变应性鼻炎变应原分析与治疗和阜康市哈萨克族流行病学调查

发布时间：2018-06-27 06:46

本文选题：变应性鼻炎 + 气道高反应　；参考：《新疆医科大学》2016年博士论文

【摘要】：目的:1)调查新疆地区变应性鼻炎患者变应原的分布,分析其相关因素,为变应性鼻炎患者群体采取提前预防措施提供帮助。2)通过比较单纯变应性鼻炎与合并下气道炎症的变应性鼻炎的抗炎治疗方案,探讨上下气道联合治疗在短期内取得的疗效分析。3)采集和统计新疆阜康市哈萨克族人群过敏性鼻炎的患病情况以及生活相关健康因素数据资料。方法:1)应用20种标准化吸入变应原对新疆医科大学第一附属医院耳鼻喉科门诊拟诊为变应性鼻炎的患者480例进行皮肤点刺试验,对比分析近年来引起变应性鼻炎的主要变应原分布。2)选取2012年5月至2012年8月在新疆医科大学第一附属医院耳鼻喉科过敏性鼻炎专病门诊确诊变应性鼻炎103例,按照是否合并下气道炎症分为A组:单纯变应性鼻炎、B组:变应性鼻炎合并气道高反应、C组:变应性鼻炎合并哮喘;治疗方案按照A组:丙酸氟替卡松喷鼻+鼻腔冲洗、B组:丙酸氟替卡松喷鼻+鼻腔冲洗+沙美特罗氟替卡松吸入剂(100ug/50ug)、C组:丙酸氟替卡松喷鼻+鼻腔冲洗+沙美特罗氟替卡松吸入剂(250ug/50ug)治疗1个月、3个月后随访对比,根据鼻内镜检查+症状体征评分、鼻阻力+肺功能测定结果评估疗效。3)采用横断面调查方法,以分层四级抽样方法随机选择1689例哈萨克族普通人群进行入户问卷调查。问卷表为统一标准问卷,筛查方式为面对面采集。结果:1)406例患者变应原呈阳性反应,阳性率相对较高的变应原为藜属(61.58%)和艾蒿(44.09%),依次为柳树、槭树、杨树、屋尘螨、车前草、刺槐、粉尘螨等。对单类变应原呈阳性反应的占9.61%,其中大多数是螨类变应原。2)治疗1个月、3个月后随访对比后发现,三组患者鼻部症状、体征都有不同程度缓解,其中单纯变应性鼻炎较合并下气道炎症的变应性鼻炎药物疗效明显;丙酸氟替卡松与沙美特罗氟替卡松吸入剂联合应用治疗变应性鼻炎合并哮喘患者,症状控制短期疗效明显。3)新疆阜康市哈萨克族人群中变应性鼻炎患病率高达11.1%,以打喷嚏症状发生率最高(54.6%),在年龄、性别、体重等方面差异没有显著意义,合并哮喘的鼻炎患者与年龄相关,合并过敏症的鼻炎患者与体重相关,过敏症中皮肤瘙痒最多(42.7%);鼻炎、哮喘与鼻窦炎发病有一定关系;发病与地毯使用率相关(94.4%);饮食方面分别与肉类水果正相关,与豆类、牛奶负相关。结论:1)新疆地区致敏的变应原分布特点与气候特殊性相一致,406例变应性鼻炎患者的主要变应原为藜属,较之既往报道的新疆主要变应原为蒿属有差别。2)变应性鼻炎应及早诊断或排除是否合并下气道炎症,确诊后根据不同类型实施治疗方案,必要时积极联合治疗,短期疗效显著;正确规范的诊疗流程可以减少临床误诊以及误治率,避免延误或过度治疗,正确诊断和治疗变应性鼻炎能有效控制局部激素用量。3)根据新疆阜康市的哈萨克族人群调查资料发现变应性鼻炎的患病率居高,其患病特点与其生活相关健康因素密切相关。
[Abstract]:Objective: 1) to investigate the distribution of allergens in patients with allergic rhinitis in Xinjiang, and analyze the related factors to provide help for.2) to help the patients with allergic rhinitis to provide help with the anti allergic rhinitis simple allergic rhinitis and lower airway inflammation, and to discuss the combination of upper airway and lower airway in the short term. .3) acquisition and statistics of the prevalence of allergic rhinitis in Kazak people in Fukang City, Xinjiang, and data of life related health factors. Methods: 1) 480 patients with allergic rhinitis in Department of ENT, the First Affiliated Hospital of Xinjiang Medical University, were treated with 20 kinds of standardized inhalation allergen. 103 cases of allergic rhinitis diagnosed in the Department of ENT of the Department of ENT, the First Affiliated Hospital of Xinjiang Medical University from May 2012 to August 2012, were divided into 103 cases of allergic rhinitis in the Department of ENT, the First Affiliated Hospital of Xinjiang Medical University, and divided into group A: simple allergic rhinitis, group B: allergic reaction. Rhinitis combined with airway hyperreaction, group C: allergic rhinitis with asthma, treatment regimen according to group A: fluticasone propionate nasal spray and nasal irrigation, group B: fluticasone propionate nasal + nasal irrigation + Shah Mette Lo fluticasone inhaler (100ug/50ug), C group: fluticasone propionate nasal spray + nasal irrigation + Shah Mette Lo flatasone inhaler (250ug/50ug) 1 months, 3 months after the follow-up