内蒙古草原环境下鼻炎患者气传变应原的调查研究

发布时间：2018-08-22 18:37

【摘要】：目的：探讨内蒙古草原环境下鼻炎患者气传变应原的致敏状况，评价居室内尘螨暴露与致敏的相关性，比较患者个人特征（年龄、性别、民族）对变应性鼻炎（allergic rhinitis, AR）与非变应性鼻炎（non-allergic rhinitis, NAR）发病的影响，并探讨变应原体内、外检测方法的临床诊断价值，为草原地区鼻炎诊断和防治策略的制定提供参考依据。方法：在内蒙古自治区锡林浩特市集中招募具有鼻炎临床表现的患者314例，所有患者接受详细的病史询问、前鼻镜检查、问卷调查、变应原皮肤点刺试验（skin prick test, SPT）以及血清特异性IgE（specific IgE, sIgE）、总IgE（totalIgE, tIgE）和嗜酸粒细胞阳离子蛋白（eosinophil cationic protein, ECP）检测。采集部分患者卧室床垫尘埃，用ELISA法检测尘埃中屋尘螨（Dermatophagoidespteronyssinus, Der p）和粉尘螨（Dermatophagoides farinae, Der f）主要变应原Der p1和Der f1浓度。以SPSS17.0软件进行统计学分析。结果：①314例鼻炎患者的年龄为5~70岁，平均年龄（30.14±14.18）岁。男125例（39.8%），女189例（60.2%）。汉族195例（62.1%），少数民族119例（37.9%）。②11种气传变应原SPT阳性率依次为艾蒿52.2%、豚草31.2%、梯牧草26.4%、桦树24.2%、粉尘螨21.9%、热带无爪螨17.5%、狗毛12.7%、猫毛11.8%、德国小蠊9.2%、链格孢霉8.3%、屋尘螨5.7%。血清sIgE阳性率依次为艾蒿47.1%、豚草34.7%、桦树21.3%、梯牧草19.7%、屋尘螨9.2%、猫毛8.0%、粉尘螨7.6%、德国小蠊7.3%、狗毛6.7%、热带无爪螨6.4%、链格孢霉4.5%。③对276例鼻炎患者居室中的床尘进行检测，结果显示：Der p1阳性2例（0.7%），Der f1阳性4例（1.4%）；每克床尘中Der p1和Der f1的最大检测含量分别为162ng和532ng。经Spearman等级相关分析（α=0.01）显示，屋尘螨的暴露水平与SPT阳性结果呈正相关（rs=0.156，P=0.010），而与sIgE的阳性结果无明显相关性（rs=0.116，P=0.055）；粉尘螨的暴露水平与SPT（rs=0.05，P=0.931）及sIgE（rs=0.070，P=0.240）阳性结果均无相关性。④患者变应原SPT、血清sIgE、tIgE和ECP阳性率均为男性高于女性（P＜0.05），并随年龄的增加阳性率呈线性下降趋势（P=0.000），但阳性率的民族差异无统计学意义（P＞0.05）。⑤314例鼻炎患者中，207例（65.9%）诊断为AR，男92例（44.4%）、女115例（55.6%）；107例（34.1%）诊断为NAR，男33例（30.8%）、女74例（69.2%）。AR患者男性高发年龄为10~19岁，女性高发年龄则为30~39岁。NAR患者女性高发年龄为30~49岁，，男性患者无明显的高发年龄。⑥11种气传变应原的体内（SPT）和体外（sIgE）检测结果均有一致性，其中艾蒿的一致性强度最高，猫毛次之，而粉尘螨、屋尘螨、热带无爪螨的一致性强度较低。所有变应原的血清sIgE检测显示出较好的特异度和阴性预测值（均＞80%）。结论：在内蒙古锡林浩特草原环境下，65.9%的鼻炎患者发病可能与变态反应有关，艾蒿花粉是最重要的气传变应原。在此特殊环境下，屋尘螨和粉尘螨的暴露水平极低，而且尘螨暴露与致敏之间也非简单的剂量-反应关系。变应原SPT、血清sIgE、tIgE和ECP阳性率随患者年龄的增加呈线性下降趋势，其阳性率均为男性高于女性，但不受民族影响。在鼻炎患者中，男性较女性易患AR，男性高发年龄为10~19岁；女性在NAR的发病中多见，高发年龄为30~49岁。临床诊断方面，艾蒿花粉和猫毛变应原的体内、外检测方法可任选一种，推荐优先选择SPT；但对于其他种类的气传变应原则建议两种检测方法联合使用，以提高诊断准确性。
[Abstract]:Objective: To investigate the sensitization status of airborne allergens in patients with rhinitis in grassland environment of Inner Mongolia, to evaluate the correlation between indoor dust mite exposure and sensitization, and to compare the effects of individual characteristics (age, sex, nationality) on the pathogenesis of allergic rhinitis (AR) and non-allergic rhinitis (NAR), and to explore the relationship between indoor dust mite exposure and sensitization. The clinical diagnostic value of in vivo and in vitro detection methods will provide reference for the diagnosis and prevention of rhinitis in grassland areas.
