特應(yīng)性斑貼試驗(yàn)在兒童變態(tài)反應(yīng)性疾病中查找過敏原的應(yīng)用
發(fā)布時(shí)間：2019-06-24 23:12
【摘要】：變態(tài)反應(yīng)性皮膚病是由過敏原通過變態(tài)反應(yīng)機(jī)制引發(fā)的皮膚病,其發(fā)生率相當(dāng)高,占各類皮膚病的50%左右。此組疾病如特應(yīng)性皮炎、蕁麻疹等往往找不到明確的過敏原,臨床癥狀遷延不愈,反復(fù)發(fā)作,給病人帶來(lái)了極大的痛苦,給臨床預(yù)防和治療造成極大困難。 目前,過敏原測(cè)定的方法總體上可以分為兩種,即體內(nèi)試驗(yàn)和體外試驗(yàn)。目前在我國(guó)臨床上應(yīng)用較為廣泛的是血清特異性IgE抗體測(cè)定(sIgE),該方法是一種體外試驗(yàn),但是只有IgE介導(dǎo)的過敏反應(yīng)本試驗(yàn)才適用,而另外3種類型的變態(tài)反應(yīng)所致的過敏性疾病及IgG介導(dǎo)的變態(tài)反機(jī)制為陰性。此外,以下情況亦可出現(xiàn)假陰性結(jié)果:1)如果患者處于過敏性疾病高峰期或者較重的過敏反應(yīng)發(fā)生后,體內(nèi)IgE耗竭。2)變應(yīng)原IgE已經(jīng)結(jié)合于細(xì)胞受體。3)患者體內(nèi)存在IgE自身抗體。另外,部分有過敏癥狀的患者并不是由變態(tài)反應(yīng)引起的。因此,臨床上需要更為安全、可靠、易于操作、痛苦性小、易于被患兒家屬接受的過敏原檢測(cè)方法。 特應(yīng)性斑貼試驗(yàn)(APT)是一種體內(nèi)試驗(yàn),該試驗(yàn)使用可以激發(fā)IgE介導(dǎo)的速發(fā)型變態(tài)反應(yīng)的變應(yīng)原,如食入性變應(yīng)原、吸入性變應(yīng)原,在受試者用斑貼試驗(yàn)的方法引起濕疹樣皮膚反應(yīng),評(píng)價(jià)變應(yīng)原與濕疹的關(guān)系。特應(yīng)性斑貼試驗(yàn)不僅可以檢測(cè)IgE介導(dǎo)的變態(tài)反應(yīng)性疾病,還可以檢測(cè)非IgE介導(dǎo)的變態(tài)反應(yīng)性疾病。目前,國(guó)外已經(jīng)有人應(yīng)用特應(yīng)性斑貼試驗(yàn)(APT)查找特應(yīng)性皮炎患兒的過敏原,國(guó)內(nèi)尚未見應(yīng)用特應(yīng)性斑貼試驗(yàn)(APT)診斷變態(tài)反應(yīng)性疾病過敏原的報(bào)道。 特應(yīng)性斑貼試驗(yàn)(APT)可以查找變態(tài)反應(yīng)性疾病的過敏原,為變態(tài)反應(yīng)性疾病尋找更為安全有效的預(yù)防和治療措施。該試驗(yàn)是一種安全、可靠、易于操作、痛苦性小、易于被患兒家屬接受的過敏原檢測(cè)方法。 我們共收集根據(jù)臨床癥狀診斷為特應(yīng)性皮炎、慢性蕁麻疹患兒共45例,均為2009年12月至2010年12月到吉林大學(xué)第二臨床醫(yī)學(xué)院門診就診的我市患兒,年齡在5個(gè)月到14歲之間。45例患兒同時(shí)進(jìn)行特應(yīng)性斑貼試驗(yàn)及測(cè)定血清特異性IgE。根據(jù)特應(yīng)性斑貼試驗(yàn)(APT)的反應(yīng)程度,分別統(tǒng)計(jì)每種變應(yīng)原的陽(yáng)性率;根據(jù)疾病種類,分為慢性蕁麻疹組和特應(yīng)性皮炎組;根據(jù)實(shí)驗(yàn)種類,分為特應(yīng)性斑貼試驗(yàn)(APT)和血清特異性免疫球蛋白(sIgE)組;根據(jù)實(shí)驗(yàn)結(jié)果,分為特應(yīng)性斑貼試驗(yàn)(APT)(+)血清特異性免疫球蛋白(sIgE)(-)組和特應(yīng)性斑貼試驗(yàn)(APT)(-)血清特異性免疫球蛋白(sIgE)(+)組。采用卡方檢驗(yàn)進(jìn)行統(tǒng)計(jì)學(xué)分析。得出以下結(jié)果及結(jié)論:1)、在45例患兒中,斑貼陽(yáng)性者36例,陽(yáng)性率為80%,其中陽(yáng)性率較高的抗原吸入組為榆樹(69.44%),食入組陽(yáng)性率較高的為海蝦(69.44%)、海魚(66.67%)、雞蛋(61.11%)。sIgE的陽(yáng)性率為35/45(78%),牛奶的陽(yáng)性率較高(29%)。進(jìn)一步證明變態(tài)反應(yīng)性疾病病因復(fù)雜,吸入、食入過敏原都可以引起過敏。2)在本組試驗(yàn)中,特應(yīng)性皮炎組較慢性蕁麻疹組斑貼陽(yáng)性率高的變應(yīng)原是海蝦、海魚、小麥、肉牛、榆樹、多價(jià)羽毛。慢性蕁麻疹組較特應(yīng)性皮炎組斑貼陽(yáng)性率較高的變應(yīng)原是雞蛋、牛奶、香煙。3)在本組試驗(yàn)中,兩種方法對(duì)魚蝦、牛肉、榆樹具有良好的一致性,P0.05,無(wú)統(tǒng)計(jì)學(xué)差異。兩種方法檢測(cè)牛奶、小麥,APT陽(yáng)性率更高,P0.05,兩者有統(tǒng)計(jì)學(xué)差異。表明特應(yīng)性斑貼試驗(yàn)(APT)相對(duì)于血清特異性IgE(-),在患兒牛奶、小麥時(shí)較為敏感。4)特應(yīng)性斑貼試驗(yàn)(APT)(+)特異性IgE(-)組的陽(yáng)性率高于特應(yīng)性斑貼試驗(yàn)(APT)(-)特異性IgE(+)組,表明特應(yīng)性斑貼試驗(yàn)(APT)相對(duì)于血清特異性IgE(-),在診斷特應(yīng)性皮炎和慢性蕁麻疹患兒過敏原時(shí)更為敏感。5)45例患兒在特應(yīng)性斑貼試驗(yàn)(APT)中,對(duì)1種物質(zhì)過敏1例(1/45),2種物質(zhì)過敏3例(3/45),3種物質(zhì)過敏4例(4/45),4種及4種以上物質(zhì)過敏28例(28/45);在45例患兒中,sIgE的陽(yáng)性率為35/45(78%),其中對(duì)1種物質(zhì)過敏2例(2/45),2種物質(zhì)過敏3例(3/45),3種物質(zhì)過敏4例(5/45),4種及4種以上物質(zhì)過敏29例(29/45)。表明過敏性皮膚病患者在高敏狀態(tài)時(shí),可同時(shí)對(duì)多種過敏原產(chǎn)生過敏。6)、兩種方法結(jié)果具有良好的一致性,在診斷上有相互補(bǔ)充作用。特應(yīng)性斑貼試驗(yàn)(APT)相對(duì)于血清特異性IgE(sIgE)在診斷慢性蕁麻疹和特應(yīng)性皮炎時(shí)更為敏感,臨床上可以兩者結(jié)合并參考病史,為變態(tài)反應(yīng)性疾病篩查變態(tài)反應(yīng)原。 通過統(tǒng)計(jì)分析,本文認(rèn)為特應(yīng)性斑貼試驗(yàn)(APT)較血清特異性免疫球蛋白(sIgE)試驗(yàn)更敏感,而且兩者具有良好的一致性,在診斷上有相互補(bǔ)充作用。因此臨床上可以兩種聯(lián)合應(yīng)用或者單獨(dú)應(yīng)用特應(yīng)性斑貼試驗(yàn)(APT),作為變態(tài)反應(yīng)性疾病尋找過敏原的一個(gè)方法。
[Abstract]:Allergic skin diseases are skin diseases caused by the allergen through the allergic mechanism, and the incidence rate is quite high, accounting for about 50% of all kinds of skin diseases. This group of diseases, such as atopic dermatitis, urticaria, and the like, often fails to find a definite allergen, and the clinical symptoms are delayed and repeated, which brings great pain to the patients, and has great difficulty for clinical prevention and treatment. At present, the method for determination of the allergen can be divided into two types, namely in-vivo