發(fā)布時間：2018-02-27 21:29

  本文關(guān)鍵詞： 支氣管哮喘 過敏因素 過敏原 空氣污染 脫敏治療　出處：《山西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:通過血清過敏原的檢測分析哮喘患者過敏原與年齡、性別、體重指數(shù)(Body Mass Index,BMI)、過敏性疾病家族史、肺功能、空氣污染的關(guān)系,探討太原及周邊地區(qū)支氣管哮喘患者過敏因素的特點,更好地將針對過敏原的特異性免疫治療應(yīng)用于臨床,提高患者的生活質(zhì)量。方法:采用免疫印跡方法對2014年11月至2016年10月期間于山西醫(yī)科大學(xué)第一醫(yī)院呼吸科門診確診為急性發(fā)作期輕至中度的哮喘患者213例進(jìn)行血清過敏原(包括食入性和吸入性過敏原)檢測,根據(jù)其結(jié)果分為過敏原陽性組與過敏原陰性組,同時收集兩組哮喘患者的一般資料以及肺功能指標(biāo):FEV1%Pre、FEV1/FVC%、PD20、PEF等,分析比較過敏原與年齡、性別、BMI、過敏性疾病家族史、肺功能以及空氣污染1-3天內(nèi)使用峰流速儀測得的平均PEF值的關(guān)系。在過敏原陽性組中選取60例存在塵螨過敏原的哮喘患者,隨機(jī)分為給予常規(guī)治療的對照組和給予常規(guī)治療加用針對過敏因素治療(包括避免接觸、脫敏治療)的觀察組,在觀察組中脫敏治療應(yīng)開始于常規(guī)治療1月哮喘控制之后,然后6個月后評價支氣管哮喘常規(guī)治療以及加用針對過敏因素治療后的臨床療效。結(jié)果:1.支氣管哮喘患者過敏因素的特點確診為支氣管哮喘患者的血清特異性IgE抗體和總IgE抗體結(jié)果顯示:過敏原為陽性的總共158例,陽性率74.2%,單一過敏原陽性的患者陽性率為76例(48.1%),2種及以上過敏原陽性的患者陽性率為82例(51.9%);有總IgE100IU/mL的患者8例(5.1%),100—200iu/ml的患者27例(17.1%),200iu/ml的患者123例(77.8%);吸入性過敏原的陽性率(65.8%)高于食入性sige(9.5%)。2.哮喘患者的過敏原陽性率與患者一般條件的關(guān)系1)哮喘患者過敏原陽性組的年齡、bmi與過敏原陰性組無明顯差異(t=1.609,p=0.109;t=0.915,p=0.361);2)不同年齡段(青年、中年、老年)哮喘患者的過敏原陽性率無差異(變應(yīng)原陽性率分別為71.0%,78.0%,94.1%,x2=4.683,p=0.096);3)男性患者過敏原陽性率為72.4%,女性患者過敏原陽性率為75.4%,女性患者的過敏原陽性率高于男性患者,兩組間差異無統(tǒng)計學(xué)意義(x2=0.239,p=0.636);4)哮喘患者過敏原陽性與過敏性疾病家族史有關(guān)(x2=92.031,p0.05)。3.哮喘患者過敏原陽性率與肺功能指標(biāo)的關(guān)系哮喘患者過敏原陽性組哮喘患者的pd20、fev1%pre、fev1/fvc%均低于過敏原陰性組,兩組結(jié)果相比,差異有統(tǒng)計學(xué)意義(t=-8.503,p0.05;t=-2.384,p=0.019;t=-2.932,p=0.004)。4.空氣污染對哮喘患者的影響過敏原陽性組在經(jīng)歷中至重度空氣污染1-3天內(nèi)使用峰流速儀的平均pef為(196.95±46.89)l/min,過敏原陰性組在相同空氣污染期間的平均pef為(213.98±46.12)l/min,過敏原陽性組的平均pef明顯低于過敏原陰性組的平均pef,兩者間差異有統(tǒng)計學(xué)意義(t=-2.349,p=0.021)。5.針對過敏因素治療的療效觀察分析6個月后接受過敏因素治療的患者與只接受常規(guī)治療患者的客觀pef與主觀act的結(jié)果:觀察組的act評分結(jié)果升高值(3.30±1.97)顯著大于對照組(2.10±1.35),兩組間差異有統(tǒng)計學(xué)意義(t=2.755,p0.05);觀察組的pef(86.0±5.8)l/min明顯高于對照組(80.6±5.4)l/min,兩組間差異有統(tǒng)計學(xué)意義(t=3.727,p0.05)。結(jié)論:1.塵螨、蒿草、矮豚草是太原及周邊地區(qū)引起哮喘的常見過敏原;2.哮喘患者過敏原陽性可能與過敏性疾病家族史及肺功能有關(guān),而與性別、年齡、BMI無關(guān);3.空氣污染可能對過敏原陽性的患者影響更大;4.針對過敏因素采取避免接觸及脫敏治療后,可以更好地改善肺功能、減少急性發(fā)作,從而提高患者的生活質(zhì)量,降低社會和家庭的經(jīng)濟(jì)負(fù)擔(dān)。
[Abstract]:Objective: through the analysis of serum allergen detection in patients with asthma allergens with age, sex, body mass index (Body Mass, Index, BMI), family history of allergic diseases, pulmonary function, the relationship of air pollution in Taiyuan and surrounding areas, to explore the characteristics of patients with bronchial asthma allergic factors, will be better for specific immunotherapy the allergens in the clinic, improve the quality of life of patients. Methods: using Western blot methods during November 2014 to October 2016 in the first hospital of Shanxi Medical University, Department of respiration clinic diagnosed as acute exacerbation of mild to moderate asthma patients with 213 cases of serum allergen (including food and inhalant allergens) according to the detection, the result is divided into allergen positive group and negative group allergens, while collecting two groups of asthma patients with general information and lung function index: FEV1%Pre, FEV1/FVC%, PD20, PEF, compare analysis Allergens with age, gender, BMI, family history of allergic diseases, the relationship between the average PEF pulmonary function and air pollution within 1-3 days with the peak flow meter measured values. In allergen positive group 60 cases selected are dust mite allergens in patients with asthma, were randomly divided into routine treatment group and the control give for treatment of allergic factors (including routine treatment and avoid contact with the observation group, desensitization therapy) in the observation group after desensitization treatment should begin with the conventional treatment of asthma control in