Methods: A total of 314 patients with rhinitis were recruited in Xilinhot city of Inner Mongolia Autonomous Region. All patients received detailed medical history, nose examination, questionnaire survey, skin prick test (SPT), serum specific IgE (sIgE), total IgE (IgE, tIgE) and eosinophil fineness. The concentrations of Dermatophagoides pteronyssinus (Der p) and Dermatophagoides farinae (Der f) major allergens Derp1 and Der F1 in bedroom mattress dust of some patients were detected by ELISA.
Results: The age of 314 patients with rhinitis ranged from 5 to 70 years old, with an average age of (30.14 65507 The positive rates of sIgE in serum were Artemisia argyi 47.1%, ragweed 34.7%, birch 21.3%, terracotta 19.7%, house dust mite 9.2%, cat hair 8.0%, dust mite 7.6%, Blattella germanica 7.3%, dog hair 6.7%, Tropical claw mite 6.4% and trematode mite 4.5%. The results showed that Der P1 was positive in 2 cases (0.7%) and Der F1 was positive in 4 cases (1.4%). The maximum detectable contents of Der P1 and Der F1 were 162ng and 532ng respectively in each gram of bed dust. Spearman grade correlation analysis (a=0.01) showed that the exposure level of house dust mites was positively correlated with the positive results of SPT (rs=0.156, P=0.010), but not significantly correlated with the positive results of sIgE. (rs = 0.116, P = 0.055); there was no correlation between the level of Dermatophagoides farinae exposure and the positive results of SPT (rs = 0.05, P = 0.931) and sIgE (rs = 0.070, P = 0.240). Among 314 rhinitis patients, 207 (65.9%) were diagnosed as AR, 92 (44.4%) were male, 115 (55.6%) were female, and 107 (34.1%) were diagnosed as NAR, 33 (30.8%) were male and 74 (69.2%) were female. _The results of in vivo (SPT) and in vitro (sIgE) tests of 11 kinds of airborne allergens were consistent. Artemisia argyi had the highest consistency intensity, followed by cat hair, while dust mites, house dust mites and tropical acaroid mites had lower consistency intensity. > 80%).
Conclusion: 65.9% of the patients with rhinitis in Xilinhot grassland of Inner Mongolia may be related to allergic reaction. Artemisia argyi pollen is the most important airborne allergen. In this special environment, the exposure level of house dust mite and dust mite is very low, and there is not a simple dose-response relationship between dust mite exposure and sensitization. The positive rates of IgE, tIgE and ECP were all higher in males than in females, but not affected by ethnicity. In vitro and in vivo detection of allergens is optional and SPT is recommended as the preferred method, but for other types of airborne allergy, two methods should be combined to improve the diagnostic accuracy.
【学位授予单位】：南京医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R765.21

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