49.69%。其中,鸡蛋、牛奶、大豆、小麦和花生过敏的发生率分别为78%、60.67%、32.58%、22.76%和45.78%。AD患儿的食物过敏反应以迟发型反应为主,主要表现为湿疹。 2.APT/ SPT检测鸡蛋、牛奶、大豆、小麦和花生过敏的敏感性分别为100%/82.9%、83.5%/90.1%、95.3%/44.2%、100%/7.1%和84.2%/28.9%;特异性分别为63.6%/63.6%、72.9%/67.8%、62.9%/74.2%、84.2%/95.8%和75.6%/91.1% ;阳性预测值分别为90.7%/89.0%、81.2%/82.6%、55.4%/45.2%、65.1%/33.3%和74.4%/73.3%;阴性预测值分别为100%/51.2%、74.1%/81.6%、96.6%/73.3%、100%/77.8%和85.0%/60.3%。 3.APT检测鸡蛋、大豆、小麦和花生过敏的敏感性和NPV均显著高于SPT,两者对牛奶过敏的检测的差异无统计学意义。SPT检测小麦和花生过敏的特异性明显高于APT。其它指标间的比较差异无统计学意义。 4.APT/SPT诊断鸡蛋、牛奶、大豆、小麦和花生过敏的ROC曲线下面积(判断诊断准确度的指标)分别为0.935/0.789、0.846/0.826、0.840/0.666、0.959/0.515和0.870/0.601。 5.APT和SPT诊断速发反应的阳性率之间的差异无统计学意义(P=0.289),APT对迟发反应的阳性率显著大于SPT(P=0.000)。APT和SPT诊断速发反应的敏感性分别为77.8%和55.6%,差异无统计学意义(χ2=2.000,P=0.157);诊断迟发反应的敏感性分别为85.8%和38.1%,差异有统计学意义(χ2=85.024,P=0.000)。 6. APT和SPT并联诊断牛奶过敏的敏感性显著高于APT(P=0.037),但与SPT单独诊断比较却无显著差异(P=0.419);两者并联诊断能提高牛奶过敏的阴性预测值,但与单独诊断比较,差异无统计学意义(P0.05)。并联诊断能提高花生过敏的敏感性和NPV,但与APT单独诊断差异无统计学意义(P0.05)。串联诊断能提高小麦过敏的特异性,但与SPT比较差异无统计学意义(P=0.700)。在诊断鸡蛋和大豆过敏中,联合诊断的效能与SPT或APT单独诊断的效力相同。所有联合诊断的PPV与单独诊断的PPV之间的差异无统计学意义。结论 1.AD患儿食物过敏的发生率显著高于正常人群。 2.APT对鸡蛋、大豆、小麦和花生过敏的诊断准确度优于SPT,尤其是对小麦过敏的诊断。两者对牛奶过敏的诊断的准确度之间的差异无统计学意义。 3.APT对以迟发反应为主要临床表现的食物过敏的诊断效能显著优于SPT。 4.与APT或SPT单独应用相比较,两者联合应用并不能提高诊断AD患儿食物过敏的阳性预测值。
[Abstract]:Background of the study

The atopic dermatitis ( AD ) is a kind of chronic , recurrent and inflammatory skin disease with genetic tendency . Most of them are ill in infancy . At present , it is believed that food antigens play an important role in the pathogenesis of AD . At present , the main means and methods for screening food allergens are : medical history , skin prick test ( SPT ) and serum - specific IgE ( sIgE ) .

Purpose

To evaluate the efficacy and clinical value of APT in diagnosing food allergy in children with AD .

method

In order to test the sensitivity , specificity , positive predictive value , negative predictive value and ROC curve of food allergy in children with AD , the sensitivity , specificity , positive predictive value , negative predictive value and ROC curve of food allergy in children with AD were compared with APT and SPT .

Results

1 . The incidence of food allergy in AD group was 49.69 % . The incidence of allergy to eggs , milk , soybean , wheat and peanut was 78 % , 60.67 % , 32.58 % , 22.76 % and 45.78 % , respectively .

2 . The sensitivity of APT / SPT in eggs , milk , soybean , wheat and peanut allergy was 100 % / 82.9 % , 83.5 % / 90.1 % , 95.3 % / 44.2 % , 100 % / 7.1 % and 84.2 % , 75.6 % / 91.1 % , respectively ; the positive predictive values were 90.7 % / 89.0 % , 81.2 % / 82.6 % , 55.4 % / 45.2 % , 65.1 % / 33.3 % and 74.4 % / 77.3 % , respectively ; the negative predictive values were 100 % / 51.2 % , 74.1 % / 81.6 % , 96.6 % / 73.3 % , 100 % / 79.8 % and 85.0 % / 60.3 % , respectively .

3 . The sensitivity of APT to detect allergy to eggs , soybean , wheat and peanut was significantly higher than that of SPT . There was no statistical significance in the difference between the two tests . The specificity of SPT in detecting allergy to wheat and peanut was higher than that of APT . There was no significant difference between other indexes .

4 . The area under ROC curve of APT / SPT diagnosis of allergy to eggs , milk , soybean , wheat and peanut was 0.935 / 0.789 , 0.846 / 0.826 , 0.840 / 0.666 , 0.959 / 0.5515 and 0.870 / 0.601 , respectively .

5 . There was no significant difference between the positive rates of APT and SPTs ( P = 0.289 ) . The sensitivity of APT to late - onset reaction was significantly higher than that of SPT ( P = 0.000 ) . The sensitivity of APT and SPT in diagnosis of delayed reaction was 77.8 % and 55.6 % , respectively . The sensitivity of APT and SPT was 85.8 % and 39.1 % , respectively . The difference was significant ( 蠂2 = 85.024 , P = 0.000 ) .

6 . The sensitivity of APT and SPT in diagnosis of milk allergy was significantly higher than that of APT ( P = 0.037 ) , but there was no significant difference compared with that of SPT alone ( P = 0.419 ) . In the diagnosis of egg and soybean allergy , the difference was not statistically significant ( P = 0.700 ) . In the diagnosis of egg and soybean allergy , the efficacy of combined diagnosis was the same as that of SPT or APT alone .

Conclusion

1 . The incidence of food allergy in children with AD was significantly higher than that in the normal group .

2 . The diagnostic accuracy of APT for allergy to eggs , soybean , wheat and peanut was better than that of SPT , especially the diagnosis of allergy to wheat . There was no statistical significance between the accuracy of diagnosis and the accuracy of diagnosis of cow ' s milk allergy .

3 . APT is superior to SPT in the diagnosis of food allergy characterized by delayed reaction .

4 . Compared with APT or SPT alone , the combined application of both can not improve the positive predictive value of food allergy in children diagnosed with AD .
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R758.2

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