本文選題：過(guò)敏性鼻炎　切入點(diǎn)：兒童　出處：《青島大學(xué)》2015年博士論文　論文類型：學(xué)位論文

【摘要】：目的過(guò)敏性鼻炎是一種常見(jiàn)的氣道疾病,在不同的地區(qū)有不同的發(fā)病率和致敏特征。本研究旨在了解青島地區(qū)過(guò)敏性鼻炎兒童常見(jiàn)過(guò)敏原及其特點(diǎn),為兒童過(guò)敏性鼻炎的診斷、治療及預(yù)防提供科學(xué)依據(jù);同時(shí)評(píng)價(jià)兒童過(guò)敏性鼻炎患者進(jìn)行舌下免疫治療(sublingual immunotherapy SLIT)過(guò)程中的短期臨床療效,并檢測(cè)部分顯效患者微小RNA(micro RNA,mi RNA)-146a的表達(dá)變化;觀察粉塵螨滴劑舌下免疫治療過(guò)敏性鼻炎患兒的臨床療效。方法回顧性分析2003年1月至2014年12月間2841例過(guò)敏性鼻炎(伴或不伴哮喘)兒童過(guò)敏原點(diǎn)刺實(shí)驗(yàn)檢查結(jié)果,其中3-5歲者1500例,6-12歲者1341例,分析其中塵螨及其他過(guò)敏原組成,研究其相關(guān)性。為評(píng)估SLIT的短期療效及機(jī)制,納入42例年齡6~11歲過(guò)敏性鼻炎患者,采用商品化粉塵螨滴劑(暢迪)舌下含服治療半年,比較治療前后鼻炎癥狀評(píng)分的改變。同時(shí)選取13例臨床療效顯著的患者,采用反轉(zhuǎn)錄聚合酶鏈反應(yīng)(RT-PCR)檢測(cè)外周血單個(gè)核細(xì)胞mi R-146a和Foxp3基因表達(dá)的改變,采用酶聯(lián)免疫吸附試驗(yàn)(ELISA)檢測(cè)血清IL-5和IL-10蛋白水平的改變。為評(píng)估舌下免疫治療的臨床療效,選擇到我院就診的塵螨過(guò)敏的過(guò)敏性鼻炎患兒110例,按患兒監(jiān)護(hù)人意愿分為舌下免疫治療組(60例)和藥物對(duì)照組(50例),舌下免疫治療組使用粉塵螨滴劑聯(lián)合對(duì)癥藥物治療,藥物組僅使用單純對(duì)癥藥物治療;治療2年結(jié)束后評(píng)估舌下免疫治療組和藥物對(duì)照組的鼻部癥狀總評(píng)分(total nasal symptom scores,TNSS)和藥物總評(píng)分(Total medication scores,TMS)。結(jié)果2841例過(guò)敏性鼻炎患兒皮膚點(diǎn)刺試驗(yàn)結(jié)果顯示:(1)吸入性過(guò)敏原中前三位分別是屋塵螨(69.3%)、粉塵螨(66.2%)、點(diǎn)青霉(38.9%),食物性過(guò)敏原中前三位分別為蚌類(39.2%)、鯉魚(yú)(36.5%)、海蝦(36.3%)。(2)3-5歲兒童中,吸入性過(guò)敏原中前三位分別是屋塵螨(67.53%)、粉塵螨(62.47%)、點(diǎn)青霉(36.40%);6-12歲兒童中,吸入性過(guò)敏原中前三位分別是屋塵螨(71.96%)、粉塵螨(70.84%)、點(diǎn)青霉(41.98%)。例數(shù)最多的前10種過(guò)敏原兩組間比較,粉塵螨、屋塵螨、點(diǎn)青霉、煙曲霉、夏秋花、豚草、禾本科等過(guò)敏原差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(3)3-5歲兒童中,食物性過(guò)敏原中前三位分別為蚌類(39.60%)、鯉魚(yú)(34.33%)、海蝦(34.13%);6-12歲兒童中,食物性過(guò)敏原中前三位分別為鯉魚(yú)(39.00%)、蚌類(38.70%)、海蝦(38.63%)。例數(shù)最多的前10種過(guò)敏原兩組間比較,其中海蝦、鯉魚(yú)、鰻魚(yú)、海蟹4種過(guò)敏原差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(4)不同性別比較,吸入性過(guò)敏原中的點(diǎn)青霉、豚草和食入性過(guò)敏原中的牛奶,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(5)粉塵螨及屋塵螨同時(shí)出現(xiàn)過(guò)敏的陽(yáng)性率為60.0%,其中伴隨出現(xiàn)其他一種或多種過(guò)敏原陽(yáng)性者占56.7%。屋塵螨陽(yáng)性強(qiáng)度高于粉塵螨,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(6)6-12歲兒童塵螨感染率高于3-5歲兒童,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。男童塵螨感染率高于女童,其差異有統(tǒng)計(jì)學(xué)意義(P0.05)。SLIT治療半年后AR患者臨床癥狀評(píng)分較治療前出現(xiàn)顯著改善,差異有統(tǒng)計(jì)學(xué)意義(P0.01)。檢測(cè)13例顯效患者治療前后外周血單個(gè)核細(xì)胞mi R-146a、Foxp3基因表達(dá)和血清IL-10蛋白表達(dá),與基線值比較均出現(xiàn)顯著的增高,而血清IL-5蛋白水平顯著下降,差異均有有統(tǒng)計(jì)學(xué)意義(P0.05)。mi R-146a表達(dá)水平與Foxp3 m RNA表達(dá)水平之間存在顯著的關(guān)聯(lián)性,有統(tǒng)計(jì)學(xué)意義(P0.01)。SLIT治療2年結(jié)束時(shí),與藥物對(duì)照組相比,TMS、TNSS評(píng)分顯著低于藥物組且差異具有統(tǒng)計(jì)學(xué)意義(P0.01)。SLIT組治療2年結(jié)束時(shí)和治療前基線相比,TMS、TNSS評(píng)分均有顯著降低且差異具有統(tǒng)計(jì)學(xué)意義(P0.01)。藥物治療2年和治療前相比,用藥評(píng)分顯著升高且差異具有統(tǒng)計(jì)學(xué)意義(P0.01),TNSS沒(méi)有顯著變化(P0.05)。