变应性鼻炎患儿鼻炎症状分级评分的临床应用价值

Clinical Evaluation of Rhinitis Symptom Score in Allergic Rhinitis

目的通过乙酰甲胆碱气道激发试验,探讨并分析鼻炎症状分级评分诊断变应性鼻炎气道高反应性的临床应用价值。方法2005年6月～2007年2月就诊于首都儿科研究所附属儿童医院耳鼻喉科门诊≥5岁的变应性鼻炎患儿54例,行乙酰甲胆碱气道激发试验(methacholine bronchial provocation test,MthBPT)及皮肤变应原点刺试验(skin prick test,SPT),探讨鼻炎症状分级评分与变应性鼻炎气道高反应性及皮肤变应原数目的相关性。结果(1)鼻炎症状分级评分≥6分患儿乙酰甲胆碱气道激发试验阳性的发生概率是鼻炎症状分级评分≤5分患儿的3.85倍(95%可信区间1.19～12.47),两者比较差异有显著性意义(χ2=5.275,P=0.022)。(2)鼻炎症状分级评分≥6分患儿较鼻炎症状分级评分≤5分患儿的PD20[第一秒钟用力呼气容积(FEV1)或呼气峰流速值(PEF)下降值≥20%对照值时的乙酰甲胆碱气道激发药物累计剂量,provoking dose,PD20]均值降低,≥6分患儿的鼻炎症状分级评分与PD20均值呈较明显的负相关。(3)鼻炎症状分级评分≥6分患儿较鼻炎症状分级评分≤5分患儿的变应原数目有所增加,鼻炎症状分级评分与变应原数目呈正相关(鼻炎症状分级评分与变应性鼻炎患儿皮肤变应原数目的spearman等级相关系数为0.277,P=0.043)。结论鼻炎症状分级评分(≥6分)可能为评估变应性鼻炎患儿气道高反应性严重程度的临床参考指标。

To discuss the clinical value of rhinitis symptom score in diagnosing of airway hyperresponsiveness （AHR） exists in the children of allergic rhinitis （AR）. Methods There were fifty-four children （age≥5 years old） in the AR group, who were diagnosed as AR from June, 2005 to February, 2007 in E.N.T Dept. and Asthma Dept. at Children＇s Hospital Affiliated to the Capital Institute of Pediatrics, and were examined by methacholine bronchial provocative test （Mth BPT） and skin prick test （SPT） to discuss about the value of rhinitis symptom score clinically related to the AHR in the children with AR. Results （1） There was a significant difference （X^2=5.275, P〈 0.05） on Mth BPT in the AR group between rhinitis symptom scored ≥16 and rhinitis symptom score ≤5. The OR in children with rhinitis symptom scored ≥6 was 3.85 times （95% CI：1.19-12.47） high than children with rhinitis symptom score ≤5. （2） Column figure analysis revealed that there was a significant decrease in the mean of PD20 while the score of rhinitis symptom increased （negative correlation）. The mean of PD20 of the children with the rhinitis symptom score ≥16 was lower than that of the children with the rhinitis symptom score ≤5. （3） There was a positive correlation between the score of rhinitis symptom and the number of SPT poeitive results （spearman 0.277, P 〈 0.05）. There was an increase in the number of SPT poeitive results while the score of rhinitis symptom increased （positive correlation）. The number of SPT pocitive results of the children with rhinitis symptom score ≥ 6 was more than that of the children with rhinitis symptom score ≤ 5. Conclusions AHR in AR was correlated with the score of rhinitis symptom （≥ 6）. It is possible that the score of rhinitis symptom （≥ 6） can be used as a clinical index to evaluate the severity of AHR in AR.