广东地区变应性鼻炎儿童患者临床特点研究

发布时间：2018-06-16 17:09

本文选题：变应性鼻炎 + 证型　；参考：《广州中医药大学》2016年博士论文

【摘要】：目的：通过临床调查和实验对比不同生命周期的变应性鼻炎的临床特点,从而得出变应性鼻炎儿童患者的临床特点,并预测变应性鼻炎的病情发展趋势。用于指导诊治,提高疗效。方法：本课题的所有病例都来自2014年9月至2016年2月期间广州中医药大学第一附属医院耳鼻咽喉科的门诊患者,其年龄至少3岁,病史至少3个月,经过变应原检测后确诊为变应性鼻炎的患者共384例。全部采用自制的“变应性鼻炎临床特点及中医证型调查表”由导师和本人现场调查。采集的内容包括患者的鼻部症状VAS评分、家族史、变应性鼻炎的伴随症状和中医症候分型常见影响因素等。在动物实验方面,用OVA致敏BALB/c小鼠,制造变应性鼻炎小鼠模型,通过观察记录小鼠在不同生命周期的挠鼻次数,对比其过敏的严重程度。应用计算机EXCEL表录入数据,并使用SPSS 19.0统计软件进行分析。结果：变应性鼻炎儿童患者的病程以中期为主,病程不影响体型,患儿以偏瘦为主,超重的不到偏瘦的三分之一,而体型中等者,其鼻痒、鼻塞、流涕最轻。发作地点排前两位的是家里、学校。而变应性鼻炎成人患者的病程以长期为主,体型以中等体型为主,体型偏瘦的大概是超重的一半,偏瘦的人喷嚏、流涕最轻,平均病程最短。无论是儿童还是成人患者都以晨起发作为主,与在家无关。性别不是变应性鼻炎发病的影响因素。无论是变应性鼻炎儿童还是成人患者,其鼻部各症状的发病率相当；下鼻甲肿胀分度情况无显著性差异。变应性鼻炎儿童患者,鼻塞最严重,流涕次之。下鼻甲为3度时,其鼻塞的平均VAS评分最高；下鼻甲为2度或3度时,其病程平均比0度和1度的长,0度并不能说明其病程较短。而变应性鼻炎成人患者,以喷嚏、流涕为首要症状,下鼻甲肿胀程度越严重,其鼻塞的平均VAS评分就越高。无论是变应性鼻炎儿童还是成人患者,都是以先鼻痒后眼痒、皮肤痒为主,而且眼痒和皮肤痒互为危险因素,与变应性鼻炎儿童患者产生烦躁无明显关系;性别对烦躁与否的影响差异亦无显著性意义。担心该病对生活质量产生影响的儿童患者和成人患者均超过六成,此外,成人比儿童患者更担心该病影响睡眠质量。无论是变应性鼻炎儿童还是成人患者,合并鼾症时鼻塞更严重；此外,鼻塞最可能是引起变应性鼻炎儿童患者担心睡眠、担心发育和烦躁的因素。先有变应性鼻炎后有哮喘的发病率,成人是儿童的1.8倍。成人患者比儿童患者更怕冷,怕冷与家里有无空调的情况无关,与哮喘的发病率也无关。变应性鼻炎儿童患者与成人患者的家族史、哮喘病史无显著差异。变应性鼻炎儿童患者的中医证型分布与成人对比的差异有显著性意义,变应性鼻炎儿童患者与成人患者,其肺气虚寒证与脾气虚弱证、脾肺气虚证的发病频率总和相当,约占65%,但儿童患者属于脾虚证的明显比成人多,成人患者属于肺经蕴热证跟肾阳不足证的较儿童患者多。晨起发作的变应性鼻炎儿童患者与成人患者都是以脾肺气虚证跟肺气虚寒证为主,但儿童患者属于脾虚证的明显比成人多,成人患者属于肺经蕴热证跟肾阳不足证的较儿童患者多。肾阳不足型的儿童患者鼻痒、流涕最严重,喷嚏最轻；肺气虚寒型的儿童患者喷嚏最重；各种证型对鼻塞没有显著性差异；脾气虚弱型的成人患者流涕症状最严重。变应性鼻炎儿童患者合并鼾症的发病率(14.09%)比成人患者的发病率(9.15%)高,合并鼾症的变应性鼻炎儿童患者以脾气虚弱型为主,而成人患者则以肺气虚寒型和脾肺气虚型为主；变应性鼻炎儿童患者合并鼻窦炎的发病率(5.91%)比成人患者的发病率(3.05%)高,合并鼻窦炎的变应性鼻炎儿童患者以肺经蕴热型和脾气虚弱型为主,而成人患者则以脾肺气虚型为主；变应性鼻炎儿童患者合并哮喘的发病率(5.00%)比成人患者的发病率(4.88%)略高,合并哮喘的变应性鼻炎患者主要以肺气虚寒、脾肺气虚、肾阳不足三种证型为主。变应性鼻炎儿童患者同时伴有鼻痒、眼痒和皮肤痒的发病率(19.09%)高于成人患者(9.14%),合并眼痒、皮肤痒不影响变应性鼻炎的中医证型分布。广东地区384名变应性鼻炎患者中,无论是儿童患者还是成人患者,其变应原排在前三位的都是依次为户尘螨、粉尘螨和室内尘土,其中,粉尘螨与户尘螨的分布频率几乎一致,常同时并同等级出现,与中医证型的分布无关。无论是变应性鼻炎儿童患者还是成人患者,牛奶、海虾、棉絮、海蟹、狗毛、猫毛这几种过敏原,其过敏等级主要为1级,而且1级的阳性率是2级甚至更高级的阳性率总和的2.5倍或以上。虾与蟹,猫毛与狗毛,屋尘与螨虫,互为危险因素。棉絮不是螨虫过敏的危险因素。AR孕鼠的鼻痒程度比AR成鼠严重,而年长AR鼠的鼻痒程度比年轻AR鼠严重；AR小鼠的第一代鼠崽的鼻痒程度比正常小鼠严重,但比AR母鼠的鼻痒程度轻；小鼠从孕前到产后经历的不同的生命时期,其鼻痒的症状在产后之初表现的最严重,产前鼻痒一直在加重,产后鼻痒也开始逐步减轻。结论：1.变应性鼻炎儿童患者与成人患者对比,临床特点不一致,儿童患者,鼻塞最严重,流涕次之,成人患者,以喷嚏、流涕为首要症状。2.变应性鼻炎儿童患者与成人患者,其肺气虚寒证与脾气虚弱证、脾肺气虚证的发病频率总和相当,约占65%,但儿童患者属于脾虚证的明显比成人多,成人患者属于肺经蕴热证跟肾阳不足证的较儿童患者多。3.广东地区变应性鼻炎患者中,无论是儿童患者还是成人患者,其变应原排在前三位的都是依次为户尘螨、粉尘螨和室内尘土,其中,粉尘螨与户尘螨的分布频率几乎一致,常同时并同等级出现,与中医证型的分布无关。4.不同生命周期的变应性鼻炎小鼠模型,年长者的鼻痒程度比年轻者严重,雌性变应性鼻炎小鼠怀孕后期鼻痒症状最严重,分娩后,鼻痒症状会减轻。
[Abstract]:Objective: To compare the clinical characteristics of allergic rhinitis in different life cycle by clinical investigation and experiment, and to get the clinical characteristics of allergic rhinitis children, and to predict the trend of allergic rhinitis. It is used to guide the diagnosis and treatment and improve the curative effect. Methods: all cases in this subject are from September 2014 to February 2016. The outpatient of the Department of Otolaryngology, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, was at least 3 years old, with a history of at least 3 months, and 384 patients were diagnosed with allergic rhinitis after the allergen test. All of them were investigated by the tutor and myself by the self-made "clinical characteristics of allergic rhinitis and TCM syndrome type investigation list". The contents include VAS score of nasal symptoms, family history, accompanying symptoms of allergic rhinitis and common influencing factors of TCM syndrome. In animal experiments, BALB/c mice were sensitized by OVA to produce allergic rhinitis mice model, and the number of nose flinch in different life cycles of mice was recorded and the severity of allergic rhinitis was compared. Using the computer EXCEL