發(fā)布時(shí)間：2018-06-22 08:44

  本文選題：支氣管哮喘 + 過(guò)敏癥��； 參考：《廣州醫(yī)學(xué)院》2011年碩士論文

【摘要】：目的 一、了解廣州市區(qū)青少年支氣管哮喘(簡(jiǎn)稱(chēng)哮喘)及變應(yīng)性鼻炎的患病情況及嚴(yán)重程度。 二、了解從化農(nóng)村地區(qū)青少年哮喘及變應(yīng)性鼻炎的患病情況及嚴(yán)重程度。 三、了解廣州市區(qū)15年間青少年哮喘流行病學(xué)變化趨勢(shì)。 四、了解廣州城區(qū)與從化農(nóng)村地區(qū)青少年哮喘流行情況的差異。 方法 第一部分廣州市區(qū)青少年哮喘和變應(yīng)性鼻炎患病率和患病趨勢(shì)的流行學(xué)研究 為橫斷面調(diào)查研究,按兒童哮喘及其他變應(yīng)性疾病的國(guó)際對(duì)比研究(ISAAC)研究方案,在與ISAAC前兩個(gè)階段(階段Ⅰ、階段Ⅲ)相同的月份(2009年11月～12月),相同的4個(gè)城區(qū)中相同的10所中學(xué),沿用與前相同的ISAAC中文問(wèn)卷,包括書(shū)面問(wèn)卷和錄像問(wèn)卷,對(duì)年齡在13～14歲的初一及初二級(jí)中學(xué)生,共計(jì)6928人進(jìn)行調(diào)查。內(nèi)容包括哮喘、變應(yīng)性鼻炎的相關(guān)癥狀患病率和嚴(yán)重程度。在參與問(wèn)卷調(diào)查的學(xué)生中隨機(jī)抽取329人進(jìn)行常見(jiàn)變應(yīng)原皮膚點(diǎn)刺試驗(yàn)。結(jié)果分別與前兩個(gè)階段調(diào)查對(duì)比。 第二部分從化農(nóng)村地區(qū)青少年支氣管哮喘流行病學(xué)調(diào)查及與廣州市區(qū)的對(duì)比 為橫斷面調(diào)查研究,在2009年11月～2010年1月,在從化農(nóng)村4個(gè)鄉(xiāng)鎮(zhèn)的四所中學(xué),采用與廣州城區(qū)調(diào)查相同的ISAAC中文問(wèn)卷(書(shū)面問(wèn)卷和錄像問(wèn)卷),對(duì)5841名年齡在13～14歲的初一、初二級(jí)中學(xué)生調(diào)查哮喘、變應(yīng)性鼻炎相關(guān)癥狀的患病率和嚴(yán)重程度進(jìn)行調(diào)查,結(jié)果與同時(shí)期廣州市區(qū)的調(diào)查對(duì)比。 第三部分廣州市區(qū)和從化農(nóng)村地區(qū)青少年進(jìn)一步臨床檢查的對(duì)比研究 從廣州市區(qū)參加問(wèn)卷調(diào)查的學(xué)生抽取其中417人,從化農(nóng)村地區(qū)抽取443人,共860人參加哮喘相關(guān)實(shí)驗(yàn)室客觀(guān)檢查,包括11種變應(yīng)原皮膚點(diǎn)刺試驗(yàn)、嗜酸粒細(xì)胞計(jì)數(shù)、基礎(chǔ)肺通氣功能和支氣管激發(fā)試驗(yàn),結(jié)果進(jìn)行地區(qū)間比較。 統(tǒng)計(jì)學(xué)方法:用18.0版SPSS (SPSS Inc. Chicago, IL, USA)進(jìn)行分析�；疾÷�(即癥狀的陽(yáng)性率)為報(bào)告癥狀陽(yáng)性的人數(shù)與實(shí)際調(diào)查人數(shù)之比,并計(jì)算95%可信區(qū)間(95%CI)。用二元logistic回歸、卡方檢驗(yàn)、t檢驗(yàn)分析地區(qū)間、性別間患病率及檢查結(jié)果的差異, p0.05視為有統(tǒng)計(jì)學(xué)意義上的差異。 結(jié)果 第一部分廣州市區(qū)青少年哮喘和變應(yīng)性鼻炎患病率和患病趨勢(shì)的流行學(xué)研究 一、本次調(diào)查回收有效問(wèn)卷6928張,應(yīng)答率96.7%。平均年齡為13.3±0.64歲,13～14歲兒童共6062人,占總?cè)藬?shù)87.5%。男性3524人,女性3424人,分別占總?cè)藬?shù)50.6%和49.4%。以上年齡和性別構(gòu)成與1994年(ISAAC階段Ⅰ)、2001年(階段Ⅲ)均大致相似。 