儿童变应性鼻炎临床特点分析及相关问题调查

Survey on clinical characteristics of pediatric allergic rhinitis

目的 探讨15岁及以下变应性鼻炎（allergic rhinitis,AR）患儿的临床表现、诱因、伴发疾病、家族史及生活质量情况,分析不同年龄段儿童AR临床特点,为提高儿童AR患者的综合诊疗提供临床参考.方法 2008年6月至2010年6月对148例15岁及以下确诊为AR的连续病例进行问卷调查及鼻腔检查,100分制视觉模拟量表（visual analogue scale,VAS）作为症状调杳量表评价症状的严重程度,将所调查对象分为：学龄前儿童组（43例,年龄3.2～6.0岁）、学龄儿童组（105例,年龄6.1～14.8岁）.根据VAS评分对单个样本各症状严重程度横向对比以减少主观因素即不同个体对症状严重程度认知判断上的差异,然后对两组症状特点进行比较,应用SPSS 13.0软件完成统计学分析.结果 学龄前儿童组患儿以鼻塞为最严重症状,其发生率（67.4%）高于学龄儿童组（21.0%）,差异有统计学意义（Х^2=29.194,P〈0.05）;喷嚏、鼻痒两组间无明显差异（Х^2值分别为0.464、0.046,P值均〉0.05）;学龄儿童组以鼻涕为最严重症状,其发生率（58.1%）高于学龄前儿童组（20.9%）,差异有统计学意义（Х^2=16.904,P〈0.05）;两组伴发眼部症状发生率差异无统计学意义（Х^2=0.086,P〉0.05）;伴发咳嗽症状发生率学龄前儿童组（69.8%）高于学龄儿童组（38.1%）,差异有统计学意义（Х^2=12.277,P〈0.05）.分型分析表明学龄前儿童组以轻度间歇性AR为主,学龄儿童组以中-重度持续性AR为主,差异有统计学意义（Х^2值分别为20.370、24.546,P值均〈0.05）.148例患儿中认为长期上呼吸道感染、家庭装修、气候、环境变化为AR诱因者分别为33例（22.3%）,8例（5.4%）,24例（16.2%）,5例（3.4%）,其他诱因7例（4.7%）,无明显诱因者71例（48.0%）;父母一方或双方有过敏史者17例（11.5%）;因AR症状影响睡眠质量者98例（66.2%）;因AR症状难以集中注意力者92例（62.2%）.结论 学龄前儿童与学龄儿童AR的临床表现特点不同.本研究获得了儿童AR伴发症状、诱因等临床资料,为提高儿童AR综合诊疗水平提供参考.

Objective To investigate the clinical symptom, precipitating factor, associated symptom, family history and life quality of pediatric patients with allergic rhinitis, and to analyze the characteristic of clinical symptoms. Methods A questionnaire survey on pediatric AR patients since June 2008 to June 2010, one hundred and forty-eight pediatric AR patients were divided into 2 groups, group A （n =43） included children aged from 3.2 to 6.0, group B（n = 105） included children aged from 6.1 to 14.8. The severity degree of clinical symptom was assessed by visual analogue scale. Results Preschool age children had more severe rhinocleisis, more severe cough and less rhinorrhea than school age children （Х^2 value were 29. 194, 12.277 and 16. 904, respectively, P 〈 0.05 ）. According to the classification criteria of ARJA 2008, preschool children had more mild intermittent AR and less moderate-severe persistent AR than school age children （ Х^2 value were 20. 370 and 24. 546, P 〈 0.05 ）. The precipitating factor of common cold, fitment, climate, environment factors were 22.3% （ 33/148 ）, 5.4% （ 8/148 ）, 16.2%（24/148）, 3.4% （5/148）, the others was 4.7% （7/148）, no obvious precipitating factor was 48.0%（71/148）. The rate of parent or parents who had allergic disease history was 11.5% （17/148） . Quality of sleep that 66.2% （ 98/148 ） were upset and 62.2% （ 92/148 ） had no cathexis. Conclusions The preschool children have different clinical symptom characteristic from the school age children, and we got some clinical data of pediatric AR patients, those were beneficial to the diagnose and therapy of pediatric AR. The clinical data obtained in this study from pediatric AR patients are beneficial to the diagnosis and therapy of pediatric AR.