【摘要】：目的：探討內(nèi)蒙古草原環(huán)境下鼻炎患者氣傳變應(yīng)原的致敏狀況，評價居室內(nèi)塵螨暴露與致敏的相關(guān)性，比較患者個人特征（年齡、性別、民族）對變應(yīng)性鼻炎（allergic rhinitis, AR）與非變應(yīng)性鼻炎（non-allergic rhinitis, NAR）發(fā)病的影響，并探討變應(yīng)原體內(nèi)、外檢測方法的臨床診斷價值，為草原地區(qū)鼻炎診斷和防治策略的制定提供參考依據(jù)。 方法：在內(nèi)蒙古自治區(qū)錫林浩特市集中招募具有鼻炎臨床表現(xiàn)的患者314例，所有患者接受詳細的病史詢問、前鼻鏡檢查、問卷調(diào)查、變應(yīng)原皮膚點刺試驗（skin prick test, SPT）以及血清特異性IgE（specific IgE, sIgE）、總IgE（totalIgE, tIgE）和嗜酸粒細胞陽離子蛋白（eosinophil cationic protein, ECP）檢測。采集部分患者臥室床墊塵埃，用ELISA法檢測塵埃中屋塵螨（Dermatophagoidespteronyssinus, Der p）和粉塵螨（Dermatophagoides farinae, Der f）主要變應(yīng)原Der p1和Der f1濃度。以SPSS17.0軟件進行統(tǒng)計學(xué)分析。 結(jié)果：①314例鼻炎患者的年齡為5~70歲，平均年齡（30.14±14.18）歲。男125例（39.8%），女189例（60.2%）。漢族195例（62.1%），少數(shù)民族119例（37.9%）。②11種氣傳變應(yīng)原SPT陽性率依次為艾蒿52.2%、豚草31.2%、梯牧草26.4%、樺樹24.2%、粉塵螨21.9%、熱帶無爪螨17.5%、狗毛12.7%、貓毛11.8%、德國小蠊9.2%、鏈格孢霉8.3%、屋塵螨5.7%。血清sIgE陽性率依次為艾蒿47.1%、豚草34.7%、樺樹21.3%、梯牧草19.7%、屋塵螨9.2%、貓毛8.0%、粉塵螨7.6%、德國小蠊7.3%、狗毛6.7%、熱帶無爪螨6.4%、鏈格孢霉4.5%。③對276例鼻炎患者居室中的床塵進行檢測，結(jié)果顯示：Der p1陽性2例（0.7%），Der f1陽性4例（1.4%）；每克床塵中Der p1和Der f1的最大檢測含量分別為162ng和532ng。經(jīng)Spearman等級相關(guān)分析（α=0.01）顯示，屋塵螨的暴露水平與SPT陽性結(jié)果呈正相關(guān)（rs=0.156，P=0.010），而與sIgE的陽性結(jié)果無明顯相關(guān)性（rs=0.116，P=0.055）；粉塵螨的暴露水平與SPT（rs=0.05，P=0.931）及sIgE（rs=0.070，P=0.240）陽性結(jié)果均無相關(guān)性。④患者變應(yīng)原SPT、血清sIgE、tIgE和ECP陽性率均為男性高于女性（P＜0.05），并隨年齡的增加陽性率呈線性下降趨勢（P=0.000），但陽性率的民族差異無統(tǒng)計學(xué)意義（P＞0.05）。⑤314例鼻炎患者中，207例（65.9%）診斷為AR，男92例（44.4%）、女115例（55.6%）；107例（34.1%）診斷為NAR，男33例（30.8%）、女74例（69.2%）。AR患者男性高發(fā)年齡為10~19歲，女性高發(fā)年齡則為30~39歲。NAR患者女性高發(fā)年齡為30~49歲，，男性患者無明顯的高發(fā)年齡。⑥11種氣傳變應(yīng)原的體內(nèi)（SPT）和體外（sIgE）檢測結(jié)果均有一致性，其中艾蒿的一致性強度最高，貓毛次之，而粉塵螨、屋塵螨、熱帶無爪螨的一致性強度較低。所有變應(yīng)原的血清sIgE檢測顯示出較好的特異度和陰性預(yù)測值（均＞80%）。 結(jié)論：在內(nèi)蒙古錫林浩特草原環(huán)境下，65.9%的鼻炎患者發(fā)病可能與變態(tài)反應(yīng)有關(guān)，艾蒿花粉是最重要的氣傳變應(yīng)原。在此特殊環(huán)境下，屋塵螨和粉塵螨的暴露水平極低，而且塵螨暴露與致敏之間也非簡單的劑量-反應(yīng)關(guān)系。變應(yīng)原SPT、血清sIgE、tIgE和ECP陽性率隨患者年齡的增加呈線性下降趨勢，其陽性率均為男性高于女性，但不受民族影響。在鼻炎患者中，男性較女性易患AR，男性高發(fā)年齡為10~19歲；女性在NAR的發(fā)病中多見，高發(fā)年齡為30~49歲。臨床診斷方面，艾蒿花粉和貓毛變應(yīng)原的體內(nèi)、外檢測方法可任選一種，推薦優(yōu)先選擇SPT；但對于其他種類的氣傳變應(yīng)原則建議兩種檢測方法聯(lián)合使用，以提高診斷準確性。
[Abstract]:Objective: To investigate the sensitization status of airborne allergens in patients with rhinitis in grassland environment of Inner Mongolia, to evaluate the correlation between indoor dust mite exposure and sensitization, and to compare the effects of individual characteristics (age, sex, nationality) on the pathogenesis of allergic rhinitis (AR) and non-allergic rhinitis (NAR), and to explore the relationship between indoor dust mite exposure and sensitization. The clinical diagnostic value of in vivo and in vitro detection methods will provide reference for the diagnosis and prevention of rhinitis in grassland areas.
