本文選題：變應(yīng)性鼻炎 + 證型　； 參考：《廣州中醫(yī)藥大學(xué)》2016年博士論文

【摘要】：目的：通過(guò)臨床調(diào)查和實(shí)驗(yàn)對(duì)比不同生命周期的變應(yīng)性鼻炎的臨床特點(diǎn),從而得出變應(yīng)性鼻炎兒童患者的臨床特點(diǎn),并預(yù)測(cè)變應(yīng)性鼻炎的病情發(fā)展趨勢(shì)。用于指導(dǎo)診治,提高療效。方法：本課題的所有病例都來(lái)自2014年9月至2016年2月期間廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院耳鼻咽喉科的門(mén)診患者,其年齡至少3歲,病史至少3個(gè)月,經(jīng)過(guò)變應(yīng)原檢測(cè)后確診為變應(yīng)性鼻炎的患者共384例。全部采用自制的“變應(yīng)性鼻炎臨床特點(diǎn)及中醫(yī)證型調(diào)查表”由導(dǎo)師和本人現(xiàn)場(chǎng)調(diào)查。采集的內(nèi)容包括患者的鼻部癥狀VAS評(píng)分、家族史、變應(yīng)性鼻炎的伴隨癥狀和中醫(yī)癥候分型常見(jiàn)影響因素等。在動(dòng)物實(shí)驗(yàn)方面,用OVA致敏BALB/c小鼠,制造變應(yīng)性鼻炎小鼠模型,通過(guò)觀察記錄小鼠在不同生命周期的撓鼻次數(shù),對(duì)比其過(guò)敏的嚴(yán)重程度。應(yīng)用計(jì)算機(jī)EXCEL表錄入數(shù)據(jù),并使用SPSS 19.0統(tǒng)計(jì)軟件進(jìn)行分析。結(jié)果：變應(yīng)性鼻炎兒童患者的病程以中期為主,病程不影響體型,患兒以偏瘦為主,超重的不到偏瘦的三分之一,而體型中等者,其鼻癢、鼻塞、流涕最輕。發(fā)作地點(diǎn)排前兩位的是家里、學(xué)校。而變應(yīng)性鼻炎成人患者的病程以長(zhǎng)期為主,體型以中等體型為主,體型偏瘦的大概是超重的一半,偏瘦的人噴嚏、流涕最輕,平均病程最短。無(wú)論是兒童還是成人患者都以晨起發(fā)作為主,與在家無(wú)關(guān)。性別不是變應(yīng)性鼻炎發(fā)病的影響因素。無(wú)論是變應(yīng)性鼻炎兒童還是成人患者,其鼻部各癥狀的發(fā)病率相當(dāng)；下鼻甲腫脹分度情況無(wú)顯著性差異。變應(yīng)性鼻炎兒童患者,鼻塞最嚴(yán)重,流涕次之。下鼻甲為3度時(shí),其鼻塞的平均VAS評(píng)分最高；下鼻甲為2度或3度時(shí),其病程平均比0度和1度的長(zhǎng),0度并不能說(shuō)明其病程較短。而變應(yīng)性鼻炎成人患者,以噴嚏、流涕為首要癥狀,下鼻甲腫脹程度越嚴(yán)重,其鼻塞的平均VAS評(píng)分就越高。無(wú)論是變應(yīng)性鼻炎兒童還是成人患者,都是以先鼻癢后眼癢、皮膚癢為主,而且眼癢和皮膚癢互為危險(xiǎn)因素,與變應(yīng)性鼻炎兒童患者產(chǎn)生煩躁無(wú)明顯關(guān)系;性別對(duì)煩躁與否的影響差異亦無(wú)顯著性意義。擔(dān)心該病對(duì)生活質(zhì)量產(chǎn)生影響的兒童患者和成人患者均超過(guò)六成,此外,成人比兒童患者更擔(dān)心該病影響睡眠質(zhì)量。無(wú)論是變應(yīng)性鼻炎兒童還是成人患者,合并鼾癥時(shí)鼻塞更嚴(yán)重；此外,鼻塞最可能是引起變應(yīng)性鼻炎兒童患者擔(dān)心睡眠、擔(dān)心發(fā)育和煩躁的因素。先有變應(yīng)性鼻炎后有哮喘的發(fā)病率,成人是兒童的1.8倍。成人患者比兒童患者更怕冷,怕冷與家里有無(wú)空調(diào)的情況無(wú)關(guān),與哮喘的發(fā)病率也無(wú)關(guān)。變應(yīng)性鼻炎兒童患者與成人患者的家族史、哮喘病史無(wú)顯著差異。變應(yīng)性鼻炎兒童患者的中醫(yī)證型分布與成人對(duì)比的差異有顯著性意義,變應(yīng)性鼻炎兒童患者與成人患者,其肺氣虛寒證與脾氣虛弱證、脾肺氣虛證的發(fā)病頻率總和相當(dāng),約占65%,但兒童患者屬于脾虛證的明顯比成人多,成人患者屬于肺經(jīng)蘊(yùn)熱證跟腎陽(yáng)不足證的較兒童患者多。晨起發(fā)作的變應(yīng)性鼻炎兒童患者與成人患者都是以脾肺氣虛證跟肺氣虛寒證為主,但兒童患者屬于脾虛證的明顯比成人多,成人患者屬于肺經(jīng)蘊(yùn)熱證跟腎陽(yáng)不足證的較兒童患者多。腎陽(yáng)不足型的兒童患者鼻癢、流涕最嚴(yán)重,噴嚏最輕；肺氣虛寒型的兒童患者噴嚏最重；各種證型對(duì)鼻塞沒(méi)有顯著性差異；脾氣虛弱型的成人患者流涕癥狀最嚴(yán)重。變應(yīng)性鼻炎兒童患者合并鼾癥的發(fā)病率(14.09%)比成人患者的發(fā)病率(9.15%)高,合并鼾癥的變應(yīng)性鼻炎兒童患者以脾氣虛弱型為主,而成人患者則以肺氣虛寒型和脾肺氣虛型為主；變應(yīng)性鼻炎兒童患者合并鼻竇炎的發(fā)病率(5.91%)比成人患者的發(fā)病率(3.05%)高,合并鼻竇炎的變應(yīng)性鼻炎兒童患者以肺經(jīng)蘊(yùn)熱型和脾氣虛弱型為主,而成人患者則以脾肺氣虛型為主；變應(yīng)性鼻炎兒童患者合并哮喘的發(fā)病率(5.00%)比成人患者的發(fā)病率(4.88%)略高,合并哮喘的變應(yīng)性鼻炎患者主要以肺氣虛寒、脾肺氣虛、腎陽(yáng)不足三種證型為主。變應(yīng)性鼻炎兒童患者同時(shí)伴有鼻癢、眼癢和皮膚癢的發(fā)病率(19.09%)高于成人患者(9.14%),合并眼癢、皮膚癢不影響變應(yīng)性鼻炎的中醫(yī)證型分布。廣東地區(qū)384名變應(yīng)性鼻炎患者中,無(wú)論是兒童患者還是成人患者,其變應(yīng)原排在前三位的都是依次為戶塵螨、粉塵螨和室內(nèi)塵土,其中,粉塵螨與戶塵螨的分布頻率幾乎一致,常同時(shí)并同等級(jí)出現(xiàn),與中醫(yī)證型的分布無(wú)關(guān)。無(wú)論是變應(yīng)性鼻炎兒童患者還是成人患者,牛奶、海蝦、棉絮、海蟹、狗毛、貓毛這幾種過(guò)敏原,其過(guò)敏等級(jí)主要為1級(jí),而且1級(jí)的陽(yáng)性率是2級(jí)甚至更高級(jí)的陽(yáng)性率總和的2.5倍或以上。蝦與蟹,貓毛與狗毛,屋塵與螨蟲(chóng),互為危險(xiǎn)因素。棉絮不是螨蟲(chóng)過(guò)敏的危險(xiǎn)因素。AR孕鼠的鼻癢程度比AR成鼠嚴(yán)重,而年長(zhǎng)AR鼠的鼻癢程度比年輕AR鼠嚴(yán)重；AR小鼠的第一代鼠崽的鼻癢程度比正常小鼠嚴(yán)重,但比AR母鼠的鼻癢程度輕；小鼠從孕前到產(chǎn)后經(jīng)歷的不同的生命時(shí)期,其鼻癢的癥狀在產(chǎn)后之初表現(xiàn)的最嚴(yán)重,產(chǎn)前鼻癢一直在加重,產(chǎn)后鼻癢也開(kāi)始逐步減輕。結(jié)論：1.變應(yīng)性鼻炎兒童患者與成人患者對(duì)比,臨床特點(diǎn)不一致,兒童患者,鼻塞最嚴(yán)重,流涕次之,成人患者,以噴嚏、流涕為首要癥狀。2.變應(yīng)性鼻炎兒童患者與成人患者,其肺氣虛寒證與脾氣虛弱證、脾肺氣虛證的發(fā)病頻率總和相當(dāng),約占65%,但兒童患者屬于脾虛證的明顯比成人多,成人患者屬于肺經(jīng)蘊(yùn)熱證跟腎陽(yáng)不足證的較兒童患者多。3.廣東地區(qū)變應(yīng)性鼻炎患者中,無(wú)論是兒童患者還是成人患者,其變應(yīng)原排在前三位的都是依次為戶塵螨、粉塵螨和室內(nèi)塵土,其中,粉塵螨與戶塵螨的分布頻率幾乎一致,常同時(shí)并同等級(jí)出現(xiàn),與中醫(yī)證型的分布無(wú)關(guān)。4.不同生命周期的變應(yīng)性鼻炎小鼠模型,年長(zhǎng)者的鼻癢程度比年輕者嚴(yán)重,雌性變應(yīng)性鼻炎小鼠懷孕后期鼻癢癥狀最嚴(yán)重,分娩后,鼻癢癥狀會(huì)減輕。