二、本次調(diào)查中,書(shū)面問(wèn)卷的近12個(gè)月喘息為6.1% ,醫(yī)生診斷的哮喘病史為6.9% ,1994年(階段Ⅰ)相應(yīng)的患病率為3.4%、3.9%,而2001年(階段Ⅲ)為4.8%、4.6%,2009年均較前兩階段上升(p0.05)。 三、錄像問(wèn)卷中,2009年近期休息時(shí)喘息的發(fā)病率為4.9%,較94年的2%與01年的3.8%增加(p0.05);運(yùn)動(dòng)后喘息的發(fā)病率為13.7%,較94年(6.9%)與01年(11.3%)有顯著性增加(p0.01)。 四、2009年醫(yī)生診斷的變應(yīng)性鼻炎、花粉癥分別為25.1%、5.3%,較94年(17.4%、2.9%)、01年(22.7%、4.1%)顯著性增高(p0.05)。09年近12個(gè)月鼻炎和鼻結(jié)膜炎癥狀的患病率,分別為43.2%、10.4%,較94年顯著增高(p0.05)。 五、2010年廣州地區(qū)青少年特應(yīng)性和變應(yīng)原陽(yáng)性率較前明顯升高。2010年和2002年特應(yīng)性分別為62.2%和46.3%,兩次調(diào)查變應(yīng)原分布基本相似,陽(yáng)性率最高的是粉塵螨,在兩次調(diào)查中分別是55.9%和44.9%。貓毛和蟑螂是次于塵螨的常見(jiàn)變應(yīng)原。 第二部分從化農(nóng)村地區(qū)青少年支氣管哮喘流行病學(xué)調(diào)查及與廣州市區(qū)的對(duì)比 一、從化市四所鄉(xiāng)鎮(zhèn)中學(xué)共6087人參加了問(wèn)卷調(diào)查,回收有效問(wèn)卷5841份,應(yīng)答率96%。平均年齡14.2±0.83歲。13～14歲兒童4815人,占總?cè)藬?shù)82.4%。其中男性2953人,女性2888人,分別占總?cè)藬?shù)50.6%、49.4%。 二、從化的哮喘及鼻炎相關(guān)癥狀的發(fā)病率均顯著低于同時(shí)期廣州的發(fā)病率:醫(yī)生診斷的哮喘從化與廣州分別為3.4%與6.9%,既往哮喘為4.2%與14.6%,近期喘息1.5%與6.1%;錄像問(wèn)卷中的近期癥狀中,休息時(shí)喘息的發(fā)病率為1.7%與4.9% (p0.01)。男性和女性的患病率無(wú)顯著性差異。 三、醫(yī)生診斷的鼻炎、季節(jié)性花粉過(guò)敏癥的發(fā)病率從化與廣州分別為4.4%與25.1%、2.6%與5.3%,近期鼻炎患病率為25.8%與43.2%,以上指標(biāo)均有顯著性差異(p0.01)。 第三部分廣州市區(qū)和從化農(nóng)村地區(qū)青少年進(jìn)一步臨床檢查的對(duì)比研究 從化與廣州靜脈血嗜酸性粒細(xì)胞計(jì)數(shù)分別為0.19和0.27(×109/l),特應(yīng)性為51.1%和66.4%,氣道高反應(yīng)性為3.1%和20.2%,上述指標(biāo)從化均低于廣州(p0.05)。結(jié)合氣道高反應(yīng)性和病史,從化地區(qū)哮喘現(xiàn)患率為2.4%,遠(yuǎn)低于廣州的7.4%。 結(jié)論 一、廣州市13～14歲青少年的哮喘和變應(yīng)性鼻炎病史和癥狀的患病率15年來(lái)整體呈上升趨勢(shì)。 二、廣州市區(qū)13～14歲青少年特應(yīng)性和變應(yīng)原致敏性顯著升高。 三、從化農(nóng)村地區(qū)13～14歲兒童的哮喘和變應(yīng)性疾病的患病率低于同時(shí)期廣州市區(qū)水平。從化地區(qū)皮試陽(yáng)性率、嗜酸粒計(jì)數(shù)及氣道高反應(yīng)性的比例均顯著低于廣州市區(qū)。 四、特應(yīng)性和塵螨等變應(yīng)原陽(yáng)性是哮喘及變應(yīng)性鼻炎發(fā)生的危險(xiǎn)因素。
[Abstract]:objective
First, to understand the prevalence and severity of bronchial asthma (asthma) and allergic rhinitis in adolescents in Guangzhou.
