广州地区儿童呼吸道变态反应性疾病螨性变应原相关危险因素分析

Risk factors of acarines sensitization for respiratory allergic diseases of children in Guangzhou urban districts

目的了解广州地区呼吸道变态反应性疾病患儿常见变应原种类特点及螨性变应原相关危险因素，为预防和治疗患儿变应性疾病提供科学依据。方法选择2006年2月至2007年3月在广州医学院第一附属医院儿科门诊符合哮喘和（或）鼻炎的广州地区5岁以上患儿183例，其中男l32例，平均年龄（8．2±0．21）岁；女51例，平均年龄（7．8±0．44）岁；哮喘并鼻炎者105例，哮喘患儿58例，仅鼻炎患儿20例。所有对象均由家长及其监护人回答统一标准的问卷调查，并进行皮肤变应原点刺试验（SPT）及血清总IgE、特异性IgE和嗜酸粒细胞计数。结果在入选的183例患儿中，SPT阳性（≥1个变应原阳性）157例，占85．8％，各变应原阳性率为5．5％～75．4％，变应原中以屋尘螨致敏的阳性率最高，达79．8％（146／183），其次为粉尘螨与热带螨，分别为72．7％（133／183）～65．0％（119／183），其余过敏原阳性率依次为：狗毛48．6％（89／183），美洲大蠊47．0％（86／183），猫毛34．4％（63／183），德国小蠊29．5％（s4／183），霉菌类19．7％（36／183），花粉类15．9％（29／183），艾蒿7．7％（14／183），豚草5．5％（10／183）。螨过敏阳性患儿有146例，常合并其他一种或多种变应原阳性（115例，78．8％），而螨过敏阴性患儿（37例，20．2％）中仅有11例（29．7％）合并其他一种或多种变应原阳性（Х^2=33．099，P〈0．001），差异有统计学意义，提示螨类过敏是呼吸道变态反应性疾病的重要致敏原，而螨性已致敏的患者会增加对其他过敏原的风险。以一种或多种螨过敏SPT结果“＋＋”及以上作为阳性，其余为阴性，经多因素Logistic回归分析：年龄每增加1岁、反复鼻炎、眼部及呼吸道症状是螨过敏呼吸道变态反应性疾病患儿的危险因素，而家族过敏史、居住环境及饮食习惯等因素与螨过敏所致的哮喘和（或过敏性鼻炎）差异无统计学意义。结论过敏性因素是患儿呼吸系统变态反应性疾病发病的重要环境相关危险因素，广州地区哮喘和（或）鼻炎患儿最常见的变应原是屋尘螨、粉尘螨及热带螨，可以通过SPT检查明确过敏原。年龄增加、反复鼻炎、眼部、哮喘症状控制不良是螨类致敏呼吸道变态反应性疾病发病的危险因素。变态反应性疾病应以早期防治为医疗工作的重要方针，研究本地区变态反应性疾病患者的变应原种类特点及危险因素，有助于疾病的早期诊断和早期防治，并可针对变应原采取特异性免疫治疗，可望使螨性哮喘和鼻炎患儿达到并维持稳定。

Objective To evaluate the common allergies and the acarines sensitization as risk factors for respiratory allergic diseases of children in Guangzhou urban districts and to provide the evidence for preventing allergic diseases. Methods All cases were collected from pediatric out-patient department of the first affiliated hospital of Guangzhou medical college from february 1st, 2006 to march 30th,2007. One hundred and eighty three children were above 5 years old, were diagnosed asthma and （or） allergic rhinitis,and lived in Guangzhou urban districts. In 183 cases, 132/183 were males and 51/183 were females. The average age was （8.2±0.2） years old in males and （7.8±0.44） years old in females. Among 183 patients,58 cases were asthma,20 cases were rbinitis and 105 cases were asthma and rhinitis. All the patients of their parents or guardians completed a standardized questionnaire on the presence of respiratory and allergic symptoms. They also underwent skin prick tests with 13 common aeroallergens, total IgE,specific IgE and eosinophil count in serum. Results Among the 183 patients,157 （85.8%） had at least one positive skin reaction. The rates of positive skin reaction with 13 common aeroallergens were from 5.5 % to 75.4%. The positive rate of Dermatophagoides pteronyssinus （Der p） was the highest （79.8%, 146/183）, then followed up by Dermatophagoides farinae （Der f） （ 72.7%,133/183 ）, Blomia tropicalis （65.0%, 119/183）,dog（48.6% ,89/183）,American cockroach （47.0% ,86/183）,cat（34.4%, 63/183）, Blatella germanica （ 29.5%, 54/183 ）, mixed moulds （ 19.7 %, 36/183 ）, mixed grass pollens （15.9%, 29/183 ）, Artemisia vulgaris （ 7.7%, 14/183 ）, Ambrosia artemisifolia （ 5.50%, 10/183 ）. The patients （146/183 cases） who were positive reactivity in mites were concomitant reactivity to multiple allergens（115/146 cases, 78.8% ）. Only 11 cases with negative reactivity in acaridan were combine with multiple allergens（11/37 cases, 29.7%）. There was more statistically significant between in positive/ negative skin reaction with acaridan（ Х^ 2= 33. 099, P 〈0. 001）. Patients whose underwent skin reaction ＂＋＋＂ with Der p or Der f or Blomia tropicalis was defined positive. Multivariate logistic regression analysis revealed that ages,iteretur rhinitis,ocular symptoms and respiratory symptoms were risk factors for respiratory allergic diseases of children in Guangzhou urban districts. Family allergic histories, inhabited environment and food habits et al, were not risk factors. Conclusions The allergy is the important factor in respiratory allergy disease. House dust mites were the most prevalent allergens in children with asthma and （or） rhinitis in Guangzhou urban. Those patients with asthma and （or） allergic rhinitis usually have the positive skin prick tests. With the growing up, the children with respiratory allergic disease are more sensitive to acarines sensitization. To estimate allergen patterns of sensitizations in patients from different geographic areas, age groups as well as asthma and （or） rhinitis contribute to earlier diagnosis and earlier prevention.