[Abstract]:Objective: To compare the clinical characteristics of allergic rhinitis in different life cycle by clinical investigation and experiment, and to get the clinical characteristics of allergic rhinitis children, and to predict the trend of allergic rhinitis. It is used to guide the diagnosis and treatment and improve the curative effect. Methods: all cases in this subject are from September 2014 to February 2016. The outpatient of the Department of Otolaryngology, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, was at least 3 years old, with a history of at least 3 months, and 384 patients were diagnosed with allergic rhinitis after the allergen test. All of them were investigated by the tutor and myself by the self-made "clinical characteristics of allergic rhinitis and TCM syndrome type investigation list". The contents include VAS score of nasal symptoms, family history, accompanying symptoms of allergic rhinitis and common influencing factors of TCM syndrome. In animal experiments, BALB/c mice were sensitized by OVA to produce allergic rhinitis mice model, and the number of nose flinch in different life cycles of mice was recorded and the severity of allergic rhinitis was compared. Using the computer EXCEL table to record the data, and use the SPSS 19 statistical software to analyze. Results: the course of the allergic rhinitis children's course of disease is mainly in the middle period, the course does not affect the body shape, the child is mainly thin, the overweight is less than 1/3 thin, and the body with medium size, its nose itching, nasal congestion, runny nose is the lightest. The site of the attack is the two place. The course of the adult patients with allergic rhinitis is a long term, with a medium size, and a thin body of about half of the overweight, the thinner sneeze, the lightest runny nose, and the shortest average course. Both children and adult patients are mainly in the morning and have nothing to do with the family. Sex is not allergic rhinitis. The influence factors of the allergic rhinitis children and adult patients have the same incidence of each symptom in the nose; there is no significant difference in the degree of lower turbinate swelling. The patients with allergic rhinitis have the most severe nasal congestion and runny nose. The average VAS score of the nasal plug is the highest when the inferior turbinate is 3 degrees; the course of the lower turbinate is 2 degrees or 3 degrees. The average length of 0 degrees and 1 degrees does not indicate a shorter course of disease. In adult patients with allergic rhinitis, the first symptom is sneezing and runny nose. The more severe the swelling of the inferior turbinate is, the higher the average VAS score of the nasal plug. There was no significant relationship with itching of the skin with irritability and irritability in children with allergic rhinitis, and there was no significant difference in the impact of sex on irritability. There were more than 60% of the children and adults who worried about the quality of life. In addition, adults were more worried about the quality of sleep than in children. In the case of allergic rhinitis children or adult patients, nasal congestion is more severe with snoring; in addition, nasal congestion is most likely to cause anxiety in children with allergic rhinitis, worry about sleep, worry about development and irritability. After allergic rhinitis, the incidence of asthma is 1.8 times as high as adults. Adult patients are more afraid of cold, cold and more afraid of cold than children. There is no relation between the condition of air conditioning in the family and the incidence of asthma. There is no significant difference in the history of asthma in children with allergic rhinitis and adults, and there is no significant difference in the history of asthma. The difference in TCM syndrome distribution of allergic rhinitis children with adults is significant, and the Asthenia Cold of the allergic rhinitis children and the adult patients, and the Asthenia Cold of the lung. Syndrome and spleen qi deficiency syndrome, the sum of the incidence of spleen and lung qi deficiency syndrome is equal, accounting for about 65%, but children's patients belong to the spleen deficiency more than adults, adult patients belong to the lung meridian heat syndrome and kidney yang deficiency syndrome more than those of children. But children are more than adults