table to record the data, and use the SPSS 19 statistical software to analyze. Results: the course of the allergic rhinitis children's course of disease is mainly in the middle period, the course does not affect the body shape, the child is mainly thin, the overweight is less than 1/3 thin, and the body with medium size, its nose itching, nasal congestion, runny nose is the lightest. The site of the attack is the two place. The course of the adult patients with allergic rhinitis is a long term, with a medium size, and a thin body of about half of the overweight, the thinner sneeze, the lightest runny nose, and the shortest average course. Both children and adult patients are mainly in the morning and have nothing to do with the family. Sex is not allergic rhinitis. The influence factors of the allergic rhinitis children and adult patients have the same incidence of each symptom in the nose; there is no significant difference in the degree of lower turbinate swelling. The patients with allergic rhinitis have the most severe nasal congestion and runny nose. The average VAS score of the nasal plug is the highest when the inferior turbinate is 3 degrees; the course of the lower turbinate is 2 degrees or 3 degrees. The average length of 0 degrees and 1 degrees does not indicate a shorter course of disease. In adult patients with allergic rhinitis, the first symptom is sneezing and runny nose. The more severe the swelling of the inferior turbinate is, the higher the average VAS score of the nasal plug. There was no significant relationship with itching of the skin with irritability and irritability in children with allergic rhinitis, and there was no significant difference in the impact of sex on irritability. There were more than 60% of the children and adults who worried about the quality of life. In addition, adults were more worried about the quality of sleep than in children. In the case of allergic rhinitis children or adult patients, nasal congestion is more severe with snoring; in addition, nasal congestion is most likely to cause anxiety in children with allergic rhinitis, worry about sleep, worry about development and irritability. After allergic rhinitis, the incidence of asthma is 1.8 times as high as adults. Adult patients are more afraid of cold, cold and more afraid of cold than children. There is no relation between the condition of air conditioning in the family and the incidence of asthma. There is no significant difference in the history of asthma in children with allergic rhinitis and adults, and there is no significant difference in the history of asthma. The difference in TCM syndrome distribution of allergic rhinitis children with adults is significant, and the Asthenia Cold of the allergic rhinitis children and the adult patients, and the Asthenia Cold of the lung. Syndrome and spleen qi deficiency syndrome, the sum of the incidence of spleen and lung qi deficiency syndrome is equal, accounting for about 65%, but children's patients belong to the spleen deficiency more than adults, adult patients belong to the lung meridian heat syndrome and kidney yang deficiency syndrome more than those of children. But children are more than adults with spleen deficiency syndrome. Adult patients are more than children with syndrome of lung meridian accumulation and kidney yang deficiency. Children with deficiency of kidney yang have the most severe nasal itching, the most serious sneeze, and the most severe sneeze in children with cold type of lung qi deficiency; there is no significant difference in nasal congestion in various types of syndrome; deficiency of Spleen