过敏性鼻炎脱敏治疗前后鼻阻力、EOS及ECP相关性研究

发布时间：2018-04-26 20:56

本文选题：过敏性鼻炎 + 鼻阻力　；参考：《南方医科大学》2012年硕士论文

【摘要】：过敏性鼻炎(allergicrhinitis,AR)是一种易感机体接触致敏变应原后导致的主要由IgE介导的炎性介质的释放和多种免疫活性细胞,炎性细胞因子参与的鼻粘膜非感染性炎性疾病。过敏性鼻炎在世界范围内的患病率呈上升趋势,欧美国家成人中过敏性鼻炎患病率一般为10%-25%,我国近年门诊病人明显上升,严重影响了患者的生活质量。到目前,还没有一种可有效预防和根治这些疾病的治疗方法。全身与局部双途径抗变态反应和抗炎是治疗过敏性鼻炎的主要途径,这种双途径治疗主要包括全身抗组胺药物(如,西替利嗪和氯雷他定)和局部抗变态反应抗炎药(如内舒拿及布地奈德)最为安全和有效。一项最新的meta分析,糠酸莫米松-内舒拿可以有效减轻过敏性鼻炎患者的鼻症状总计分和单个症状计分,包括鼻塞症状。但药物只是对症治疗,它并不能在停药后持久地维持疗效。变应原特异性免疫治疗是给对某种变应原敏感的患者逐渐增加该变应原产品的用量,从而减轻其以后暴露在有该变应原的环境下的症状的疗法,其可以诱导临床和免疫耐受,经过一段时间的SIT后,即使停止治疗仍对机体有长期的疗效并能预防变应性疾病的进一步发展,降低哮喘的发病率,同时它还能提高过敏性疾病患者的生活质量。特异性免疫治疗的原理就是调节Th1和Th2免疫反应失衡。免疫治疗才是改变疾病发展过程唯一的对因治疗。变应原产品的成分质量对疾病的诊断治疗预防很重要。安脱达是全球最多患者选用及具有最多文献记载的免疫治疗制剂。目前过敏性鼻炎药物治疗前后及变应原特异性免疫治疗前后缺少客观的指标评价治疗的效果,在临床实际工作中,目前仍然以患者主诉作为评价治疗效果及调整治疗方案的主要依据。症状分级记分标准(如鼻症状总计分和单个症状计分)在过敏性鼻炎严重性及临床疗效判定中广泛使用,临床上需要通过客观的方法去评价过敏性鼻炎的治疗效果,鼻阻力及鼻细胞学检查是一个客观的评价症状严重程度的方法,并作为症状分级记分标准的补充本文通过变应原特异性免疫治疗前后鼻阻力及鼻细胞学相关指标的变化规律了解其在评价治疗效果及调整治疗方案中的应用价值,假如AR患者症状严重程度及治疗后缓解程度与鼻阻力、EOS、ECP呈负相关,配合主观症状评分及鼻粘膜病理检查,评价其相关性。如果知道AR患者在安脱达脱敏治疗前后鼻阻力及鼻灌洗液中EOS,ECP的动态变化情况就可以客观地知道它们对疾病的控制情况,就可为临床疗效评价或调整治疗提供指导意见。可以明确监测鼻阻力、鼻灌洗液中EOS、ECP在过敏性鼻炎疗效评价中的作用。而鼻阻力、鼻灌洗液中EOS、ECP在临床疗效判定应用中的文章很少。目前尚无应用鼻阻力及鼻灌洗液中嗜酸性粒细胞及嗜酸性粒细胞阳离子蛋白检测在药物治疗和安脱达脱敏治疗过敏性鼻炎前后中应用研究报道。 1、观察比较安脱达脱敏治疗过敏性鼻炎前后鼻阻力及鼻腔灌洗液中嗜酸性粒细胞EOS及嗜酸性粒细胞阳离子蛋白ECP的动态变化情况。 2、鼻阻力及鼻腔灌洗液中嗜酸性粒细胞EOS及嗜酸性粒细胞阳离子蛋白ECP在过敏性鼻炎疗效判断中的应用价值。追踪观察自2009年1月到2011年5月在中山市中医院耳鼻喉科门诊主要症状为打喷嚏、鼻塞、流清涕、鼻痒43例成人患者,均有2—14年的相关病史. 