皮内试验和血清特异性IgE检测在诊断葎草花粉症中的临床价值

Values of intradennal skin test and serum sIgE detection in diagnosing Humulus scandens pollinosis

目的评价皮内试验和血清特异性IgE(sIgE)检测在诊断葎草花粉症中的临床价值。方法对1150例(5-75岁)夏秋季变应性鼻炎和哮喘患者进行葎草花粉等20种吸入过敏原皮内试验和葎草花粉血清sIgE检测。皮内试验所用葎草花粉变应原浸液浓度1:100(w／v),其他变应原浓度除蒿属花粉和豚草花粉为1:1000(w／v)外均为1:100(w／v)。对所有入选者进行葎草花粉sIgE检测(Phadia Uni CAP)。根据典型病史、皮内试验和sIgE检测结果建立临床综合诊断标准并以此评价皮内试验和sIgE检测的临床价值。结果以临床综合诊断为诊断标准时葎草花粉皮内试验的敏感度(89．0％)、阳性预期值(77．9％)、阴性预期值(90．6％)和诊断的准确率(80．4％)等指标均高于单纯以sIgE≥0．35 kUa／L为参考标准时皮内试验的各项评价指标,但假阳性率为50．2％;葎草花粉sIgE检测的敏感度(97．6％)、特异度(97．5％)、阳性预期值(98．8%)、阴性预期值(88．0％)和诊断的准确率(92．0％)等指标高于单纯以皮内试验≥5 mm为参考标准时体外试验的各项指标。当以皮内试验≥10 mm为阳性标准时,皮内试验假阳性率从59．9％降至17．4％。在288例葎草花粉皮内试验阳性而sIgE阴性者中,有84例皮内试验≥10 mm。结论皮内试验与sIgE检测有很好的相关性,但其诊断葎草花粉过敏的假阳性率高于sIgE检测。当单独使用皮内试验或sIgE检测诊断葎草花粉症时,应避免仅凭低水平的阳性结果进行免疫治疗。

Objective To evaluate the values of intradermal skin test（ IDT） and serum specific IgE detection in diagnosing Humulus scandens sensitivity in Chinese patients with autumnal hay fever. Methods 1150 patients, 504 males and 646 females, aged 5 - 75, were evaluated as with autumnal rhinitis and asthma by experienced physicians. Then the patients underwent IDT by using 20 kinds of aeroallergen extracts, at the concentration of 1 ： 1000 （w/v） for Artimisia spp. and ragweed or at the concentration of 1：100 （w/v） for Humulus scandens and others. The Humulus slgE level was performed in all patients. A diagnosing criteria was established according to typical history, symptoms, and any one f following findings ： ① wheal ≥5 mm in diameter by IDT and slgE to Humulus of the concentration ≥ 0. 35 kUa/L at same time; ② wheal ≥10 mm in diameter by IDT alone; and ③ sIgE to Humulus of the concentration ≥0. 70 kUa/L alone. Results When using the above diagnosing criteria as the reference standard, IDT had better sensitivity （ 97. 2% ）, positive predictive value （ PV ＋ ） （ 77. 9% ）, negative predictive value （PV-） （90. 6% ） and efficiency （80.4%than using slgE ≥ 0. 35 kUa/L alone as the reference criteria of IDT, however, had a lower specificity （49. 8% ） ; and slgE detection had better sensitivity （89.0%）, specificity （97.5%）, PV ＋ （98.8%）, PV-（88.0%） and efficiency （92.0%） than using wheal ≥ 5 mm in diameter alone as the reference criteria of slgE detection. The false positive rate of IDT decreased from 59. 9% to 17.4% when using wheal diameter≥10 mm as the positive criteria. In the 288 patients with a negative sIgE result and a positive IDT result 84 cases had stronger positive IDT result （ with the wheal diameter ≥ 10 mm ）. Conclusion IDT is correlated well with sIgE detection in diagnosing Humulus scandens pollinosis, but the false positive rate of IDT is higher than that of sIgE test. The false positive rate of IDT can be decreased by increasing the positive criteria to higher grading reaction. The immunotherapy according to the lower grading positive result of IDT alone or sIgE alone should be avoided.