Qi. The symptoms of runny nose in the weak adult patients were the most serious. The incidence of snoring in children with allergic rhinitis (14.09%) was higher than that of adult patients (9.15%). The patients with allergic rhinitis with snoring were mainly of weak temper, while the adult patients were mainly with lung qi deficiency cold type and spleen and lung qi deficiency type, and allergic rhinitis children patients. The incidence of sinusitis (5.91%) was higher than that of adult patients (3.05%). The patients with allergic rhinitis with nasosinusitis were mainly pulmonary meridian and spleen qi deficiency, while the adult patients were mainly with spleen and lung qi deficiency, and the incidence of asthma in children with allergic rhinitis (5%) was more than that of adult patients (4.88%). The incidence of allergic rhinitis in children with nasal itching, itching and skin itching (19.09%) was higher than that of adult patients (19.09%), combined with itching and itching, and skin itching did not affect the distribution of TCM syndrome of allergic rhinitis in Guangdong area. Among the 384 patients with allergic rhinitis, both children and adults, their allergens were in the top three of the family dust mite, dust mites and indoor dust. Among them, the distribution frequency of dust mite and household dust mite was almost identical, often at the same level, and was not related to the distribution of the TCM syndrome type. The allergen of milk, shrimp, cotton, sea crab, dog hair and cat hair is 1 grade, and the positive rate of grade 1 is 2.5 times or more of the positive rate of 2 or more advanced. Shrimp and crab, cat hair and dog hair, house dust and mites are risk factors. Cotton is not a risk factor for mites allergy.AR pregnancy. The itching degree of the mice was more severe than that of the AR rat, while the nasal itching of the older AR mice was more severe than that of the young AR mice; the first generation of the mice in the AR mice was more itchy than the normal mice, but less than that of the AR mice; the symptoms of the nose itching from pre pregnancy to postpartum were the most serious in the early postpartum period. Conclusion: 1. children with allergic rhinitis and adult patients are compared with adult patients, with different clinical characteristics, children, the most serious nasal congestion, runny nose, adult patients,.2. allergic rhinitis children and adult patients with sneezing and runny nose as the primary symptom, their lung qi deficiency cold syndrome and temper. Deficiency syndrome, the sum of the incidence of spleen and lung qi deficiency syndrome is equal, accounting for about 65%, but children with spleen deficiency syndrome are obviously more than adults, adult patients are more.3. Guangdong area allergic rhinitis patients with lung meridian heat syndrome and kidney yang deficiency syndrome, both children and adult patients, their allergens are in the top three. The distribution frequency of dust mite and indoor dust mite is almost the same, and the distribution frequency of dust mite and household dust mite is almost identical, often at the same time and in the same grade. It is not related to the distribution of.4. in different life cycle of allergic rhinitis in mice. The degree of nasal itching in the elderly is worse than that of the young, and the female allergic rhinitis in the later period of pregnancy. The symptoms of nasal itching are most serious, and the symptoms of nasal itching will be reduced after delivery.
【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R765.21

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