Two, to understand the prevalence and severity of asthma and allergic rhinitis in adolescents in rural areas of Conghua.
Three, to understand the epidemiological trend of asthma among adolescents in Guangzhou during the past 15 years.
Four, understand the difference between the prevalence of asthma among adolescents in urban areas of Guangzhou and Conghua.
Method
Part one epidemiological study on prevalence and prevalence of asthma and allergic rhinitis in adolescents in Guangzhou urban area
For the cross-sectional study, the international comparative study (ISAAC) study of children's asthma and other allergic diseases (ISAAC) was used in the same month (from November 2009 to December), the same 10 middle schools in the same 4 urban districts (from November 2009 to December), with the same ISAAC Chinese questionnaire, including written questionnaires and videotapes. A total of 6928 students aged 13~14 years of age at the age of first and first grade two were investigated. The contents included the prevalence and severity of asthma, allergic rhinitis, and 329 of the students who participated in the questionnaire survey. The results were compared with the first two stages.
The second part is the epidemiological survey of bronchial asthma in adolescents in rural areas of Conghua and the comparison with the urban area of Guangzhou.
For the cross-sectional study, from November 2009 to January 2010, four middle schools in 4 villages and towns in Conghua, using the same ISAAC Chinese questionnaire (written questionnaire and video questionnaire) which were the same as Guangzhou city survey, were used to examine the prevalence and severity of allergic rhinitis related symptoms in 5841 junior middle school students at the age of 13~14. The results were compared with the survey of Guangzhou city in the same period.
The third part is a comparative study of further clinical examination among adolescents in Guangzhou and Conghua rural areas.
417 of them were selected from the Guangzhou urban area. 443 people were selected from the rural area of Conghua. A total of 860 people participated in the objective examination of asthma related laboratory, including 11 allergen skin pricking tests, eosinophil count, basic lung ventilation function and bronchial provocation test, and the results were compared between regions.
Statistical methods: analysis was made with the 18 version of SPSS (SPSS Inc. Chicago, IL, USA). The prevalence rate (the positive rate of symptoms) was the ratio of the number of positive symptoms to the actual number of people, and the 95% confidence interval (95%CI). Two yuan logistic regression, chi square test, and t test were used to analyze the differences between the sexes and the results of the examination, P. 0.05 considered a statistically significant difference.
Result
Part one epidemiological study on prevalence and prevalence of asthma and allergic rhinitis in adolescents in Guangzhou urban area
First, 6928 valid questionnaires were collected, the average age of response rate of 96.7%. was 13.3 + 0.64 years, and 6062 children were 13~14 years old, accounting for 3524 men and 3424 women. The total number of age and sex was 50.6% and more than 49.4%. and in 1994 (ISAAC stage I), and 2001 (stage III) were roughly similar.