comparison, according to the nasal endoscopy + symptoms and signs score, the nasal resistance + pulmonary function test results evaluation of the effect of.3), a cross-sectional survey method was used to select 1689 Kazakh general population by stratified four sampling method. The questionnaire table was a unified standard questionnaire. Results: 1) results: 1) 406 cases of allergens were positive, and the positive rate was relatively high. The positive allergens were quinoa (61.58%) and Artemisia (44.09%), which were willow, maple, poplar, house dust mite, Plantago, Robinia, and dust mites. 9.61% of them were positive for single allergens, most of which were mites allergens.2) for 1 months and 3 months later. After follow-up and comparison, it was found that the symptoms and signs of the three groups were relieved in varying degrees, and the simple allergic rhinitis was more effective than the allergic rhinitis with lower airway inflammation, and the combined use of fluticasone propionate and Shah Mette Lo fluticasone was used to treat allergic rhinitis with asthma, and the short-term effect of symptomatic control was clear. .3) the prevalence rate of allergic rhinitis in Kazakh people in Fukang city of Xinjiang was up to 11.1%, with the highest incidence of sneezing (54.6%). There was no significant difference in age, sex and weight. The patients with asthma were associated with age. The patients with allergic rhinitis were associated with body weight, and the skin pruritus was the most in allergies (42. 7%); rhinitis, asthma and nasosinusitis have a certain relationship; the incidence of the disease is related to the use of carpets (94.4%); diet is positively related to meat fruit, and is negatively related to legumes and milk. Conclusion: 1) the allergenic characteristics of allergens in Xinjiang area are associated with the climate specificity, and 406 cases of allergic rhinitis are the main allergen to the genus quinoa. The major allergens reported in Xinjiang for Artemisia are differential.2.) allergic rhinitis should be diagnosed or excluded from the inflammation of the lower airway as early as possible. After the diagnosis, the treatment plans are carried out according to different types, and the effective combined treatment is necessary when necessary. The correct and standardized diagnosis and treatment process can reduce the clinical misdiagnosis and mismanagement rate, avoid delay or delay. Over treatment, correct diagnosis and treatment of allergic rhinitis can effectively control the use of local hormone dosage.3) according to the Kazakh population survey data in Fukang City, Xinjiang, the prevalence rate of allergic rhinitis is high, and its characteristics are closely related to the health factors related to life.
【学位授予单位】：新疆医科大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R765.21

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