特应性斑贴试验在儿童变态反应性疾病中查找过敏原的应用

发布时间：2019-06-24 23:12

【摘要】：变态反应性皮肤病是由过敏原通过变态反应机制引发的皮肤病,其发生率相当高,占各类皮肤病的50%左右。此组疾病如特应性皮炎、荨麻疹等往往找不到明确的过敏原,临床症状迁延不愈,反复发作,给病人带来了极大的痛苦,给临床预防和治疗造成极大困难。目前,过敏原测定的方法总体上可以分为两种,即体内试验和体外试验。目前在我国临床上应用较为广泛的是血清特异性IgE抗体测定(sIgE),该方法是一种体外试验,但是只有IgE介导的过敏反应本试验才适用,而另外3种类型的变态反应所致的过敏性疾病及IgG介导的变态反机制为阴性。此外,以下情况亦可出现假阴性结果:1)如果患者处于过敏性疾病高峰期或者较重的过敏反应发生后,体内IgE耗竭。2)变应原IgE已经结合于细胞受体。3)患者体内存在IgE自身抗体。另外,部分有过敏症状的患者并不是由变态反应引起的。因此,临床上需要更为安全、可靠、易于操作、痛苦性小、易于被患儿家属接受的过敏原检测方法。特应性斑贴试验(APT)是一种体内试验,该试验使用可以激发IgE介导的速发型变态反应的变应原,如食入性变应原、吸入性变应原,在受试者用斑贴试验的方法引起湿疹样皮肤反应,评价变应原与湿疹的关系。特应性斑贴试验不仅可以检测IgE介导的变态反应性疾病,还可以检测非IgE介导的变态反应性疾病。目前,国外已经有人应用特应性斑贴试验(APT)查找特应性皮炎患儿的过敏原,国内尚未见应用特应性斑贴试验(APT)诊断变态反应性疾病过敏原的报道。特应性斑贴试验(APT)可以查找变态反应性疾病的过敏原,为变态反应性疾病寻找更为安全有效的预防和治疗措施。该试验是一种安全、可靠、易于操作、痛苦性小、易于被患儿家属接受的过敏原检测方法。我们共收集根据临床症状诊断为特应性皮炎、慢性荨麻疹患儿共45例,均为2009年12月至2010年12月到吉林大学第二临床医学院门诊就诊的我市患儿,年龄在5个月到14岁之间。45例患儿同时进行特应性斑贴试验及测定血清特异性IgE。根据特应性斑贴试验(APT)的反应程度,分别统计每种变应原的阳性率;根据疾病种类,分为慢性荨麻疹组和特应性皮炎组;根据实验种类,分为特应性斑贴试验(APT)和血清特异性免疫球蛋白(sIgE)组;根据实验结果,分为特应性斑贴试验(APT)(+)血清特异性免疫球蛋白(sIgE)(-)组和特应性斑贴试验(APT)(-)血清特异性免疫球蛋白(sIgE)(+)组。采用卡方检验进行统计学分析。得出以下结果及结论:1)、在45例患儿中,斑贴阳性者36例,阳性率为80%,其中阳性率较高的抗原吸入组为榆树(69.44%),食入组阳性率较高的为海虾(69.44%)、海鱼(66.67%)、鸡蛋(61.11%)。sIgE的阳性率为35/45(78%),牛奶的阳性率较高(29%)。进一步证明变态反应性疾病病因复杂,吸入、食入过敏原都可以引起过敏。2)在本组试验中,特应性皮炎组较慢性荨麻疹组斑贴阳性率高的变应原是海虾、海鱼、小麦、肉牛、榆树、多价羽毛。慢性荨麻疹组较特应性皮炎组斑贴阳性率较高的变应原是鸡蛋、牛奶、香烟。3)在本组试验中,两种方法对鱼虾、牛肉、榆树具有良好的一致性,P0.05,无统计学差异。两种方法检测牛奶、小麦,APT阳性率更高,P0.05,两者有统计学差异。表明特应性斑贴试验(APT)相对于血清特异性IgE(-),在患儿牛奶、小麦时较为敏感。4)特应性斑贴试验(APT)(+)特异性IgE(-)组的阳性率高于特应性斑贴试验(APT)(-)特异性IgE(+)组,表明特应性斑贴试验(APT)相对于血清特异性IgE(-),在诊断特应性皮炎和慢性荨麻疹患儿过敏原时更为敏感。5)45例患儿在特应性斑贴试验(APT)中,对1种物质过敏1例(1/45),2种物质过敏3例(3/45),3种物质过敏4例(4/45),4种及4种以上物质过敏28例(28/45);在45例患儿中,sIgE的阳性率为35/45(78%),其中对1种物质过敏2例(2/45),2种物质过敏3例(3/45),3种物质过敏4例(5/45),4种及4种以上物质过敏29例(29/45)。表明过敏性皮肤病患者在高敏状态时,可同时对多种过敏原产生过敏。6)、两种方法结果具有良好的一致性,在诊断上有相互补充作用。特应性斑贴试验(APT)相对于血清特异性IgE(sIgE)在诊断慢性荨麻疹和特应性皮炎时更为敏感,临床上可以两者结合并参考病史,为变态反应性疾病筛查变态反应原。通过统计分析,本文认为特应性斑贴试验(APT)较血清特异性免疫球蛋白(sIgE)试验更敏感,而且两者具有良好的一致性,在诊断上有相互补充作用。因此临床上可以两种联合应用或者单独应用特应性斑贴试验(APT),作为变态反应性疾病寻找过敏原的一个方法。
[Abstract]:Allergic skin diseases are skin diseases caused by the allergen through the allergic mechanism, and the incidence rate is quite high, accounting for about 50% of all kinds of skin diseases. This group of diseases, such as atopic dermatitis, urticaria, and the like, often fails to find a definite allergen, and the clinical symptoms are delayed and repeated, which brings great pain to the patients, and has great difficulty for clinical prevention and treatment. At present, the method for determination of the allergen can be divided into two types, namely in-vivo test and in vitro In our country, the serum-specific IgE antibody assay (sIgE) is widely used in our country. The method is an in vitro test, but only the IgE-mediated allergic reaction is the only test. The other three types of allergy-induced allergic diseases and IgG-mediated metamorphosis are applicable. negative. False negative results can also occur in the following cases:1) If the patient is in the peak of an allergic disease or a severe allergic reaction occurs, the IgE in the body is depleted.2) Allergen IgE has been bound to the cell receptor.3) IgE itself is present in the patient The antibody. In addition, some of the patients with an allergic symptom are not induced by an allergic reaction. As a result, it is clinically necessary to be more safe, reliable, easy to operate, less painful and easy to be detected by the child's family Methods. The teatopy patch test (APT) is an in vivo test that uses an allergen that can stimulate IgE-mediated rapid-type allergy, such as a food-in allergen, an inhalation allergen, an eczema that causes a patch test in a subject, a skin-like reaction to evaluate the allergen and The relationship of atopic patch test not only can detect the IgE-mediated allergic disease, but also can detect the non-IgE-mediated metamorphosis. Response diseases. At present, there have been an application of the atopic patch test (APT) in foreign countries for the search