Two, in this survey, the written questionnaire was 6.1% for the last 12 months, the history of asthma diagnosed by doctors was 6.9%, and the corresponding prevalence rate was 3.4%, 3.9% in 1994 (stage I), while 2001 (stage III) was 4.8%, 4.6% and 2009 (P0.05) compared with the previous two stages.
Three, in the video questionnaire, the incidence of wheezing was 4.9% in 2009, compared with 2% in 94 years and 3.8% in 01 years (P0.05); the incidence of wheezing after exercise was 13.7%, compared with 94 years (6.9%) and 01 years (11.3%) significantly increased (P0.01).
Four, in 2009, the allergic rhinitis diagnosed by doctors, 25.1%, 5.3%, 94 years (17.4%, 2.9%), 01 years (22.7%, 4.1%) significantly increased (P0.05) the incidence of nearly 12 months of rhinitis and rhinoconjunctivitis, respectively, 43.2%, 10.4%, significantly higher than the 94 years (P0.05).
Five, in 2010, the positive rates of adolescent idiosyncrasy and allergens in the Guangzhou area were significantly higher than those before.2010 and 2002, respectively 62.2% and 46.3%. The two survey allergens were basically similar, and the highest positive rate was the dust mites. In the two investigations, 55.9% and 44.9%. cat hair and cockroaches were the common allergens inferior to dust mites.
The second part is the epidemiological survey of bronchial asthma in adolescents in rural areas of Conghua and the comparison with the urban area of Guangzhou.
A total of 6087 people from four Township Middle Schools in Conghua participated in the questionnaire survey and recovered 5841 copies of effective questionnaires. The response rate was 4815 from.13 to 14 years old, with the average age of 96%. 14.2 + 0.83 years old, accounting for the total number of 82.4%. among men 2953 and 2888, accounting for 50.6%, 49.4%., respectively.
Two, the incidence of asthma and rhinitis related symptoms in Conghua was significantly lower than the incidence of Guangzhou at the same time: the doctors diagnosed asthma in Conghua and Guangzhou were 3.4% and 6.9%, the asthma was 4.2% and 14.6%, and the short term wheezing 1.5% and 6.1%; the incidence of wheezing at rest was 1.7% and 4.9% (P0.01) in the short term symptoms of the videotape. There was no significant difference in the prevalence of women.
Three, the incidence of seasonal allergic rhinitis and seasonal pollen allergy in Conghua and Guangzhou was 4.4% and 25.1%, 2.6% and 5.3% respectively. The incidence of recent rhinitis was 25.8% and 43.2%, and the above indexes were significantly different (P0.01).
The third part is a comparative study of further clinical examination among adolescents in Guangzhou and Conghua rural areas.
The eosinophil counts of venous blood in Conghua and Guangzhou were 0.19 and 0.27 (x 109/l), the atopy was 51.1% and 66.4%, the airway hyperresponsiveness was 3.1% and 20.2%, the above index in Conghua was lower than that of Guangzhou (P0.05). The prevalence rate of asthma in Conghua was 2.4% in combination with the history of airway hyperresponsiveness, far below the 7.4%. of Guangzhou.
conclusion
First, the prevalence of asthma and allergic rhinitis and the prevalence of symptoms in 13~14 year olds in Guangzhou have been on the rise for 15 years.
Two, sensitization of atopic and allergens in adolescents aged 13~14 years in Guangzhou increased significantly.
Three, the prevalence rate of asthma and allergic disease of 13~14 years old children in rural areas of Conghua was lower than that of Guangzhou city. The ratio of skin test positive, eosinophil count and airway hyperresponsiveness in Conghua area were significantly lower than that of Guangzhou city.
Four, atopic and dust mite allergen positive is a risk factor for asthma and allergic rhinitis.
【學(xué)位授予單位】：廣州醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類(lèi)號(hào)】：R725.6;R765.21

【引證文獻(xiàn)】

相關(guān)碩士學(xué)位論文 前1條

1 伍慧卿;變應(yīng)性鼻炎患者致敏因素調(diào)查及變應(yīng)原檢測(cè)方法分析[D];暨南大學(xué);2013年

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本文編號(hào)：2052268