January, then 6 months after the evaluation of conventional treatment of bronchial asthma and allergic factors for clinical efficacy after treatment. Results: the diagnostic characteristics of 1. in patients with bronchial asthma allergic factors for specific IgE antibody in sera of patients with bronchial asthma and total IgE antibody showed that allergen positive for a total of 158 cases, the positive rate was 74.2%, single allergen positive positive patients Rate of 76 cases (48.1%), more than 2 kinds of allergens positive patients with a positive rate of 82 cases (51.9%); a total of 8 patients with IgE100IU/mL (5.1%), 27 cases of patients with 100 - 200iu/ml (17.1%), 123 cases of patients with 200iu/ml (77.8%); inhaled allergens positive rate (65.8%) higher than the ingestion of SiGe (9.5%).2. patients with asthma allergen positive rate in patients with general conditions of 1) of patients with asthma allergen positive group age, BMI had no obvious difference with allergen negative group (t=1.609, p=0.109; t=0.915, p=0.361); 2) in different age groups (young. The middle-aged, elderly) no difference in patients with asthma allergen positive rate (allergens positive rate were 71%, 78%, 94.1%, x2=4.683, p=0.096); 3) male patients with allergen positive rate was 72.4%, female patients with allergen positive rate was 75.4%, female patients with allergen positive rate higher than that of male patients, no statistically significant the difference between the two groups (x2=0.239, P =0.636); 4) on patients with asthma and allergen positive family history of allergic diseases (x2=92.031, P0.05).3. asthma allergen positive rate and lung function index in patients with allergic asthma patients between positive group asthma pd20, fev1%pre, fev1/fvc% were lower than the allergen negative group, compared the results of the two groups was statistically significant. The difference (t=-8.503, P0.05; t=-2.384, p=0.019; t=-2.932, p=0.004).4. effects of air pollution on asthma patients average PEF allergen positive group using the peak flow meter in moderate to severe air pollution within 1-3 days for (196.95 + 46.89) l/min, allergen negative group average PEF during the same as air pollution (213.98 + 46.12) l/min, average PEF allergen positive group was significantly lower than the average PEF allergen negative group, the difference was statistically significant (t=-2.349, p=0.021) efficacy of.5. for treatment of the sensitive factors for 6 months analysis After receiving the treatment of patients with allergic factors only received routine treatment of patients with PEF objective and subjective act results: in the observation group the act score increased value (3.30 + 1.97) was significantly higher than the control group (2.10 + 1.35), the difference was statistically significant between the two groups (t=2.755, P0.05); observation group (PEF 86 + 5.8) l/min was significantly higher than the control group (80.6 + 5.4) l/min, there were statistically significant differences between the two groups (t=3.727, P0.05). Conclusion: the 1. dust mites, wormwood, dwarf ragweed is in Taiyuan and the surrounding areas caused by asthma common allergens in 2. patients with asthma; allergen may be related to family allergic disease history and lung function, and gender, age, independent of BMI; 3. air pollution may be greater for allergen positive patients; 4. for allergic factors taken to avoid contact and desensitization treatment, can better improve lung function and reduce acute episodes, so as to improve the quality of life of patients, Reduce the economic burden of the society and the family.

【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R562.25

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