CAJ | 학술논문

目的：探讨驻内蒙古某团患间歇性变应性鼻炎（allergic rhinitis，AR）官兵皮肤点刺试验（skin prick test，SPT）阳性界值对血清特异性IgE（specific IgE，sIgE）诊断价值的影响，并评估SPT与血清sIgE测定值的诊断一致性。方法对驻内蒙古某团66例间歇性AR临床症状和体征的官兵进行23种常见的吸入变应原的SPT，选择阳性变应原数量≥4个和SPT阳性结果等级高者31例进行sIgE检测，采用瑞典Pharmacia的UniCAP100系统检测其血清中艾蒿、苦蒿、三裂叶豚草、葎草、榆树、柳树、桦树和蒲公英的血清sIgE，以临床症状、体征和SPT阳性结果作为诊断AR的参考标准，评价SPT阳性界值“＋”和“＋＋”对UniCAP100系统检测血清sIgE诊断价值的影响。评价指标包括灵敏度、特异度、阳性预测值、阴性预测值、一致率，并评价两种检测方法的一致性。结果①蒿属花粉是该驻地官兵间歇性AR的最主要变应原，其SPT阳性率在60%以上，其次依次是向日葵、葎草、豚草、白桦、榆树、柳树，SPT阳性率均在30%以上。②以SPT“＋”为阳性界值时，血清sIgE的灵敏度为0.500（葎草）～0.982（蒿属），特异度为0.500（豚草、榆树、桦树）～1.000（蒿属），一致率为0.581（葎草）～0.984（蒿属）；以SPT“＋＋”为阳性界值时，血清sIgE的灵敏度为0.524（葎草）～0.982（蒿属），特异度为0.462（豚草）～1.000（蒿属），一致率为0.581（豚草、柳树）～0.984（蒿属），诊断指标无明显变化。③两种检测方法诊断一致性，经Kappa检验显示，蒿属、豚草、葎草、榆树、柳树、桦树Kappa值分别是0.900（P=0.000）、0.131（P＝0.447）、0.214（P＝0.155）、0.377（P=0.034）、0.209（P＝0.242）、0.158（P＝0.373）。结论以蒿属花粉为代表的夏秋季杂草花粉和部分春季树花粉是该驻地官兵间歇性AR的主要变应原；SPT阳性界值“＋”和“＋＋”对UniCAP100系统检测血清sIgE诊断价值的影响不大；SPT和血清sIgE检测在蒿属花粉和榆树花粉致敏的诊断中具有较好的一致性。目的：探討駐內矇古某糰患間歇性變應性鼻炎（allergic rhinitis，AR）官兵皮膚點刺試驗（skin prick test，SPT）暘性界值對血清特異性IgE（specific IgE，sIgE）診斷價值的影響，併評估SPT與血清sIgE測定值的診斷一緻性。方法對駐內矇古某糰66例間歇性AR臨床癥狀和體徵的官兵進行23種常見的吸入變應原的SPT，選擇暘性變應原數量≥4箇和SPT暘性結果等級高者31例進行sIgE檢測，採用瑞典Pharmacia的UniCAP100繫統檢測其血清中艾蒿、苦蒿、三裂葉豚草、葎草、榆樹、柳樹、樺樹和蒲公英的血清sIgE，以臨床癥狀、體徵和SPT暘性結果作為診斷AR的參攷標準，評價SPT暘性界值“＋”和“＋＋”對UniCAP100繫統檢測血清sIgE診斷價值的影響。評價指標包括靈敏度、特異度、暘性預測值、陰性預測值、一緻率，併評價兩種檢測方法的一緻性。結果①蒿屬花粉是該駐地官兵間歇性AR的最主要變應原，其SPT暘性率在60%以上，其次依次是嚮日葵、葎草、豚草、白樺、榆樹、柳樹，SPT暘性率均在30%以上。②以SPT“＋”為暘性界值時，血清sIgE的靈敏度為0.500（葎草）～0.982（蒿屬），特異度為0.500（豚草、榆樹、樺樹）～1.000（蒿屬），一緻率為0.581（葎草）～0.984（蒿屬）；以SPT“＋＋”為暘性界值時，血清sIgE的靈敏度為0.524（葎草）～0.982（蒿屬），特異度為0.462（豚草）～1.000（蒿屬），一緻率為0.581（豚草、柳樹）～0.984（蒿屬），診斷指標無明顯變化。③兩種檢測方法診斷一緻性，經Kappa檢驗顯示，蒿屬、豚草、葎草、榆樹、柳樹、樺樹Kappa值分彆是0.900（P=0.000）、0.131（P＝0.447）、0.214（P＝0.155）、0.377（P=0.034）、0.209（P＝0.242）、0.158（P＝0.373）。結論以蒿屬花粉為代錶的夏鞦季雜草花粉和部分春季樹花粉是該駐地官兵間歇性AR的主要變應原；SPT暘性界值“＋”和“＋＋”對UniCAP100繫統檢測血清sIgE診斷價值的影響不大；SPT和血清sIgE檢測在蒿屬花粉和榆樹花粉緻敏的診斷中具有較好的一緻性。
목적：탐토주내몽고모단환간헐성변응성비염（allergic rhinitis，AR）관병피부점자시험（skin prick test，SPT）양성계치대혈청특이성IgE（specific IgE，sIgE）진단개치적영향，병평고SPT여혈청sIgE측정치적진단일치성。방법대주내몽고모단66례간헐성AR림상증상화체정적관병진행23충상견적흡입변응원적SPT，선택양성변응원수량≥4개화SPT양성결과등급고자31례진행sIgE검측，채용서전Pharmacia적UniCAP100계통검측기혈청중애호、고호、삼렬협돈초、률초、유수、류수、화수화포공영적혈청sIgE，이림상증상、체정화SPT양성결과작위진단AR적삼고표준，평개SPT양성계치“＋”화“＋＋”대UniCAP100계통검측혈청sIgE진단개치적영향。평개지표포괄령민도、특이도、양성예측치、음성예측치、일치솔，병평개량충검측방법적일치성。결과①호속화분시해주지관병간헐성AR적최주요변응원，기SPT양성솔재60%이상，기차의차시향일규、률초、돈초、백화、유수、류수，SPT양성솔균재30%이상。②이SPT“＋”위양성계치시，혈청sIgE적령민도위0.500（률초）～0.982（호속），특이도위0.500（돈초、유수、화수）～1.000（호속），일치솔위0.581（률초）～0.984（호속）；이SPT“＋＋”위양성계치시，혈청sIgE적령민도위0.524（률초）～0.982（호속），특이도위0.462（돈초）～1.000（호속），일치솔위0.581（돈초、류수）～0.984（호속），진단지표무명현변화。③량충검측방법진단일치성，경Kappa검험현시，호속、돈초、률초、유수、류수、화수Kappa치분별시0.900（P=0.000）、0.131（P＝0.447）、0.214（P＝0.155）、0.377（P=0.034）、0.209（P＝0.242）、0.158（P＝0.373）。결론이호속화분위대표적하추계잡초화분화부분춘계수화분시해주지관병간헐성AR적주요변응원；SPT양성계치“＋”화“＋＋”대UniCAP100계통검측혈청sIgE진단개치적영향불대；SPT화혈청sIgE검측재호속화분화유수화분치민적진단중구유교호적일치성。
