慢性特发性荨麻疹的流行病学调查与自体血清皮肤试验的应用分析

发布时间：2019-02-19 18:08

【摘要】： 目的：探讨济南地区慢性特发性荨麻疹的流行病学特点、评估常规实验室检查指标及自体血清皮肤试验的临床意义。从而进一步认识慢性自身免疫性荨麻疹的发病规律,为有效指导临床治疗,改善患者预后提供参考。方法：按照一定的纳入标准,选取2009年6月到2010年3月在我科门诊确诊为慢性特发性荨麻疹病例60人,详细询问患者一般情况及病史,填写调查问卷,并行外周血嗜酸性粒细胞计数、血清总IgE测定、抗甲状腺球蛋白抗体测定与自体血清皮肤试验。比较ASST阳性组患者与阴性组患者的流行病学特点,实验室检查结果以及疗效。所得数据应用SPSS13.0软件进行统计学分析。结果：本课题共纳入慢性特发性荨麻疹患者60例,男性15例,女性45例,男女比例1：3；年龄为12岁～68岁,平均年龄为39.82±14.63岁,以30岁～50岁患者为多(占病例总人数的53.3％)。其中室内工作者41例,室外工作者19例；城镇居民39例,农村居民21例。60例患者均行ASST检测,阴性29例,阳性31例,阳性率为51.7％。ASST阳性组较阴性组风团数量多(P0.05)、瘙痒重(P0.05),发作持续时间长(P0.05),风团大小无明显差异(P0.05)。45例患者检测外周血嗜酸性粒细胞计数,共2例嗜酸性粒细胞计数升高,23例ASST阳性病例中1例升高(4.3％),22例阴性病例中1例升高(4.5％)。44例患者行血清总IgE检测,共10例血清总IgE升高,其中22例ASST阳性病例有6例升高(27.3％),22例阴性病例中4例升高(18.2％)。43例患者行抗甲状腺球蛋白抗体检测,8例抗甲状腺球蛋白升高,其中22例ASST阳性病例共有7例升高(31.8％)；21例阴性病例中1例升高(4.8％),两者之间差异存在统计学意义。分别于实验结束后2周及4周观察疗效显示,ASST阳性患者中24例应用第二代抗组胺药物疗效显著,其余7例联合免疫抑制剂雷公藤多甙后症状缓解；29例ASST阴性患者应用第二代抗组胺药物后28例疗效显著,1例联合雷公藤多甙后症状仍未缓解。试验过程中发现血液标本静置时间、皮试部位、患者皮肤划痕反应以及操作者熟练程度可能影响ASST结果。结论： 1.济南地区慢性特发性荨麻疹患者以中青年为主,女性发病高于男性,室内工作者高于室外工作者,城镇居民高于农村居民。 2.在济南地区慢性特发性荨麻疹患者中ASST阳性率为51.7％,与国内外以往报道相符。 3.ASST阳性组患者与阴性组相比风团数量较多,持续时间较长,瘙痒较剧烈。 4.ASST阳性组患者同时罹患自身免疫性甲状腺疾病可能性更大。 5.ASST阳性患者抗组胺药与免疫抑制剂联合应用疗效更好。 6.血液标本静置时间、皮试部位、患者皮肤划痕反应以及操作者熟练程度可能影响ASST结果。
[Abstract]:Objective: to investigate the epidemiological characteristics of chronic idiopathic urticaria in Jinan area and to evaluate the clinical significance of routine laboratory tests and autologous serum skin test. In order to further understand the pathogenesis of chronic autoimmune urticaria, to effectively guide the clinical treatment and improve the prognosis of patients with reference. Methods: according to certain inclusion criteria, 60 patients with chronic idiopathic urticaria were selected from June 2009 to March 2010. Peripheral blood eosinophil count, serum total IgE, anti-thyroglobulin antibody and autologous serum skin test were performed. The epidemiological characteristics, laboratory results and efficacy of ASST positive and negative patients were compared. The data were analyzed by SPSS13.0 software. Results: a total of 60 patients with chronic idiopathic urticaria were included in this study, including 15 males and 45 females, the ratio of male to female was 1: 3; The average age was 39.82 卤14.63 years old. The majority of the patients were 30 ~ 50 years old (53.3% of the total cases). There were 41 indoor workers and 19 outdoor workers. There were 39 urban residents and 21 rural residents. All the 60 patients were tested by ASST, 29 cases were negative and 31 cases were positive. The positive rate was that the number of wind masses in 51.7%.ASST positive group was more than that in negative group (P0.05), and the pruritus weight was heavy (P0.05). The attack lasted for a long time (P0.05), but there was no significant difference in wind mass size (P0.05). The eosinophil count in peripheral blood was detected in 45 patients, and the eosinophil count was increased in 2 patients. In 23 cases of ASST positive, 1 case (4.3%) was elevated, and 1 case (4.5%) of 22 cases was negative. Total serum IgE was detected in 44 cases (10 cases). In 22 cases of ASST positive, 6 cases (27.3%) were elevated, 4 cases (18.2%) of 22 negative cases were increased, 43 cases were tested for anti-thyroglobulin antibody, 8 cases were increased in anti-thyroglobulin. In 22 cases of ASST positive, 7 cases (31.8%) were elevated. One of the 21 negative cases was elevated (4.8%), and the difference was statistically significant. The curative effects were observed at 2 weeks and 4 weeks after the end of the experiment. The results showed that 24 cases of ASST positive patients were treated with the second generation antihistamine and the other 7 cases were relieved after the use of tripterygium wilfordii polyglycosides. Twenty-eight patients with ASST negative were treated with second generation antihistamine, and 1 patient with tripterygium wilfordii was not relieved. During the experiment, it was found that the rest time of the blood sample, the site of the skin test, the skin scratch reaction of the patient and the operator's proficiency may affect the results of ASST. Conclusion: 1. The incidence of chronic idiopathic urticaria in Jinan was mainly young and middle-aged, the incidence of female was higher than that of male, that of indoor worker was higher than that of outdoor worker, and that of urban residents was higher than that of rural residents. 2. The positive rate of ASST in patients with chronic idiopathic urticaria in Jinan area was 51.7%, which was consistent with previous reports at home and abroad. Compared with the negative group, the 3.ASST positive group had more wind masses, longer duration and more severe pruritus. 4.ASST positive patients were more likely to develop autoimmune thyroid disease at the same time. The combination of antihistamines and immunosuppressants was better in 5.ASST positive patients. 6. The rest time of the blood sample, the site of the skin test, the skin scratch reaction of the patient and the operator's proficiency may affect the results of ASST.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R758.24

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