温州地区402例哮喘患儿特应质现象分析

Atopic characteristics of 402 children with asthma in Wenzhou

目的对温州地区15岁以下哮喘患儿特应质现象进行分析,探讨其临床及理论价值。方法回顾性分析402例哮喘患儿皮肤过敏原诊断试验、血清特异性IgE、总IgE、个人过敏史、家族史、过敏原检出率、类型及与年龄关系。结果哮喘发病有家族聚集倾向,家族过敏史总阳性率为52.74%。个人过敏史总阳性率为61.69%。过敏原皮肤诊断试验和过敏原血清特异IgE阳性率达83.58%,吸入性过敏原阳性人数占检测患儿的74.13%,其中以粉尘螨(61.44%)、屋尘螨(58.96%)为主;食入性过敏原阳性占24.38%,以小虾(16.67%)、牛奶(8.46%)为主。血清总IgE阳性率87.9%,总IgE阳性组和阴性组的哮喘患儿血清嗜酸性细胞阳离子蛋白(ECP)、户尘螨sIgE(D1)、粉尘螨sIgE(D2),皮肤过敏原诊断试验(pt)、家族过敏史、个人过敏史差异有统计学意义(P均≤0.05)。哮喘患儿3岁前、后过敏原分布不同,3岁以后吸入性过敏原阳性为主。发病诱因中以上呼吸道感染为最多,哮喘症状发作的时间主要集中在临睡、夜晚、清晨。结论儿童哮喘存在明显特应质现象,对其的正确认识和诊断对哮喘免疫机制的深入研究、综合治疗如在糖皮质激素吸入治疗的基础上,增加患儿教育、过敏原避免、特异性的免疫治疗等具有实用和理论指导意义.

Objectives To analyze the atopic characteristics in children under 15-year old with asthma in Wen-zhou, and evaluate their practical and theoretical values. Methods Retrospectively analysis of 402 children with asthma were done on skin prick test, serum allergen-specific IgE, serum total IgE, individual allergic manifestations, familial history, allergen detected rate and type, and age. Results Asthma had a familial trend, the total positive rate of familial history was 52.74%. The total positive rate of individual allergic manifestations was 61.69%. The positive rate of skin prick test and serum allergen-specificity IgE was 83.58 %. The positive rate of allergen inhale was 74.13% in tested patients, and dermatophagoides farinae （61.44%）, dermatophagoides pteronyssinus （58.96%） were two dominant allergens. The total positive rate of food allergens is 24.38%, and two main sources were shrimp （16.67%） and milk （8.46%）. The total positive rate of serum total IgE was 87.9%. There were significant differences （P〈0.05） of the total IgE between asthma children having positive and those having negative results of serum eosinophil cationic protein （ECP）, slgE （D1）, sIgE （D2）, skin prick test （pt）, familial history of allergy, individual allergen manifestations. Children with asthma had different allergens before and after 3 years old. After 3 years old, the allergens mainly were inhaled allergens. The asthma were triggered mainly by upper respiratory tract infection. The onsets of asthma were mainly before sleeping, in the night and early in the morning. Conclusions Childhood asthma has obvious atopic characteristics. Understanding and recognizing the atopic characteristics have practical and theoretical significance in researches on the immune mechanism and combined treatments of asthma, such as the treatment based on the inhaled glucocorticoid, education of the patients avoidance of allergens, and specific immunotherapy.