Objective To explore the influence of different positive cut-off values of skin prick test(SPT) in the evaluation of serum specific IgE(sIgE) in the diagnosis of allergic rhinitis(AR) soldiers in Inner Mongolia,and to evaluate the diagnostic consistency between SPT and serum sIgE.Methods66 soldiers in a station of Inner Mongolia who had positive clinical symptoms and signs of AR were accepted SPT with 23 kinds of inhalant allergens, then 31 intermittent AR soldiers were selected, who had no less than 4 positive SPT and higher level of positve results. According to SPT, aforementioned 31 soldiers underwent detection of Artemisia vulgaris, Artemisia absinthium, Ambrosia trifida, Humulus scandens, Ulmus americana, Salix caprea, Betula verrucosa and taraxaci sIgE that was performed, using UniCAP100 system. The reference standard of AR was established according to the clinical symptoms, signs and positive SPT. The influence of diagnostic value of sIgE was evaluated based on“+”and“++”positive cut-off value of SPT, respectively. The diagnostic indexes includes sensitivity, specificity, positive predictive value, negative predictive value and concordance rate. And the diagnostic consistency between SPT and serum sIgE was also evaluated.Results ①Artemisia pollen was the major allergen among intermittent AR soldiers at this station and its SPT positive rate was more than 60%, followed by Sunflower, Humulus scandens, ragweed, Betula alba, Ulmus americana and Salix caprea in turns, with the SPT positive rate being more than 30%.②Based on“+” positive cut-off value of SPT, the sensitivity of serum sIgE ranged from 0.500(Humulus scandens) to 0.982(Artemisia), the specificity ranged from 0.500(ragweed, Ulmus americana, Betula verrucosa) to 1.000(Artemisia), and the concordance rate ranged from 0.581(Humulus scandens) to 0.984(Artemisia). When adjusting the cut-off value to“++”, the sensitivity of serum sIgE ranged from 0.524(Humulus scandens) to 0.982(Artemisia), the specificity ranged from 0.462(ragweed) to 1.000(Artemisia), and the concordance rate ranged from 0.581(ragweed, Salix caprea) to 0.984(Artemisia). The diagnostic indexes changed slightly.③The Kappa value of SPT and sIgE was 0.900(P=0.000)for Artemisia, 0.131(P=0.447)for ragweed, 0.214(P=0.155)for Humulus scandens, 0.377(P=0.034) for Ulmus americana, 0.209(P=0.242)for Salix caprea, 0.158(P=0.373)for Betula verrucosa, respectively.ConclusionRepresented by Artemisia pollen, summerish and autumnal weed pollen and some spring tree pollen were the main allergens of intermittent AR at this station. The effect on the diagnostic value of serum sIgE detected by UniCAP100 could be ignorable when the positive cut-off value of SPT was“+”or“++”.There was high consistency between SPT and serum sIgE in the detection of sensitization to Artemisia and Ulmus americana pollen.