大连地区变应性鼻炎变应原调查和78例特异性免疫治疗效果分析

发布时间：2018-04-13 04:07

本文选题：变应性鼻炎 + 皮肤点刺试验　；参考：《大连医科大学》2011年硕士论文

【摘要】：目的:了解大连地区变应性鼻炎患者皮肤点刺试验(SPT)阳性率、变应原分布特点,为变应性鼻炎的防治提供可靠的依据;并对我院78例变应性鼻炎患者接受标准化尘螨变应原疫苗特异性免疫治疗后的疗效及安全性进行评价。方法:对2009年3月-2011年3月于大连医科大学附属第一医院耳鼻咽喉头颈外科门诊拟诊为变应性鼻炎的1035例患者进行回顾性分析,对这些患者采用13组标准化变应原(Alutard? SQ)进行SPT,并按照2004年兰州会议中变应性鼻炎的诊断标准选择患者,采用自身对照的方法,将78例尘螨引起的变应性鼻炎患者他们治疗前的症状、体征评分及VAS评分分别与接受1年、2年特异性免疫治疗后的症状、体征评分及VAS评分相比较,并采取秩和等检验方法进行统计学分析。结果:1035例变应性鼻炎患者中有802例对变应原中至少一组呈阳性反应(77.5%)。粉尘螨、屋尘螨及热带螨阳性率分别为63.7%、61.2%和39.6%,其它变应原阳性率依次是艾蒿(24.2%)、狗毛(22.9%)、美洲大蠊(14.7%)、德国小蠊(10.9%)、豚草(9.7%)、猫毛(7.8%)、霉菌I组(7.3%)、花粉I组(3.6%)、花粉Ⅱ组(3.1%)和霉菌Ⅱ组(2.1%)。男性和女性SPT阳性率分别为77.8%(375/482)和77.2%(427/553),男女之间比较差异无统计学意义(P0.05)。少年儿童组、青年组及中老年组SPT阳性率分别为91.6%、76.7%及62.6%,SPT的总阳性率随着年龄的增长呈下降趋势,3组间两两比较差异有统计学意义(P0.05)。大连地区变应性鼻炎患者中并发哮喘者10.2%。78例接受特异性免疫治疗的患者治疗前症状、体征评分男女之间比较差异无统计学意义(P0.05),经特异性免疫治疗1年患者的症状、体征评分及VAS评分较治疗前均显著降低,有统计学差异(P0.05);坚持完成2年治疗后患者的症状、体征评分及VAS评分较治疗前、治疗1年时亦有明显减少,三者之间有显著性差异(P0.05)。合并哮喘12例,经特异性免疫治疗后,鼻部症状与哮喘症状均有不同程度缓解或好转,其疗效与单纯AR患者之间的差异无明显统计学意义(P0.05)。78例患者中40例出现局部过敏反应,1例全身过敏反应,未出现致命性不良反应。结论:大连地区变应性鼻炎患者皮肤点刺试验阳性率较高,且随年龄的增长而下降。男女之间皮肤点刺试验阳性率无明显差异。尘螨是大连地区变应性鼻炎的首要的吸入性变应原,为本地区变应性鼻炎的防治提供了流行病学资料和临床防治依据。大连地区变应性鼻炎患者合并哮喘者比我国普通人群哮喘发病率明显增高。应用标准化尘螨变应原疫苗治疗尘螨引起的变应性鼻炎是一种比较安全、有效的方法,为提高疗效,建议完成足够的疗程。
[Abstract]:Objective: to investigate the positive rate of skin prick test (SPT) and the distribution of allergens in patients with allergic rhinitis in Dalian area, and to provide a reliable basis for the prevention and treatment of allergic rhinitis.The efficacy and safety of 78 patients with allergic rhinitis treated with standard dust mite allergen vaccine were evaluated.Methods: from March 2009 to March 2011, 1035 patients with allergic rhinitis in the Department of Otorhinolaryngology and neck surgery, first affiliated Hospital of Dalian Medical University, were retrospectively analyzed. 13 groups of patients were treated with standardized allergen Alutard?The patients were selected according to the diagnostic criteria of allergic rhinitis in Lanzhou in 2004. 78 patients with allergic rhinitis caused by dust mite were treated with self-control method.The scores of physical signs and VAS were compared with the scores of symptoms, signs and VAS after 1 year and 2 years of specific immunotherapy, and the results were analyzed statistically by rank sum test.Results 802 out of 1035 cases of allergic rhinitis showed positive reaction to at least one group of allergens (77.5%).The positive rates of SPT in male and female were 77.8% and 77.2%, respectively. There was no significant difference between male and female (P 0.05).The positive rates of SPT in children, youth and middle and old age groups were 91.6% and 62.6%, respectively. The total positive rate of SPT showed a decreasing trend with the increase of age. There were significant differences among the three groups (P 0.05).Among the patients with allergic rhinitis in Dalian area, 10.2.78 patients with asthma received specific immunotherapy before treatment. There was no significant difference in the scores of signs between men and women (P 0.05). The symptoms of patients treated with specific immunotherapy for one year were not significantly different.The scores of physical signs and VAS were significantly lower than those before treatment (P 0.05), and the scores of symptoms, signs and VAS of the patients after 2 years of treatment were significantly lower than those before treatment, and there was a significant difference among the three groups (P 0.05).After specific immunotherapy, nasal symptoms and asthma symptoms were relieved or improved in different degrees.There was no significant difference between the curative effect and the simple AR patients. There was no significant difference between 40 cases of local allergic reaction and 1 case of systemic anaphylaxis, but no fatal side effects.Conclusion: the positive rate of skin prick test in patients with allergic rhinitis in Dalian area was higher and decreased with age.There was no significant difference in the positive rate of skin prick test between male and female.Dust mite is the primary inhalant allergen of allergic rhinitis in Dalian area, which provides epidemiological data and clinical basis for the prevention and treatment of allergic rhinitis in this area.The incidence of asthma in patients with allergic rhinitis in Dalian was significantly higher than that in the general population.The application of standardized dust mite allergen vaccine in the treatment of allergic rhinitis caused by dust mite is a safe and effective method.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R765.21

【引证文献】