Methods: A total of 314 patients with rhinitis were recruited in Xilinhot city of Inner Mongolia Autonomous Region. All patients received detailed medical history, nose examination, questionnaire survey, skin prick test (SPT), serum specific IgE (sIgE), total IgE (IgE, tIgE) and eosinophil fineness. The concentrations of Dermatophagoides pteronyssinus (Der p) and Dermatophagoides farinae (Der f) major allergens Derp1 and Der F1 in bedroom mattress dust of some patients were detected by ELISA.
Results: The age of 314 patients with rhinitis ranged from 5 to 70 years old, with an average age of (30.14 65507 The positive rates of sIgE in serum were Artemisia argyi 47.1%, ragweed 34.7%, birch 21.3%, terracotta 19.7%, house dust mite 9.2%, cat hair 8.0%, dust mite 7.6%, Blattella germanica 7.3%, dog hair 6.7%, Tropical claw mite 6.4% and trematode mite 4.5%. The results showed that Der P1 was positive in 2 cases (0.7%) and Der F1 was positive in 4 cases (1.4%). The maximum detectable contents of Der P1 and Der F1 were 162ng and 532ng respectively in each gram of bed dust. Spearman grade correlation analysis (a=0.01) showed that the exposure level of house dust mites was positively correlated with the positive results of SPT (rs=0.156, P=0.010), but not significantly correlated with the positive results of sIgE. (rs = 0.116, P = 0.055); there was no correlation between the level of Dermatophagoides farinae exposure and the positive results of SPT (rs = 0.05, P = 0.931) and sIgE (rs = 0.070, P = 0.240). Among 314 rhinitis patients, 207 (65.9%) were diagnosed as AR, 92 (44.4%) were male, 115 (55.6%) were female, and 107 (34.1%) were diagnosed as NAR, 33 (30.8%) were male and 74 (69.2%) were female. _The results of in vivo (SPT) and in vitro (sIgE) tests of 11 kinds of airborne allergens were consistent. Artemisia argyi had the highest consistency intensity, followed by cat hair, while dust mites, house dust mites and tropical acaroid mites had lower consistency intensity. > 80%).
Conclusion: 65.9% of the patients with rhinitis in Xilinhot grassland of Inner Mongolia may be related to allergic reaction. Artemisia argyi pollen is the most important airborne allergen. In this special environment, the exposure level of house dust mite and dust mite is very low, and there is not a simple dose-response relationship between dust mite exposure and sensitization. The positive rates of IgE, tIgE and ECP were all higher in males than in females, but not affected by ethnicity. In vitro and in vivo detection of allergens is optional and SPT is recommended as the preferred method, but for other types of airborne allergy, two methods should be combined to improve the diagnostic accuracy.
【學(xué)位授予單位】：南京醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R765.21

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