治療2年結(jié)束后,SLIT組60例患者中有41例(68.33%)停止使用對(duì)癥藥物,藥物對(duì)照組50例患者中有8例(16.0%)停止使用對(duì)癥藥物,兩者相比差異有顯著統(tǒng)計(jì)學(xué)意義(P0.01)。結(jié)論在青島地區(qū),屋塵螨和粉塵螨是兒童過(guò)敏性鼻炎最常見(jiàn)的過(guò)敏原,臨床中多見(jiàn)二者同時(shí)出現(xiàn),常伴隨其他一種或多種過(guò)敏原陽(yáng)性。隨著年齡增長(zhǎng),過(guò)敏性鼻炎兒童對(duì)塵螨敏感性更高,尤其是男性患兒。因此,明確塵螨主要過(guò)敏原后可以采取相應(yīng)的措施避免接觸塵螨或進(jìn)行特異性免疫治療以減輕機(jī)體過(guò)敏反應(yīng),從而大大降低患兒的痛苦。暢迪SLIT治療過(guò)敏性鼻炎的臨床療效可能與誘導(dǎo)mi R-146a介導(dǎo)的調(diào)節(jié)性T細(xì)胞上調(diào)有關(guān)。經(jīng)過(guò)2年左右的對(duì)比研究證實(shí),SLIT聯(lián)合藥物治療過(guò)敏性鼻炎臨床效果優(yōu)于單純對(duì)癥藥物治療。
[Abstract]:The purpose of allergic rhinitis is a common airway disease in different regions have different incidence and sensitization characteristics. This study aims to understand children with allergic rhinitis in Qingdao area and the characteristics of common allergens in children with allergic rhinitis, diagnosis, treatment and prevention to provide the scientific basis for the evaluation of patients with allergic children; rhinitis of sublingual immunotherapy (sublingual immunotherapy SLIT) short-term clinical effect in the process of detection and effective part of patients with small RNA (micro RNA, MI RNA) the expression of -146a; to observe the clinical effect of Dermatophagoides Farinae Drops sublingual immunotherapy in children with allergic rhinitis. Methods Retrospective analysis of January 2003 to December 2014 of 2841 cases of allergic rhinitis (with or without asthma) children prick test results, including 1500 cases of 1341 patients 3-5 years of age, 6-12 years of age, the analysis of dust mites and other allergens, Study on the relationship between the curative effect and mechanism. For the assessment of SLIT, included 42 cases of aged 6~11 patients with allergic rhinitis, the commercialization of Dermatophagoides Farinae Drops (Chang DI) sublingual treatment for half a year, before and after the treatment of rhinitis symptoms score changes. At the same time selected 13 cases of clinical curative effect significantly in patients by reverse transcription polymerase chain reaction of (RT-PCR) MI in mononuclear cells of R-146a and Foxp3 gene expression in peripheral blood detected changes by enzyme-linked immunosorbent assay (ELISA) detection of serum IL-5 and IL-10 protein levels. The change of clinical curative effect evaluation of sublingual immunotherapy, 110 cases of children with allergic rhinitis in our hospital from dust mite allergy according to the children, guardian will be divided into sublingual immunotherapy group (60 cases) and control group (50 cases), sublingual immunotherapy using Dermatophagoides Farinae Drops combined symptomatic drug treatment, the drug group using only simple medicine 娌葷枟;娌葷枟2騫寸粨鏉熷悗璇勪及鑸屼笅鍏嶇柅娌葷枟緇勫拰鑽墿瀵圭収緇勭殑榧婚儴鐥囩姸鎬昏瘎鍒，

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