湿疹皮炎患者过敏原特异性IgE检测阳性结果的多中心研究

Detection of allergen-specific serum IgE in patients with eczema or dermatitis： a multicenter study

目的探讨湿疹皮炎患者血清过敏原检测常见的阳性过敏原及其临床意义。方法回顾性分析中国10家医院皮肤科就诊并进行了血清变应原特异性IgE检测且至少一项阳性的湿疹皮炎患者。结果458例患者纳入研究，其中男209例（45．63％），女249例（54．37％），年龄（28．13±23．11）岁。前3位常见阳性过敏原为蟑螂（180／458，占39．30％）、尘螨组合（152／458，占33．19％）、花生（116／458，占25．33％）。89．66％（26／29）特应性皮炎患者及86．84％（33／38）面部湿疹患者存在多种过敏原。皮损相对泛发者过敏率（88／110，占80％）较皮损相对局限者（245／348，占70．40％）高，差异有统计学意义χ2=3．880，P=0．049）。吸人变应原阳性率在11-20岁年龄组最高（39／43，占90．70％）；牛奶（26／98，占26．53％）、牛肉（19／98，占19．39％），特异性IgE阳性多见于3岁以下婴幼儿。北方与南方常见变应原不同，艾蒿、蟑螂、牛奶、黄豆、牛肉、淡水鱼特异性IgE阳性率（10．35％、42．42％、14．39％、13．89％、11．36％、13．38％）均分别高于南方（1．61％、19．35％、3．23％、3．23％、1．61％、3．23％），差异有统计学意义（r=4．917、11．959、5．958、5．594、5．641、5．235，均P〈0．05）。结论蟑螂是湿疹皮炎患者致敏率较高的变应原，临床意义值得研究。面部湿疹及特应性皮炎更容易多发过敏。年龄是影响变应原致敏的较重要因素。不同地域常n尢变应原不同。

Objective To identify common allergens in patients with eczema or dermatitis by using serum IgE tests, and to explore their clinical significance. Methods A retrospective study was carried out on eczema or dermatitis patients with at least one positive serum IgE test result from 10 hospitals in China. Results Totally, 458 patients were included in this study with an average age of 28.13± 23.11 years. Of these patients, 209 （45.63%） were male, and 249 （54.37%） were female. The top three allergens were cockroaches （ 180/458, 39.30% ）, dust mite mix（ 152/458, 33.19% ） and peanuts （116/458, 25.33%）. Polysensitization （sensitization to more than one allergen） was observed in 89.66% （26/29） of patients with atopic dermatitis and 86.84% （33/38） of patients with facial eczema. Moreover, the rate of polysensitization was significantly higher in patients with generalized lesions than in those with circumscribed lesions （80% （88/110） vs. 70.40% （245/348）, χ2= 3.880, P = 0.049 ）. The positive rate of specific IgE against inhaled allergens was highest in the age group of 11 - 20 years （39/43, 90.70%）, while the specific IgE against milk （26.53%, 26/98） and beef （19.39%, 19/98） was mainly observed in children aged less than 3 years. In addition, patients in northern areas showed increased positive rates of specific IgE to mugwort （10.35% vs. 1.61%, χ2 = 4.917, P 〈 0.05）, cockroaches （42.42% vs. 19.35%, χ2 = 11.959, P 〈 0.05）, milk （14.39% vs. 3.23%, χ2 = 5.958, P 〈 0.05）, soybeans （13.89% vs. 3.23%,χ2 = 5.594, P 〈 0.05）, beef （ 11.36% vs. 1.61%,χ2 = 5.641, P 〈 0.05） and fresh-water fish （ 13.38% vs. 3.23%, = 5.235, P 〈 0.05） compared with those in southern areas. Conclusions Cockroaches are a common allergen in patients with eczema or dermatitis, and their clinical significance is worthy of further study. Polysensitization seems to be more frequent in patients with facial eczema or atopic dermatitis. Age is an important factor influencing allergen sensitization, and there is a regional difference in the distribution of common allergens.