变应性鼻炎患者鼻与下气道炎症相关性研究

发布时间：2018-03-07 07:14

本文选题：变应性鼻炎　切入点：鼻灌洗　出处：《南京大学》2012年硕士论文　论文类型：学位论文

【摘要】：背景及目的 1997年Grossman首先明确提出“同一气道,同一疾病”的论点,强调上下呼吸道炎症性疾病整体性的概念。2001年世界卫生组织编写出版的指导性文件“变应性鼻炎及其对哮喘的影响”(allergic rhinitis and its impact on asthma, ARIA)指出变应性鼻炎是导致哮喘的主要因素之一,ARIA2008年修订本更加明确阐述“变应性鼻炎与哮喘是一个综合征在呼吸道两个部分的表现”这一基本观点,可见将二者作为整体进行研究具有重要意义。因此,上下呼吸道之间气道炎症一致性和相关性的课题一直是近几年研究的热点。本研究通过对变应性鼻炎患者与健康对照组鼻与下气道炎症指标,以及变应性鼻炎患者鼻与下气道炎症指标的对照研究,进一步探讨上、下呼吸道变应性炎症相关性,从而为更深入的基础和临床研究提供参考。方法将有典型变应性鼻炎临床症状和体征的病人按照过敏原皮肤点刺实验结果阳性诊断为变应性鼻炎,选择高校就读的健康学生及到本院体检中心体检的健康成人作为健康对照组,其中变应性鼻炎组53例,健康对照组50例。所有入选者均行血常规检查、鼻灌洗液和诱导痰炎症细胞分类计数、鼻激发、支气管激发试验。按照变应性鼻炎患者组与健康对照组两组各参数进行比较,分析变应性鼻炎组与正常组的检查指标是否有差异；将变应性鼻炎组组内各参数进行比较,分析变应性鼻炎患者鼻部与下气道相关性。结果一、变应性鼻炎患者与健康对照组鼻与下气道炎症指标研究结果 1.变应性鼻炎组鼻灌洗液嗜酸性粒细胞(eosinophil, EOS)比例(7.93±7.15)及诱导痰EOS比例(3.49±4.25)均高于健康对照组鼻灌洗液EOS(0.72±0.71)及诱导痰EOS比例(1.33±1.08),差异具有统计学意义(P0.05)。 2.变应性鼻炎组患者鼻激发的阳性率及支气管激发阳性率均明显高于正常组,差异具有统计学意义(P0.05)。二、变应性鼻炎患者组鼻与下气道炎症指标研究结果 1.变应性鼻炎组鼻灌洗液EOS比例与诱导痰EOS比例呈正相关(r=0.385,P=0.04)。 2.变应性鼻炎组鼻激发阳性率与支气管激发阳性率无相关性(r==0.143,P=0.308)。 3.变应性鼻炎组以支气管激发阴、阳分组两组间诱导痰EOS比例存在差异(P0.05),而两组间鼻灌洗液EOS比例无差异(P0.05)。 4.变应性鼻炎组以鼻激发阴、阳分组两组间鼻灌洗液EOS比例存在差异(P0.05),而两组间诱导痰EOS比例无差异(P0.05)。 5.变应性鼻炎组鼻灌洗液EOS比例与诱导痰EOS比例以及血常规中EOS比例均有相关性(P0.05)。结论 1.变应性鼻炎组病人与正常对照组比较,鼻与下气道炎症均明显增高。 2.变应性鼻炎组病人鼻与下气道炎症具有一致性。 3.鼻与下气道以及血常规的嗜酸性粒细胞具有高度相关性,提示变应性鼻炎是一种局部炎症与全身炎症共存的变态反应性疾病。 4.下气道嗜酸粒细胞性炎症可能是支气管高反应性的原因。
[Abstract]:Background and purpose
1997 Grossman first explicitly put forward the "one airway, one disease" argument, emphasizes on the concepts of.2001 lower respiratory tract inflammatory disease of the whole year WHO published the guidance document "allergic rhinitis and its impact on asthma" (allergic rhinitis and its impact on asthma, ARIA) pointed out that allergic rhinitis is one of the the main factors that lead to asthma, ARIA2008 revised more clearly "allergic rhinitis and asthma is a syndrome in two parts of the respiratory tract" this basic viewpoint, the two were visible for the whole study has important significance. Therefore, between the upper and lower respiratory tract inflammation consistency and correlation research has been a research hotspot in recent years. Based on the control group and the nasal airway inflammation in patients with allergic rhinitis and health, and patients with allergic rhinitis A comparative study of nasal and lower airway inflammatory indexes will further explore the correlation between upper and lower respiratory tract allergic inflammation, so as to provide a reference for further in-depth basic and clinical research.
Method
There will be a typical allergic rhinitis clinical symptoms and signs of patients with allergic rhinitis in accordance with allergen skin prick test results positive diagnosis, healthy students choose to attend college and to the health of adults from medical examination center as a healthy control group, the allergic rhinitis group 53 cases, 50 cases of healthy control groups. In all the subjects. Underwent blood routine examination, nasal lavage and induced sputum inflammatory cell counts, nasal provocation, bronchial provocation test in patients with allergic rhinitis group and healthy control group of two groups of parameters were compared, analysis indexes of allergic rhinitis group and normal group whether there are differences; each parameter in allergic rhinitis group by comparison, correlation analysis of patients with allergic rhinitis and nasal airway.
Result
The results of nasal and lower airway inflammation in patients with allergic rhinitis and healthy controls
1. in the allergic rhinitis group, the proportion of eosinophil (EOS) in nasal lavage fluid (7.93 + 7.15) and the ratio of EOS in induced sputum (3.49 + 4.25) were all higher than those in healthy control group, EOS (0.72 + 0.71) and sputum sputum EOS ratio (1.33 + 1.08), the difference was statistically significant (P0.05).
2. the positive rate of nasal excitation and the positive rate of bronchial provocation in the patients with allergic rhinitis were significantly higher than those in the normal group, and the difference was statistically significant (P0.05).
Two, research results of nasal and lower airway inflammation in patients with allergic rhinitis
There was a positive correlation between the ratio of EOS and the proportion of induced sputum EOS in 1. allergic rhinitis group (r=0.385, P=0.04).
There was no correlation between the positive rate of nasal excitation and the positive rate of bronchial provocation in 2. allergic rhinitis group (r==0.143, P=0.308).
In 3. allergic rhinitis group, the ratio of induced sputum EOS in the two groups was different (P0.05), but there was no difference in the proportion of EOS between the two groups (P0.05).
In 4. allergic rhinitis, the proportion of EOS in the two groups was different (P0.05), but there was no difference in the proportion of EOS between the two groups (P0.05).
In 5. allergic rhinitis, the proportion of EOS in nasal lavage fluid was correlated with the proportion of induced sputum EOS and the proportion of EOS in blood routine (P0.05).
conclusion
1. patients with allergic rhinitis were significantly higher in nasal and lower airway inflammation compared with the normal control group.
2. the nasal and lower airway inflammation in the patients with allergic rhinitis is consistent.
3., nose is highly correlated with lower airway and blood routine eosinophils, suggesting allergic rhinitis is an allergic disease with local inflammation and systemic inflammation.
4. the eosinophilic inflammation in the lower airway may be the cause of bronchial hyperreactivity.

【学位授予单位】：南京大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R765.21

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