广州城市青少年特应性与支气管哮喘的关系调查

A survey on the relationship between atopy and bronchial asthma among adolescents in the city of Guangzhou,China

目的了解广州城市青少年特应性的流行情况,探讨特应性与支气管哮喘(简称哮喘)的关系,明确主要的吸入性变应原。方法 2002年4至5月在广州市参加儿童哮喘和变应性疾病的国际性对比研究(简称 ISAAC)第三阶段调查的10所学校学生中,每所学校以班级为单位进行随机整群抽样调查。采用5组9种吸人性变应原(屋尘螨、粉尘螨、猫毛、美洲大镰、德国小镰、混合草花粉、混合树木花粉、链格孢属真菌、混合霉菌)对1187名学生进行皮肤点刺试验。哮喘定义为:既往或近12个月胸部有喘息声、胸闷或曾被医生诊断为哮喘,有哮喘、鼻炎、湿疹中的任1种疾病视为有变应性疾病史。变应原皮试反应的风团直径大于阴性对照3 mm 以上为阳性,有1个或以上变应原反应阳性视为特应性。特应性程度及变应原阳性反应强度分别以特应性指数(AI)及皮肤指数(SI)分级表示。结果随机抽取1543人参加调查,实际应答率为77.0%(1187/1543),其中男性为51.6%(613/1187),女性为48.4%(574/1187),年龄12～17岁(中位数14岁)。哮喘的患病率为9.4%(111/1187),其中合并鼻炎率为81.1%(90/111),合并湿疹率为24.3%(27/111)。686例有鼻炎史患者合并哮喘率为[13.1%(90/686)],高于无鼻炎史者[4.2%(21/501),OR 值为3.444,95%可信区间(CI)为2.110～5.622,P<0.01];200例有湿疹史患者合并哮喘率为[13.5%(27/200)],也高于无湿疹史者[8.5%(84/987),OR 值为1.676,95%CI 为1.055～2.663,P<0.05]。特应性阳性率为46.3%(549/1187),其中尘螨(屋尘螨、粉尘螨)皮试反应阳性率最高[分别为41.8%(496/1187)、42.7%(507/1187)]。哮喘患者特应性阳性率为[71.2%(79/111)],高于无变应性疾病者[26.4%(112/425),OR 值为6.812,95%CI 为4.276～10.853,P<0.01],且随着合并其他疾病种类的增加而升高。与特应性阴性者比较,特应性阳性是哮喘的危险因素(OR 值为3.183,95%CI 为2.075～4.883,P<0.01),且哮喘的患病风险随着特应性程度的增加而升高。单因素 Logistic 回归分析结果表明,哮喘的危险因素有屋尘螨(SI≥2)、粉尘螨(SI=3～4)、美洲大蠊、德国小蠊、猫毛、链格孢属、混合草花粉。多因素 Logistic 回归分析结果表明,屋尘螨(SI=3～4)、链格孢属阳性仍是哮喘独立的危险因素。结论广州城市青少年哮喘患者大多属尘螨变应性的,哮喘的患病风险随着特应性程度及屋尘螨皮试反应强度增加而升高。

Objective To access the relationship between atopy and bronchial asthma in adolescents. Methods A cross-sectional study was conducted. Cluster randomized subgroups of schoolchildren who had participated in ISAAC phase Ⅲ survey in Guangzhou were enrolled from april to May, 2002. Skin prick test with 5 groups totally for 9 common aeroallergens （dermatophagoides pteronyssinus, Dermatophagoides farinae, cat, Ahernaria tenuis, mixed tree pollen, mixed grass pollen, American cockroach, German cockroach and mixed moulds ） was performed. Asthma was defined as wheezing or whistling in the chest in the lifetime or in the last 12 months, or diagnosed asthma. Allergy disease was defined as any of asthma, rhinitis and eczema. A wheal size with the diameter of 3 mm or more after subtraction of the negative control was considered as positive and subjects with one or more positive reactions were considered as atopy. The degree of atopy and the sensitivity of the allergen were graded by atopic index （AI） and skin index （SI）, respectively. Results 1543 subjects were selected randomly for the skin prick test, and the response rate was 77.0% （1187/1543 ）. 51.6% （613/1187） were males and 48.4% （574/1187） were females. The median age was 14 years old （range from 12 - 17 years old）. The prevalence of asthma was 9.4% （111/1187） , among whom 81.1% （90/111） also had rhinitis and 24. 3% （27/111） had eczema. Asthma was more prevalent in 686 patients with rhinitis [ 13. 1% （90/686） ] or 200 patients with eczema [ 13. 5% （27/200） ] than those without rhinitis [4. 2% （21/501）, OR：3.444, 95% CI：2.110-5.622, P〈0.01] or eczema [8.5% （84/987）,0R：1.676, 95%CI：1.055 -2.663,P〈 0. 05 ]. The prevalence of atopy was 46. 3% （549/1187 ） and the positive rates of house dust mite （ Der p and Der f） were the highest [41.8% （496/1187） and 42. 7% （507/1187） ,respectively]. Atopy was more common in asthmatic patients [ 71.2% （79/111）] than in those without any allergic diseases [ 26. 4% （112/425） , OR： 6. 812, 95% CI： 4. 276 - 10. 853, P 〈 0. 01 ]. Asthma was more prevalent in patients with atopy （ 14.4% ） than those without atopy （5.5%, OR： 3. 183, 95% CI： 2. 075 -4. 883 ,P 〈 0. 01 ）. The relative risk of having asthma was increased with the higher AI degree. Univariate logistic regression analysis showed that the risk factors for asthma were Der p （ SI ≥ 2 ） , Der f （ SI = 3 - 4 ） , American cockroach, German cockroach, cat, Alternaria tenuis, mixed grass pollen. Multivariate logistic regression analysis showed that Der p （ SI = 3 - 4 ）, and Alternaria tenuis were independent risk factors for asthma. Conclusion Most asthmatic adolescents were allergic to house dust mite in the city of Guangzhou. The risk of asthma was positively correlated with the degree of atopy, as well as the sensitivity to Der p.