for allergens in children with atopic dermatitis, which has not been shown in the country for the diagnosis of allergic diseases by the use of the atopic patch test (APT). The AAPT can find the allergen of an allergic disease and find a more safe and effective way to find an allergic disease. The test is safe, reliable, easy to operate, small in pain and easy to be accepted by the family of the child A total of 45 patients with atopic dermatitis and chronic urticaria were collected from December 2009 to December 2010, and the second clinical medicine of Jilin University was collected from December 2009 to December 2010. The age of the children in the city of the college is between 5 and 14 years. And determining the specific IgE of the serum. According to the degree of the reaction of the atopy patch test (APT), the positive rate of each allergen is respectively counted; according to the type of the disease, the positive rate of each allergen is divided into a chronic urticaria group and an atopic dermatitis group; and according to the experimental type, the serum-specific IgE is divided into a teatopy patch test (APT) and a serum-specific immunity-free group. The serum-specific immune globulin (sIgE) group and the serum-specific immunoglobulin (APT) (-) serum-specific immune globulin test (APT) (-) were classified according to the experimental results. White (sIgE) (+) group. Use The results and conclusions were as follows:1) The positive rate was 80% in the 45 cases, and the positive rate of the positive rate was elm (69.44%), and the positive rate of the positive rate was sea shrimp (69.44%). The positive rate of sIgE was 35/45 (78%) and milk was 35/45 (78%). The positive rate of allergic disease is high (29%). It is further proved that the cause of allergic diseases is complicated, the inhalation and the ingestion of the allergen can cause the allergy.2) In this group, the allergen with high positive rate in the atopic dermatitis group with chronic urticaria is sea shrimp, sea fish and wheat. The allergen with high positive rate in chronic urticaria and atopic dermatitis is egg, milk and cigarette. In this group, the two methods have good consistency with fish and shrimp, beef and elm. 0.05. There was no statistical difference. The positive rate of milk, wheat and APT was higher in two methods, and P0. There was a statistical difference between the two groups. It was indicated that the specific IgE (-) was more sensitive to the serum-specific IgE (-) in the children.4) The positive rate of the specific IgE (-) group was higher than that of the T (-) group (-) (-) (-). ) The specific IgE (+) group, which indicates that the atopic patch test (APT) is more sensitive to serum specific IgE (-), is more sensitive in the diagnosis of atopic dermatitis and in children with chronic urticaria.5)45 children with atopic dermatitis There were 1 case (1/45),3 cases (3/45),4 (4/45),4 (4) and more than 4 (28/45), and the positive rate of sIgE in 45 children. 35/45 (78%), of which 2 (2/45),3 (3/45),4 (5/45),4 and 4 or more were allergic to one substance. In 29 cases (29/45), it is indicated that in the case of allergic dermatoses in the hypersensitive state, it is possible to have an allergic reaction to a variety of allergens at the same time.6) The results of the two methods have good consistency. It is more sensitive to the diagnosis of chronic urticaria and atopic dermatitis compared with serum-specific IgE (sIgE) in the diagnosis of chronic urticaria and atopic dermatitis. By statistical analysis, this paper is considered to be more sensitive to the test of serum-specific immunoglobulin (sIgE) than the serum-specific immunoglobulin (sIgE) test, and both have a good one. There is a complementary effect on the diagnosis. Therefore, it can be used in two kinds of joint applications or the application of the homography test (APT) alone as a pervert.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R758.23

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