中华耳鼻咽喉头颈外科杂志
中華耳鼻嚥喉頭頸外科雜誌
중화이비인후두경외과잡지
CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY
2012年
1期
19-25
,共7页
王云丽%赵祥%李风荷%陆忆%陶绮蕾%陆美萍%程雷
王雲麗%趙祥%李風荷%陸憶%陶綺蕾%陸美萍%程雷
왕운려%조상%리풍하%륙억%도기뢰%륙미평%정뢰
鼻炎%尘螨科%粉尘螨%超敏反应%环境
鼻炎%塵螨科%粉塵螨%超敏反應%環境
비염%진만과%분진만%초민반응%배경
Rhinitis%Pyroglyphidae%Dermatophagoides farinae%Hypersensitivity%Environment
目的 探讨内蒙古草原环境下鼻炎患者居室尘螨变应原暴露水平与致敏的关系,评估皮肤点刺试验(skin prick test,SPT)和血清特异性IgE( specific IgE,sIgE)两种检测方法诊断尘螨致敏的一致性.方法 集中招募内蒙古锡林浩特市具有鼻炎症状的患者314例,接受病史询问、前鼻镜检查、变应原体内检测(SPT法)和体外检测(sIgE法).采集患者卧室床垫尘埃,酶联免疫吸附(enzyme linked immunosorbent assay,ELISA)试验检测屋尘螨(Dermatophagoides pteronyssinus,Der p)和粉尘螨(Dermatophagoides farinae,Der f)主要变应原Der p 1和Der f1的含量.以SPSS 17.0软件进行t检验、x2检验等.结果314例鼻炎患者中,变应原检测结果为:Der p SPT阳性率5.7％,sIgE阳性率9.2％；DerfSPT阳性率22.0％,sIgE阳性率7.6％,均低于花粉的阳性率.花粉变应原中以艾蒿阳性率最高,SPT为51.9％,sIgE为47.1％.以尘螨变应原SPT作为判定致敏与否的“金标准”,sIgE检测Der p和Der f的阳性似然比分别为4.27和10.64,Kappa值分别为0.20和0.35.共计276例鼻炎患者进行了床垫尘埃检测,Der p 1阳性2例(0.7％),Der f1阳性4例(1.4％).Der p 1暴露水平与SPT阳性呈正相关(rs =0.156,P=0.01),但与sIgE阳性的相关性无统计学意义(rs=0.116,P=0.055);Der f1暴露水平与SPT和sIgE阳性均无明显相关性(rs=0.05,P=0.931;rs=0.07,P=0.245).结论 内蒙古草原环境下尘螨暴露水平很低,Der p和Der f不是变应性鼻炎患者的主要致敏原,尘螨的暴露与致敏之间也非简单的剂量-反应关系.在此特殊环境中,尘螨变应原SPT与sIgE检测结果的一致性强度较低,故建议采取体内和体外检测手段相结合进行临床诊断.
目的 探討內矇古草原環境下鼻炎患者居室塵螨變應原暴露水平與緻敏的關繫,評估皮膚點刺試驗(skin prick test,SPT)和血清特異性IgE( specific IgE,sIgE)兩種檢測方法診斷塵螨緻敏的一緻性.方法 集中招募內矇古錫林浩特市具有鼻炎癥狀的患者314例,接受病史詢問、前鼻鏡檢查、變應原體內檢測(SPT法)和體外檢測(sIgE法).採集患者臥室床墊塵埃,酶聯免疫吸附(enzyme linked immunosorbent assay,ELISA)試驗檢測屋塵螨(Dermatophagoides pteronyssinus,Der p)和粉塵螨(Dermatophagoides farinae,Der f)主要變應原Der p 1和Der f1的含量.以SPSS 17.0軟件進行t檢驗、x2檢驗等.結果314例鼻炎患者中,變應原檢測結果為:Der p SPT暘性率5.7％,sIgE暘性率9.2％；DerfSPT暘性率22.0％,sIgE暘性率7.6％,均低于花粉的暘性率.花粉變應原中以艾蒿暘性率最高,SPT為51.9％,sIgE為47.1％.以塵螨變應原SPT作為判定緻敏與否的“金標準”,sIgE檢測Der p和Der f的暘性似然比分彆為4.27和10.64,Kappa值分彆為0.20和0.35.共計276例鼻炎患者進行瞭床墊塵埃檢測,Der p 1暘性2例(0.7％),Der f1暘性4例(1.4％).Der p 1暴露水平與SPT暘性呈正相關(rs =0.156,P=0.01),但與sIgE暘性的相關性無統計學意義(rs=0.116,P=0.055);Der f1暴露水平與SPT和sIgE暘性均無明顯相關性(rs=0.05,P=0.931;rs=0.07,P=0.245).結論 內矇古草原環境下塵螨暴露水平很低,Der p和Der f不是變應性鼻炎患者的主要緻敏原,塵螨的暴露與緻敏之間也非簡單的劑量-反應關繫.在此特殊環境中,塵螨變應原SPT與sIgE檢測結果的一緻性彊度較低,故建議採取體內和體外檢測手段相結閤進行臨床診斷.
