难治性变应性鼻炎患者血清维生素D与嗜酸性粒细胞水平及应用维生素D钙咀嚼片治疗的价值

发布时间：2018-01-21 11:13

本文关键词： 维生素D 嗜酸性粒细胞过敏性鼻炎药物治疗　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的研究成人难治性变应性鼻炎(AR)患者血清1,25-二羟维生素D3及嗜酸性粒细胞水平,并且观察维生素D钙咀嚼片在该类患者应用过程中的临床疗效,为成人难治性变应性鼻炎的临床诊断和治疗提供进一步的理论依据。方法研究的对象为2014年5月-2015年11月安徽医科大学第一附属医院门诊收治的60例成人难治性中重度AR患者。所有患者均在治疗前进行皮肤点刺试验和血清特异性Ig E检测,同时检测血清1,25-二羟维生素D3及嗜酸性粒细胞的水平。该60例患者随机分为实验组及对照组并给予不同的治疗,每组各30例。同时于我院健康体检门诊随机选取60名健康人群的血清维生素D及嗜酸性粒细胞水平作为健康人群组。对照组患者联合使用丙酸氟替卡松鼻喷雾剂及左西替利嗪,实验组在对照组的基础上加用维生素D钙咀嚼片。分别于治疗前、治疗后两周、治疗后四周采用视觉模拟评分量表(VAS)对总体症状及鼻部分类症状进行临床疗效评分。结果皮肤点刺试验结果:过敏性鼻炎患者皮肤变应原检测阳性结果60例,占总数的100%。其中对单一过敏原致敏的13例,占总数的(21.6%)。对两种及两种以上过敏原致敏的47例,占总数的(78.4%)。血清特异性Ig E检测:过敏性鼻炎患者血清特异性Ig E检测阳性结果60例,占总数的100%。过敏性鼻炎患者血清1,25-二羟维生素D3的含量为(17.46±4.94)ng/ml,明显低于健康人群组(21.70±7.32)ng/ml,二组差异有统计学意义(P0.05)。过敏性患者血清嗜酸性粒细胞的含量为1.76×109/L明显高于健康人群组0.46×109/L,二组差异有统计学意义(P0.05)。治疗前实验组患者和对照组患者总体症状及鼻部症状评分均相近,差异无统计学意义;实验组和对照组患者治疗14天后与治疗前比较,评分均明显下降,差异有统计学意义;实验组和对照组患者治疗28天后与治疗14天后比较,除流涕症状无明显差异外,其余症状评分实验组较对照组均明显下降,差异有统计学意义。治疗14天后实验组与对照组相比鼻塞、鼻痒、喷嚏无明显差异,实验组的流涕及总体症状评分较对照组明显下降,差异均有统计学意义。治疗28天后实验组总体症状及鼻部症状评分均低于对照组,差异有统计学意义。结论难治性过敏性鼻炎患者中普遍存在血清1,25-二羟维生素D3的缺乏及嗜酸性粒细胞的升高。在治疗难治性过敏性鼻炎时,加用维生素D钙咀嚼片可以更有效的控制过敏性鼻炎的相关症状。
[Abstract]:Objective to study the serum levels of 1m25-dihydroxyvitamin D3 and eosinophil in adult patients with refractory allergic rhinitis (ARA). And to observe the clinical effect of vitamin D calcium chewable tablets in this kind of patients. To provide further theoretical basis for the clinical diagnosis and treatment of refractory allergic rhinitis in adults. Methods from May 2014 to November 2015, the subjects of this study were admitted to the outpatient clinic of the first affiliated Hospital of Anhui Medical University. 60 adult patients with refractory moderate and severe AR were treated with skin prick test and serum specific Ig before treatment. E test. At the same time, the serum levels of 1b25-dihydroxyvitamin D3 and eosinophils were measured. The 60 patients were randomly divided into experimental group and control group and treated with different treatments. At the same time, the serum vitamin D and eosinophil levels of 60 healthy people were randomly selected as a healthy group. The patients in the control group were treated with fluticasone propionate nasal spray. Aerosols and levo-cetirizine. The experimental group was treated with vitamin D calcium chewable tablets on the basis of the control group. Visual analogue scale (VAS) was used four weeks after treatment. Results the results of skin prick test showed that 60 patients with allergic rhinitis had positive skin allergen test. 13 cases were sensitized to a single allergen, and 47 cases were sensitized to two or more allergens. Serum specific IgE was detected in 60 patients with allergic rhinitis, accounting for 100% of the total. The content of 25-dihydroxyvitamin D3 was 17.46 卤4.94 ng / ml, which was significantly lower than that of healthy group (21.70 卤7.32 ng / ml). The serum eosinophil content in allergic patients was 1.76 脳 10 9 / L, which was significantly higher than that in healthy subjects (0.46 脳 10 9 / L). The difference between the two groups was statistically significant (P 0.05). The scores of the overall symptoms and nasal symptoms of the patients in the experimental group and the control group were similar before treatment, but the difference was not statistically significant. The scores of the patients in the experimental group and the control group decreased significantly after 14 days of treatment compared with those before treatment, and the difference was statistically significant. After 28 days of treatment and 14 days after treatment, the scores of other symptoms in the experimental group and the control group were significantly lower than those in the control group, except that there was no significant difference in the symptoms of snot. After 14 days of treatment, there was no significant difference in nasal congestion, itching and sneezing between the experimental group and the control group. The score of runny and overall symptoms in the experimental group was significantly lower than that in the control group. After 28 days of treatment, the scores of overall symptoms and nasal symptoms in the experimental group were lower than those in the control group, and the difference was statistically significant. Conclusion Serum 1 is common in the patients with refractory allergic rhinitis. In the treatment of refractory allergic rhinitis, the addition of vitamin D calcium chewable tablets can more effectively control the symptoms of allergic rhinitis.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R765.21

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