苏皖地区变应性鼻炎患者吸入性变应原谱分析

doi:10.6040/j.issn.1673-3770.1.2019.036

摘要/Abstract

摘要： 目的

了解苏皖地区变应性鼻炎（AR）患者的吸入性变应原谱，为AR诊治和预防提供思路与方法。

方法

回顾分析自2013年至2017年就诊于南京医科大学第一附属医院的501例鼻炎患者，按年龄分为≤12岁儿童组、13~17岁少年组、18~39岁青年组及≥40岁中老年组，所有患者均来自于江苏省和安徽省。按组别对患者进行基本情况调查，并行10种常见吸入性变应原血清特异性IgE检测。采用SPSS 20.0软件对数据进行统计学分析。

结果

501例鼻炎患者中，血清特异性IgE检测132例（26.35%）为阴性，不纳入进一步分析：369例（73.65%）至少有一项变应原为阳性，确诊为AR患者。所有AR患者中，阳性率前5位的变应原是户尘螨（75.88%）、粉尘螨（73.98%）、屋尘（19.24%）、链格孢霉（11.11%）、猫皮屑（6.78%），其中链格孢霉在儿童组和少年组的阳性率分别为26.79%和28.36%。分析同一患者的变应原谱发现大多数属于多重致敏，3种变应原阳性最多见（60.16%），主要组合为户尘螨+粉尘螨+屋尘，占三重致敏者的91.44%。血清特异性IgE≥3级的主要变应原为粉尘螨（55.56%）、户尘螨（50.95%）、链格孢霉（6.78%）。

结论

户尘螨和粉尘螨是苏皖地区AR患者的主要变应原，链格孢霉是该地区少年儿童AR患者的常见变应原，应引起足够重视。户尘螨、粉尘螨、屋尘三种室内变应原关系密切，可作为一个组合用于AR的筛查诊断。

关键词: 变应性鼻炎, 变应原, 特异性IgE, 尘螨, 真菌

Abstract: Objective

In this study, we aimed to understand the inhaled allergen spectrum of patients with allergic rhinitis (AR) in Jiangsu and Anhui provinces, and provide the basis for clinical diagnosis and the methods for intervention of AR.

Methods

A retrospective analysis of patients with rhinitis admitted to the First Affiliated Hospital of Nanjing Medical University from 2013 to 2017 was conducted. Based on age, the patients were divided into children groups (aged ≤12 years), juvenile group (aged 13~17 years), young group (aged 18~39 years), and quinquagenarian group (aged ≥40 years). All patients were from Jiangsu and Anhui provinces. Demographic and clinical features of the patients were investigated based on their age groups. Overall, 10 types of common inhaled allergens with specific IgE in serum were detected. The SPSS software (version 20) was used for the statistical analysis.

Results

Among 501 patients included in the study, 132 (26.35%) were found to be negative for serum-specific IgE test and 369 (73.65%) were positive for ≥1 allergen(s). Among the patients with AR, the first five allergens to show positivity were dermatophagoides pteronyssinus (75.88%), dermatophagoides farinae (73.98%), house dust (19.24%), alternaria (11.11%), and cat dander (6.78%). The positivity rate of alternaria in children and adolescents was 26.79% and 28.36%, respectively. Analysis of the allergen spectrum of the same patient showed that most of the sensitization was multiple allergens, and the triple allergens showed the highest positivity rate (60.16%). The main combination was dermatophagoides pteronyssinus + dermatophagoides farinae + house dust, accounting for 91.44% of the patients affected with triple allergens. The main allergens with serum specific IgE ≥grade 3 were dermatophagoides farinae (55.56%), dermatophagoides pteronyssinus (50.95%), and alternaria (6.78%).

Conclusion

Dermatophagoides pteronyssinus and dermatophagoides farinae were the main allergens affecting patients with AR in Jiangsu and Anhui areas. Alternaria is a common allergen affecting children and adolescents in this area and requires greater attention. Three indoor allergens, dermatophagoides pteronyssinus, dermatophagoides farinae, and house dust were closely related and can be used as a combination for the screening and diagnosis of AR.

Key words: Allergic rhinitis, Allergens, Specific immunoglobulin E, Dust mites, Fungi

中图分类号:

R765

钱俊俊,周文成,吴中飞,卜冬云,汪李琴,陆美萍,程雷. 苏皖地区变应性鼻炎患者吸入性变应原谱分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(3): 147-151.

Junjun QIAN,Wencheng ZHOU,Zhongfei WU,Dongyun BU,Liqin WANG,Meiping LU,Lei CHENG. Analysis of sensitization to inhalant allergens in patients with allergic rhinitis from Jiangsu and Anhui areas[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(3): 147-151.

图/表 4

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变应原	儿童组（n=56）	青少年组(n=67)	青年组(n=223)	中老年组(n=23)	合计（n=369）
户尘螨	50(89.29)	59(88.06)	151(67.71)	20(86.96)	280(75.88)
粉尘螨	48(85.71)	61(91.04)	154(69.06)	10(43.48)	273(73.98)
屋尘	12(21.43)	15(22.39)	29(13.00)	15(65.22)	71(19.24)
链格孢霉	15(26.79)	19(28.36)	6(2.69)	1(4.35)	41(11.11)
猫皮屑	3(5.36)	5(7.46)	16(7.17)	1(4.35)	25(6.78)
狗皮屑	3(5.36)	3(4.48)	6(2.69)	0	12(3.25)
德国小蠊	1(1.79)	2(2.99)	12(5.38)	1(4.35)	16(4.34)
柳树	1(1.79)	0	1(0.45)	0	2(0.54)
豚草	1(1.79)	3(4.48)	9(4.04)	0	13(3.52)
艾蒿	2(3.57)	3(4.48)	10(4.48)	0	15(4.07)

变应原	儿童组（n=56）	少年组(n=67)	青年组(n=223)	中老年组(n=23)	合计（n=369）
合计	6	4	24	7	41
户尘螨	1	0	0	5	6
粉尘螨	3	0	16	1	20
屋尘	0	0	0	1	1
链格孢霉	2	3	0	0	5
猫皮屑	0	0	2	0	2
狗皮屑	0	0	1	0	1
德国小蠊	0	0	0	0	0
柳树	0	0	1	0	1
豚草	0	1	2	0	3
艾蒿	0	0	2	0	2

变应原	儿童组（n=56）	少年组(n=67)	青年组(n=223)	中老年组(n=23)	合计（n=369）
户尘螨	44(78.57)	50(74.63)	79(35.43)	15(65.22)	188(50.95)
粉尘螨	44(78.57)	53(79.10)	100(44.84)	8(34.78)	205(55.56)
屋尘	0	0	2(0.90)	0	2(0.54)
链格孢霉	8(14.29)	15(22.39)	2(0.90)	0	25(6.78)
猫皮屑	0	1(1.49)	1(0.45)	0	2(0.54)
狗皮屑	1(1.79)	1(1.49)	1(0.45)	0	3(0.81)
德国小蠊	0	1(1.49)	1(0.45)	0	2(0.54)
柳树	0	0	0	0	0
豚草	0	0	2(0.90)	0	2(0.54)
艾蒿	0	0	7(3.14)	0	7(1.90)