목적 탐토내몽고초원배경하비염환자거실진만변응원폭로수평여치민적관계,평고피부점자시험(skin prick test,SPT)화혈청특이성IgE( specific IgE,sIgE)량충검측방법진단진만치민적일치성.방법 집중초모내몽고석림호특시구유비염증상적환자314례,접수병사순문、전비경검사、변응원체내검측(SPT법)화체외검측(sIgE법).채집환자와실상점진애,매련면역흡부(enzyme linked immunosorbent assay,ELISA)시험검측옥진만(Dermatophagoides pteronyssinus,Der p)화분진만(Dermatophagoides farinae,Der f)주요변응원Der p 1화Der f1적함량.이SPSS 17.0연건진행t검험、x2검험등.결과314례비염환자중,변응원검측결과위:Der p SPT양성솔5.7％,sIgE양성솔9.2％；DerfSPT양성솔22.0％,sIgE양성솔7.6％,균저우화분적양성솔.화분변응원중이애호양성솔최고,SPT위51.9％,sIgE위47.1％.이진만변응원SPT작위판정치민여부적“금표준”,sIgE검측Der p화Der f적양성사연비분별위4.27화10.64,Kappa치분별위0.20화0.35.공계276례비염환자진행료상점진애검측,Der p 1양성2례(0.7％),Der f1양성4례(1.4％).Der p 1폭로수평여SPT양성정정상관(rs =0.156,P=0.01),단여sIgE양성적상관성무통계학의의(rs=0.116,P=0.055);Der f1폭로수평여SPT화sIgE양성균무명현상관성(rs=0.05,P=0.931;rs=0.07,P=0.245).결론 내몽고초원배경하진만폭로수평흔저,Der p화Der f불시변응성비염환자적주요치민원,진만적폭로여치민지간야비간단적제량-반응관계.재차특수배경중,진만변응원SPT여sIgE검측결과적일치성강도교저,고건의채취체내화체외검측수단상결합진행림상진단.
Objective To evaluate the correlation of exposure and sensitization to house dust mites among rhinitis patients,and the consistency of skin prick test (SPT) and serum specific IgE (sIgE) in the detection of sensitization in a steppe environment of Inner Mongolia.Methods Three hundreds and fourteen patients with rhinitis symptoms were recruited in this study in a hospital setting at Xilinhot City,Inner Mongolia.All patients underwent medical history investigation,anterior rhinoscopy,and allergen tests in vivo (SPT) and in vitro (sIgE).Dust samples were collected from mattresses in patient's bedroom.The concentrations of group Ⅰ major allergen of Dermatophagoides pteronyssinus (Der p) and Dermatophagoides farinae (Derf) were measured by enzyme linked immunosorbent assay (ELISA).Statistical analysis was performed using a SPSS 17.0 software (t test,x2 test and so on).Results Among a total of 314 patients,the prevalence of positive SPT for Der p and Derfwas 5.7％ and 22.0％,respectively; and the prevalence of positive sIgE for Der p and Derf was 9.2％ and 7.6％,respectively.Sensitization rates for house dust mites (Der p and/or Derf) were lower than those of pollens.The pollen allergen with the highest positive rate was mugwort (SPT,51.9％; sIgE,47.1％ ). Diagnostic tests using SPT as the gold standard for sensitization showed that the positive likelihood ratio of sIgE was 4.27 for Derp and 10.64 for Derf,and the Kappa value was 0.20 for Der p and 0.35 for Derf,respectively.A total of 276 dust samples collected from patient's mattresses were measured.The concentrations of Der p 1 and Derf 1 were detectable in 2 (0.7％ ) and 4 ( 1.4％ ) mattress samples,respectively.There was positive correlation between the exposure levels of Der p 1 and the SPT positive reaction to Der p ( rs =0.156,P =0.01 ),but no significant correlation was found between the exposure levels of Der p 1 and the sIgE positive reaction to Der p ( rs =0.116,P =0.055).There was no significant correlation between the exposure levels of Derf 1 and the SPT as well as sIgE positive reaction to Der f (rs =0.05,P =0.931 ; rs =0.07,P =0.245 ).Conclusions In the steppe environment of Inner Mongolia,exposure to house dust mites are very low,and the Der p and Derf are not the major allergens in patients with allergic rhinitis.Also,it was not a simple dose-response relationship between exposure and sensitization to house dust mites. In such a specific environment,there is lower consistency between the results of SPT and sIgE in the detection of sensitization to house dust mites.Therefore,it is recommended that the allergen testing in vivo and in vitro should be combined for clinical diagnosis.