test and in vitro In our country, the serum-specific IgE antibody assay (sIgE) is widely used in our country. The method is an in vitro test, but only the IgE-mediated allergic reaction is the only test. The other three types of allergy-induced allergic diseases and IgG-mediated metamorphosis are applicable. negative. False negative results can also occur in the following cases:1) If the patient is in the peak of an allergic disease or a severe allergic reaction occurs, the IgE in the body is depleted.2) Allergen IgE has been bound to the cell receptor.3) IgE itself is present in the patient The antibody. In addition, some of the patients with an allergic symptom are not induced by an allergic reaction. As a result, it is clinically necessary to be more safe, reliable, easy to operate, less painful and easy to be detected by the child's family Methods. The teatopy patch test (APT) is an in vivo test that uses an allergen that can stimulate IgE-mediated rapid-type allergy, such as a food-in allergen, an inhalation allergen, an eczema that causes a patch test in a subject, a skin-like reaction to evaluate the allergen and The relationship of atopic patch test not only can detect the IgE-mediated allergic disease, but also can detect the non-IgE-mediated metamorphosis. Response diseases. At present, there have been an application of the atopic patch test (APT) in foreign countries for the search for allergens in children with atopic dermatitis, which has not been shown in the country for the diagnosis of allergic diseases by the use of the atopic patch test (APT). The AAPT can find the allergen of an allergic disease and find a more safe and effective way to find an allergic disease. The test is safe, reliable, easy to operate, small in pain and easy to be accepted by the family of the child A total of 45 patients with atopic dermatitis and chronic urticaria were collected from December 2009 to December 2010, and the second clinical medicine of Jilin University was collected from December 2009 to December 2010. The age of the children in the city of the college is between 5 and 14 years. And determining the specific IgE of the serum. According to the degree of the reaction of the atopy patch test (APT), the positive rate of each allergen is respectively counted; according to the type of the disease, the positive rate of each allergen is divided into a chronic urticaria group and an atopic dermatitis group; and according to the experimental type, the serum-specific IgE is divided into a teatopy patch test (APT) and a serum-specific immunity-free group. The serum-specific immune globulin (sIgE) group and the serum-specific immunoglobulin (APT) (-) serum-specific immune globulin test (APT) (-) were classified according to the experimental results. White (sIgE) (+) group. Use The results and conclusions were as follows:1) The positive rate was 80% in the 45 cases, and the positive rate of the positive rate was elm (69.44%), and the positive rate of the positive rate was sea shrimp (69.44%). The positive rate of sIgE was 35/45 (78%) and milk was 35/45 (78%). The positive rate of allergic disease is high (29%). It is further proved that the cause of allergic diseases is complicated, the inhalation and the ingestion of the allergen can cause the allergy.2) In this group, the allergen with high positive rate in the atopic dermatitis group with chronic urticaria is sea shrimp, sea fish and wheat. The allergen with high positive rate in chronic urticaria and atopic dermatitis is egg, milk and cigarette. In this group, the two methods have good consistency with fish and shrimp, beef and elm. 0.05. There was no statistical difference. The positive rate of milk, wheat and APT was higher in two methods, and P0. There was a statistical difference between the two