with spleen deficiency syndrome. Adult patients are more than children with syndrome of lung meridian accumulation and kidney yang deficiency. Children with deficiency of kidney yang have the most severe nasal itching, the most serious sneeze, and the most severe sneeze in children with cold type of lung qi deficiency; there is no significant difference in nasal congestion in various types of syndrome; deficiency of Spleen Qi. The symptoms of runny nose in the weak adult patients were the most serious. The incidence of snoring in children with allergic rhinitis (14.09%) was higher than that of adult patients (9.15%). The patients with allergic rhinitis with snoring were mainly of weak temper, while the adult patients were mainly with lung qi deficiency cold type and spleen and lung qi deficiency type, and allergic rhinitis children patients. The incidence of sinusitis (5.91%) was higher than that of adult patients (3.05%). The patients with allergic rhinitis with nasosinusitis were mainly pulmonary meridian and spleen qi deficiency, while the adult patients were mainly with spleen and lung qi deficiency, and the incidence of asthma in children with allergic rhinitis (5%) was more than that of adult patients (4.88%). The incidence of allergic rhinitis in children with nasal itching, itching and skin itching (19.09%) was higher than that of adult patients (19.09%), combined with itching and itching, and skin itching did not affect the distribution of TCM syndrome of allergic rhinitis in Guangdong area. Among the 384 patients with allergic rhinitis, both children and adults, their allergens were in the top three of the family dust mite, dust mites and indoor dust. Among them, the distribution frequency of dust mite and household dust mite was almost identical, often at the same level, and was not related to the distribution of the TCM syndrome type. The allergen of milk, shrimp, cotton, sea crab, dog hair and cat hair is 1 grade, and the positive rate of grade 1 is 2.5 times or more of the positive rate of 2 or more advanced. Shrimp and crab, cat hair and dog hair, house dust and mites are risk factors. Cotton is not a risk factor for mites allergy.AR pregnancy. The itching degree of the mice was more severe than that of the AR rat, while the nasal itching of the older AR mice was more severe than that of the young AR mice; the first generation of the mice in the AR mice was more itchy than the normal mice, but less than that of the AR mice; the symptoms of the nose itching from pre pregnancy to postpartum were the most serious in the early postpartum period. Conclusion: 1. children with allergic rhinitis and adult patients are compared with adult patients, with different clinical characteristics, children, the most serious nasal congestion, runny nose, adult patients,.2. allergic rhinitis children and adult patients with sneezing and runny nose as the primary symptom, their lung qi deficiency cold syndrome and temper. Deficiency syndrome, the sum of the incidence of spleen and lung qi deficiency syndrome is equal, accounting for about 65%, but children with spleen deficiency syndrome are obviously more than adults, adult patients are more.3. Guangdong area allergic rhinitis patients with lung meridian heat syndrome and kidney yang deficiency syndrome, both children and adult patients, their allergens are in the top three. The distribution frequency of dust mite and indoor dust mite is almost the same, and the distribution frequency of dust mite and household dust mite is almost identical, often at the same time and in the same grade. It is not related to the distribution of.4. in different life cycle of allergic rhinitis in mice. The degree of nasal itching in the elderly is worse than that of the young, and the female allergic rhinitis in the later period of pregnancy. The symptoms of nasal itching are most serious, and the symptoms of nasal itching will be reduced after delivery.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R765.21

