天津地区支气管哮喘合并过敏性鼻炎的流行病学调查及肺功能分析

Lung function analysis and epidemiological survey of patients with bronchial asthma combined with allergic rhinitis in Tianjin area

目的了解天津地区支气管哮喘(简称哮喘)合并过敏性鼻炎(allergic rhinitis,AR)的流行病学情况,分析两者之间的临床相关性及对肺功能的影响。方法对天津地区142例哮喘患者进行哮喘合并过敏性鼻炎流行病学问卷调查及肺功能测定,了解患者的认知情况、治疗现状和肺功能状况,并建立相应的个人数据库档案,对数据进行统计学分析。结果 142例哮喘患者中,有97例合并过敏性鼻炎(68%),其中60例为鼻炎发病在先,占哮喘合并鼻炎患者的61.9%。哮喘合并鼻炎组和单纯哮喘组两组患者在性别、年龄和哮喘病史方面比较差异无统计学意义(P>0.05),但哮喘合并鼻炎组的组间比较显示鼻炎史显著长于哮喘史,差异有统计学意义(P<0.05)。与单纯哮喘组相比,鼻炎合并哮喘组的哮喘控制测试(asthma control test,ACT)评分明显偏低,差异有统计学意义(P<0.05)。与单纯哮喘组相比,哮喘合并鼻炎组患者的呼气峰流速(peak expirationg flow,PEF)显著下降,吸入性糖皮质激素量减低,小气道敏感指标肺活量为75%时最大呼气流量(MEF75%)和MEF50%显著降低,而脉冲振荡频率在20Hz时呼吸阻力(R20)增高。过敏性鼻炎与哮喘严重程度呈明显的正相关(rs=0.604,P<0.01)。结论过敏性鼻炎多在哮喘之前发生,其与哮喘严重程度具有高度的一致性,是引发哮喘的一项重要危险因素。哮喘合并过敏性鼻炎患者的ACT评分显著低于单纯哮喘患者,并且过敏性鼻炎进一步导致了肺通气功能的下降及气道阻力增加,提高了哮喘的控制难度。

Objective To study the epidemiology of allergic rhinitis in bronchial asthma patients from Tianjin and to analyze the correlation of clinical characteristics as well as the lung function between allergic rhinitis and bronchial asthma.Methods A questionnaire survey of 142 bronchial asthma patients from the city of Tianjin was carried out. Their cognitive environment,treatment status and Lung function condition were investigated in detail, and a database was set up for statistics.Results In 142 bronchial asthma patients,97(68%) were accompanied with allergic rhinitis,in which 60(61.9%) had allergic rhinitis earlier.The gender,episode ages and their courses of bronchial asthma of both groups had no significant differences (P>0.05),but the courses of allergic rhinitis was significantly longer than the courses of bronchial asthma in asthma patients that had allergic rhinitis (P<0.05).Compared to asthma patients who had no allergic rhinitis, the asthma control test (ACT) score, peak expirationg flow (PEF)%,MEF75% and MEF50% of asthma patients who had allergic rhinitis were significantly lower,and the inhaled glucocorticoids (IC) was decreasing as well as the R20 was increasing. The classification and severity of allergic rhinitis and bronchial asthma are highly coherent(rs=0.604,P<0.01).Conclusions Allergic rhinitis which is one of the important risk factors in leading asthma often occurred before asthma,and its classification and severity are highly consistent with bronchial asthma. The ACT score of asthma patients combined with allergic rhinitis were significantly lower than those with asthma alone. allergic rhinitis can result in lung ventilation function decline and airway resistance increases,for which increase the difficulty of controlling asthma.