groups. It was indicated that the specific IgE (-) was more sensitive to the serum-specific IgE (-) in the children.4) The positive rate of the specific IgE (-) group was higher than that of the T (-) group (-) (-) (-). ) The specific IgE (+) group, which indicates that the atopic patch test (APT) is more sensitive to serum specific IgE (-), is more sensitive in the diagnosis of atopic dermatitis and in children with chronic urticaria.5)45 children with atopic dermatitis There were 1 case (1/45),3 cases (3/45),4 (4/45),4 (4) and more than 4 (28/45), and the positive rate of sIgE in 45 children. 35/45 (78%), of which 2 (2/45),3 (3/45),4 (5/45),4 and 4 or more were allergic to one substance. In 29 cases (29/45), it is indicated that in the case of allergic dermatoses in the hypersensitive state, it is possible to have an allergic reaction to a variety of allergens at the same time.6) The results of the two methods have good consistency. It is more sensitive to the diagnosis of chronic urticaria and atopic dermatitis compared with serum-specific IgE (sIgE) in the diagnosis of chronic urticaria and atopic dermatitis. By statistical analysis, this paper is considered to be more sensitive to the test of serum-specific immunoglobulin (sIgE) than the serum-specific immunoglobulin (sIgE) test, and both have a good one. There is a complementary effect on the diagnosis. Therefore, it can be used in two kinds of joint applications or the application of the homography test (APT) alone as a pervert.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類號(hào)】：R758.23
本文編號(hào)：2505446
[Abstract]:Allergic skin diseases are skin diseases caused by the allergen through the allergic mechanism, and the incidence rate is quite high, accounting for about 50% of all kinds of skin diseases. This group of diseases, such as atopic dermatitis, urticaria, and the like, often fails to find a definite allergen, and the clinical symptoms are delayed and repeated, which brings great pain to the patients, and has great difficulty for clinical prevention and treatment. At present, the method for determination of the allergen can be divided into two types, namely in-vivo test and in vitro In our country, the serum-specific IgE antibody assay (sIgE) is widely used in our country. The method is an in vitro test, but only the IgE-mediated allergic reaction is the only test. The other three types of allergy-induced allergic diseases and IgG-mediated metamorphosis are applicable. negative. False negative results can also occur in the following cases:1) If the patient is in the peak of an allergic disease or a severe allergic reaction occurs, the IgE in the body is depleted.2) Allergen IgE has been bound to the cell receptor.3) IgE itself is present in the patient The antibody. In addition, some of the patients with an allergic symptom are not induced by an allergic reaction. As a result, it is clinically necessary to be more safe, reliable, easy to operate, less painful and easy to be detected by the child's family Methods. The teatopy patch test (APT) is an in vivo test that uses an allergen that can stimulate IgE-mediated rapid-type allergy, such as a food-in allergen, an inhalation allergen, an eczema that causes a patch test in a subject, a skin-like reaction to evaluate the allergen and The relationship of atopic patch test not only can detect the IgE-mediated allergic disease, but also can detect the non-IgE-mediated metamorphosis. Response diseases. At present, there have been an application of the atopic patch test (APT) in foreign countries for the search for allergens in children with atopic dermatitis, which has not been shown in the country for the diagnosis of allergic diseases by the use of the atopic patch test (APT). The AAPT can find the allergen of an allergic