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5 朱愉;;近幾年研究變應(yīng)性鼻炎最常用的幾種客觀指標(biāo)[A];中華中醫(yī)藥學(xué)會(huì)耳鼻喉科分會(huì)第十六次全國(guó)學(xué)術(shù)交流會(huì)論文摘要[C];2010年

6 于兆安;;卡介菌多糖核酸注射液治療變應(yīng)性鼻炎52例[A];第一屆全國(guó)變態(tài)反應(yīng)學(xué)術(shù)研討會(huì)論文匯編[C];2001年

7 葛妤;;變應(yīng)性鼻炎對(duì)健康的影響及預(yù)防[A];全國(guó)五官科護(hù)理學(xué)術(shù)交流暨專題講座會(huì)議論文匯編[C];2002年

8 鄧華;;國(guó)內(nèi)防治變應(yīng)性鼻炎的進(jìn)展[A];第五次全國(guó)中西醫(yī)結(jié)合中青年學(xué)術(shù)研討會(huì)論文匯編[C];2004年

9 韓德民;張羅;黃丹;武陽(yáng)豐;董震;許庚;孔維佳;暴繼敏;周兵;汪審清;王德輝;王秋萍;;11城市變應(yīng)性鼻炎自報(bào)患病率調(diào)查[A];中華醫(yī)學(xué)會(huì)第十次全國(guó)耳鼻咽喉-頭頸外科學(xué)術(shù)會(huì)議論文匯編（上）[C];2007年

10 趙巖;張羅;韓德民;劉承耀;;變應(yīng)性鼻炎評(píng)分在變應(yīng)性鼻炎診斷中的應(yīng)用[A];中華醫(yī)學(xué)會(huì)第十次全國(guó)耳鼻咽喉-頭頸外科學(xué)術(shù)會(huì)議論文匯編（上）[C];2007年

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9 副主任藥師 趙民生　(曹秀虹);變應(yīng)性鼻炎的藥物治療[N];醫(yī)藥經(jīng)濟(jì)報(bào);2009年

10 記者 李衛(wèi)中　通訊員 任曉輝;我國(guó)對(duì)變應(yīng)性鼻炎規(guī)范化診斷和防治體系的研究正式啟動(dòng)[N];山西經(jīng)濟(jì)日?qǐng)?bào);2008年

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