所有患者年龄范围(17—46岁)平均年龄(29±4.2岁),男20人,女23人,均符合2004年兰州会议AR诊断标准,并符合中重度过敏性鼻炎的标准,经皮肤点刺试验,确定为尘螨过敏,点刺结果≥++,点刺液为安刺SQ,由丹麦ALK公司提供,变应原筛选为屋尘螨及粉尘螨过敏。按安脱达脱敏治疗的要求行脱敏治疗,所有患者均无用药禁忌,并除外伴随鼻腔鼻窦炎性反应、鼻息肉、鼻中隔严重偏曲、药物性鼻炎、以及伴有其他部位过敏症状者如哮喘等,在接受特异性免疫治疗期间未接受过任何与变应性疾病有关的药物治疗。对照组年龄范围(17—46岁)平均年龄(29±4.2岁),男4人,女8人为我科甲状腺腺瘤病人. 1、记录治疗前病史,鼻内镜检查结果,症状体征评分；鼻阻力,鼻灌洗液嗜酸性粒细胞及嗜酸性粒细胞阳离子蛋白值,并取少量下鼻甲粘膜病理检查。 2、记录治疗15周后症状体征评分；鼻阻力,鼻灌洗液嗜酸性粒细胞阳离子蛋白值。 3、记录治疗1年后症状体征评分：鼻阻力,鼻灌洗液嗜酸性粒细胞及嗜酸性粒细胞阳离子蛋白值,治疗1年后取少量下鼻甲粘膜病理检查并行鼻内镜检查。 4、分析比较两组间及免疫治疗前后症状体征评分,鼻阻力及鼻灌洗液嗜酸性粒细胞及嗜酸性粒细胞阳离子蛋白值有无差异,比较治疗前与治疗1年后粘膜病理变化情况及鼻内镜检查情况。 1.定量资料选择算术均数±标准差(x±s)进行描述； 2.两定量资料的比较采用t检验,计数资料的比较采用x2检验； 3.分析两变量相关性时采用简单相关或偏相关； 4.以P0.05为差异有统计学意义； 5.各指标测量值采用SPSS13.0的重复测量数据的方差分析及SAS9.2统计软件的广义估计方程proc genmod过程步加以分析。 1.免疫治疗组治疗前与治疗15周后、治疗1年后鼻症状总评分比较有统计学差异(χ2=78.83,P0.05),鼻阻力比较有统计学差异(F=318.811,P0.05)。 2.免疫治疗前鼻阻力与对照组存在统计学差异(P0.05),而免疫治疗1年后鼻阻力与对照组统计学无差异(P0.05)。 3.免疫治疗前与治疗15周后、治疗1年后嗜酸性粒细胞阳离子蛋白值存在统计学差异(F=254.215,P0.05)。 4.免疫治疗前嗜酸性粒细胞阳离子蛋白值与对照组存在统计学差异(P0.05),而免疫治疗1年后嗜酸性粒细胞阳离子蛋白值与对照组无统计学差异(P0.5)。 5.鼻阻力与症状体征总分无相关性r=-0.77,(P0.5),嗜酸性粒细胞阳离子蛋白值与症状体征总分无相关性r=-0.017,(P0.5)。 6.免疫治疗前与治疗1年后鼻灌洗液嗜酸性粒细胞计数存在统计学差异(P0.05)。 1.免疫治疗前后鼻阻力及鼻腔灌洗液中嗜酸性粒细胞EOS及嗜酸性粒细胞阳离子蛋白ECP都有明显改善,与症状体征评分无相关。 2.本研究提示：过敏性鼻炎治疗过程中,连续动态的检测鼻阻力及检测鼻灌洗液嗜酸性粒细胞EOS及嗜酸性粒细胞阳离子蛋白EECP可客观判断疗效,可作为症状体征评分的补充。
[Abstract]:Allergic rhinitis ( AR ) is one of the primary IgE - mediated inflammatory mediators released by IgE - mediated inflammatory mediators and the non - infectious inflammatory diseases of nasal mucosa caused by IgE - mediated inflammatory mediators .