disease and find a more safe and effective way to find an allergic disease. The test is safe, reliable, easy to operate, small in pain and easy to be accepted by the family of the child A total of 45 patients with atopic dermatitis and chronic urticaria were collected from December 2009 to December 2010, and the second clinical medicine of Jilin University was collected from December 2009 to December 2010. The age of the children in the city of the college is between 5 and 14 years. And determining the specific IgE of the serum. According to the degree of the reaction of the atopy patch test (APT), the positive rate of each allergen is respectively counted; according to the type of the disease, the positive rate of each allergen is divided into a chronic urticaria group and an atopic dermatitis group; and according to the experimental type, the serum-specific IgE is divided into a teatopy patch test (APT) and a serum-specific immunity-free group. The serum-specific immune globulin (sIgE) group and the serum-specific immunoglobulin (APT) (-) serum-specific immune globulin test (APT) (-) were classified according to the experimental results. White (sIgE) (+) group. Use The results and conclusions were as follows:1) The positive rate was 80% in the 45 cases, and the positive rate of the positive rate was elm (69.44%), and the positive rate of the positive rate was sea shrimp (69.44%). The positive rate of sIgE was 35/45 (78%) and milk was 35/45 (78%). The positive rate of allergic disease is high (29%). It is further proved that the cause of allergic diseases is complicated, the inhalation and the ingestion of the allergen can cause the allergy.2) In this group, the allergen with high positive rate in the atopic dermatitis group with chronic urticaria is sea shrimp, sea fish and wheat. The allergen with high positive rate in chronic urticaria and atopic dermatitis is egg, milk and cigarette. In this group, the two methods have good consistency with fish and shrimp, beef and elm. 0.05. There was no statistical difference. The positive rate of milk, wheat and APT was higher in two methods, and P0. There was a statistical difference between the two groups. It was indicated that the specific IgE (-) was more sensitive to the serum-specific IgE (-) in the children.4) The positive rate of the specific IgE (-) group was higher than that of the T (-) group (-) (-) (-). ) The specific IgE (+) group, which indicates that the atopic patch test (APT) is more sensitive to serum specific IgE (-), is more sensitive in the diagnosis of atopic dermatitis and in children with chronic urticaria.5)45 children with atopic dermatitis There were 1 case (1/45),3 cases (3/45),4 (4/45),4 (4) and more than 4 (28/45), and the positive rate of sIgE in 45 children. 35/45 (78%), of which 2 (2/45),3 (3/45),4 (5/45),4 and 4 or more were allergic to one substance. In 29 cases (29/45), it is indicated that in the case of allergic dermatoses in the hypersensitive state, it is possible to have an allergic reaction to a variety of allergens at the same time.6) The results of the two methods have good consistency. It is more sensitive to the diagnosis of chronic urticaria and atopic dermatitis compared with serum-specific IgE (sIgE) in the diagnosis of chronic urticaria and atopic dermatitis. By statistical analysis, this paper is considered to be more sensitive to the test of serum-specific immunoglobulin (sIgE) than the serum-specific immunoglobulin (sIgE) test, and both have a good one. There is a complementary effect on the diagnosis. Therefore, it can be used in two kinds of joint applications or the application of the homography test (APT) alone as a pervert.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類號(hào)】：R758.23
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