PCA测定血清特异性IgE在变应性鼻炎流行病学调查中的应用

PCA quantitative detection of serum specific IgE in epidemiologic study of allergic rhinitis

目的探讨PCA测定血清特异性IgE(sIgE)在变应性鼻炎(AR)流行病学调查中的应用,并分析该方法的阳性标准对AR诊断的影响。方法 2007年4月～2009年5月,以华北地区一般人群为调查对象,通过随机整群和多级抽样共计1576例,采用直接面访并结合血清变应原sIgE检测(PCA法)进行AR患病率及相关因素调查。结果当血清sIgE≥Ⅰ级为阳性标准时,变应原检测阳性595例(37.8%),诊断AR的患者为216例(13.7%),诊断AR的阳性预测值为53.9%,阴性预测值为58.0%。血清sIgE≥Ⅱ级为阳性标准时,变应原检测阳性402例(25.5%),诊断AR的患者为146例(9.3%),诊断AR的阳性预测值为79.9%、阴性预测值为85.1%。两种阳性评判标准所致各项结果间比较,差异均有统计学意义(P<0.01)。血清sIgE为Ⅰ级者30例中,鼻激发试验阳性6例(20.0%);血清sIgE为Ⅱ级者30例中,鼻激发试验阳性17例(56.7%)。结论在流行病学研究中,血清变应原sIgE的阳性标准不同可影响AR患病率的评估,故应具体分析。采用PCA检测血清sIgE,为提高AR的诊断率,以≥Ⅱ级作为阳性标准较为科学。

Objective To discuss the application of PCA quantitative detection of serum specific IgE （slgE） in epidemiologic study of allergic rhinitis （AR）, and analysis the influence of slgE positive criteria on AR diagnosis. Method The prevalence of AR and related factors in general population of northern China were investigated by using direct interview combined with measurement of serum allergen slgE （PCA method） in from April 2007 to May 2009. Total of 1576 cases were enrolled in this study by randomly multi-stage and cluster sampling. Results As the positive criteria was 〉 grade I for serum slgE levels, 595 cases （37.8%） had positive results, 216 cases （13.7%） were diagnosis as AR, positive and negative predictive value for AR were 53.9% and 58.0%, respectively. As the positive criteria was 〉 grade II for serum slgE levels, 402 cases （25.5%） had positive results, 146 cases （9.3%） were diagnosis as AR, positive and negative predictive value for AR were 79.9% and 85.1%, respectively. Significant differences （P〈0.01） were found between the Results accroding two kinds of positive criteria for slgE. Among 30 cases whose slgE levels were grade I, 6 patients had positive results in allergen nasal provocation testing （20.0%）, and so were 17 patients in 30 cases with grade II of slgE levels （56.7%）. Conclusion The positive criteria for serum levels of allergen slgE affect the assessment of AR prevalence in epidernilogic study. It is reliable to set the positive criteria for serum slgE levels as grade Ⅱ or above in the diagnosis of AR.