Systemic and topical two - way anti - allergic and anti - inflammatory is the primary route for the treatment of allergic rhinitis , which is most safe and effective in the treatment of allergic rhinitis mainly including systemic anti - histamine drugs ( e.g . , citirazine and lortaxic ) and local anti - allergic anti - inflammatory drugs ( e.g . , naushannah and butende ) . A recent meta - analysis shows that mometasone furoate can effectively reduce the total score of nose symptoms and individual symptom scores in allergic rhinitis patients , including nasal obstruction symptoms . However , the drug is only symptomatic treatment , and it does not permanently maintain the efficacy after discontinuation .

allergen - specific immunotherapy is a therapy for gradually increasing the dosage of the allergen product to a patient sensitive to a certain allergen , thereby reducing the subsequent exposure to symptoms in an environment with the allergen , which can induce clinical and immune tolerance .

At present , there is no objective index to evaluate the effect of allergic rhinitis before and after treatment and before and after allergen - specific immunotherapy . In clinical practice , it is still used as the main basis for evaluating the therapeutic effect and adjusting the treatment plan . The symptom grading score criterion ( such as total score of nasal symptom and single symptom score ) is widely used in the assessment of the severity of allergic rhinitis and the clinical curative effect , and it is necessary to evaluate the therapeutic effect , nasal resistance and nasal cytology of allergic rhinitis by objective method .

In this paper , the changes of nasal resistance and nasal cytology indexes before and after allergen - specific immunotherapy are used to understand the application value of the indexes of nasal resistance , EOS and ECP in patients with allergic rhinitis .

1 . To observe the dynamic changes of EOS and ECP in nasal cavity before and after allergic rhinitis .

2 . The application value of EOS and ECP of eosinophils and ECP in the treatment of allergic rhinitis were studied .

From January 2009 to May , 2011 , the main symptoms of the outpatient department of ENT in Zhongshan were analyzed .

All patients age range ( 17 - 46 years ) mean age ( 29 卤 4.2 years ) , male 20 , female 23 , all met the 2004 Lanzhou Conference AR diagnostic criteria , and met the criteria of moderate and severe allergic rhinitis . The prick test was conducted to determine that dust mite had an allergic reaction . The prick test was not contraindicated in all patients . Except for nasal sinusitis , nasal polyp , severe nasal septum deviation , drug rhinitis , and other allergic symptoms such as asthma , any drug therapy related to allergic disease was not received during the specific immunotherapy .

The age range of the control group ( 17 - 46 years ) mean age ( 29 卤 4.2 years ) , 4 males and 8 females were patients with thyroid adenoma .

1 . Record the pre - treatment medical history , nasal endoscopic findings and symptom sign scores ;
Nasal resistance , nasal irrigation lotion eosinophils and eosinophils cationic protein values , and small amount of inferior nasal mucosa pathological examination .

2 . Record symptom score after treatment for 15 weeks ;
Nasal resistance , nasal irrigation lotion eosinophils cationic protein value .

3 . Record the symptoms and signs after 1 year : the nasal resistance , the eosinophils of nasal irrigation lotion and the cationic protein value of eosinophils . After 1 year of treatment , a small amount of inferior nasal mucosa pathological examination was performed in parallel nasal endoscopy .

4 . There was no difference between the scores of symptoms and signs , nasal resistance and eosinophils and cationic protein values before and after treatment , and the pathological changes of mucosa before and after treatment and nasal endoscopy were compared before and after treatment .

1 . The quantitative data selection arithmetic mean 卤 standard deviation ( x 卤 s ) is described ;

2 . The comparison of the two quantitative data is t - test , and the comparison of the counting data is checked by x2 ;

3 . The simple correlation or partial correlation is used to analyze the correlation of the two variables .

4 . The difference of P 0.05 was statistically significant .

5 . The measurement values of each index were analyzed by the ANOVA of SPSS 13.0 and the procedure of the proc genmod of the generalized estimation equation of SAS9.2 statistical software .

1 . After treatment before and after treatment for 15 weeks , the total score of nasal symptoms was significantly different after treatment for 1 year ( 蠂2 = 78.83 , P0.05 ) , and the nasal resistance was significantly different ( F = 318.811 , P0.05 ) .

2 . There was significant difference between the nasal resistance before and after the immunotherapy ( P0.05 ) , but the nasal resistance after 1 year was not significantly different from that of the control group ( P0.05 ) .

3 . There was a significant difference in the values of cationic protein in eosinophils ( F = 254.215 , P0.05 ) before and after treatment for 15 weeks before and after immunotherapy .

4 . There was a significant difference between the value of cationic protein and the control group ( P0.05 ) before immunotherapy , but the value of the cationic protein of eosinophils after 1 year was not significantly different from that of the control group ( P < 0 . 05 ) .

5 . There was no correlation between the nasal resistance and the total score of symptoms and signs ( r = - 0.77 , P < 0.05 ) . There was no correlation between the value of cationic protein in eosinophils and the total score of symptoms and signs ( r = - 0.17 , P < 0 . 5 ) .

6 . There was a significant difference in the count of eosinophils before and after immunotherapy ( P0.05 ) .

1 . Both the nasal resistance before and after the immunotherapy and the ECP of eosinophils and eosinophils in nasal lavage fluid were significantly improved , which was not related to the score of symptoms and signs .

2 . This study suggests that the continuous and dynamic detection of nasal resistance during the treatment of allergic rhinitis and the detection of eosinophils EOS and eosinophils cationic protein EECP can objectively determine the curative effect , and can be used as a supplement to symptom sign score .

【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R765.21

【参考文献】