过敏原及致敏模式对支气管哮喘患儿气道炎症状态及肺功能的影响

Effects of sensitization pattern and sensitized allergen types on the state of airway inflammation and lung function in asthmatic children

目的探讨过敏原及致敏模式对支气管哮喘(简称哮喘)患儿气道炎症状态及肺功能的影响。方法选取哮喘患儿127例,采用过敏原皮肤点刺试验对尘螨、霉菌、动物皮屑、花粉、蟑螂5类共计18种常见吸入过敏原的致敏情况进行分析;采用化学发光法检测呼出气一氧化氮(FeNO);采用儿童肺功能仪检测第1秒呼气容积(FEV1)、用力肺活量(FVC)、FEV1/FVC;常规采集无名指指端血,计数嗜酸性粒细胞(EOS)。结果首位过敏原为尘螨,阳性率为56.7%,其次是霉菌类(31.5%)、动物皮屑(29.1%);尘螨过敏者FeNO、外周血EOS数量均高于其他4类过敏原过敏者(P均<0.05)。非致敏29例、单一致敏39例、多重致敏59例,其FEV1、FVC、FEV1/FVC比较差异均无统计学意义(P均>0.05),多重致敏者FeNO、EOS数量明显高于非致敏及单一致敏者(P均<0.05)。尘螨、动物皮屑、花粉致敏者FeNO与外周血EOS数量均呈正相关(r分别为0.688、0.279、0.202,P均<0.05)。结论哮喘患儿多重致敏者气道炎症反应重;过敏原及致敏模式对肺功能无明显影响。

Objective To investigate the relationships of sensitization pattern and sensitized allergen types with the state of airway inflammation and lung function in children with bronchial asthma. Methods A total of 127 asthmatic children were enrolled. The sensitization patterns to 18 aeroallergens in five allergens categories（ dust mites,mold,animal dander,pollen and cockroach） were evaluated by skin prick test（ SPT）. The exhaled nitric oride（ FeNO） levels were measured online using an Aerocrine NIOX chemiluminescence analyzer. The forced expiratory volume in 1 second（ FEV1）,forced vital capacity（ FVC） and the FEV1/ forced vital capacity（ FEV1/ FVC） were evaluated by spirometry.The peripheral blood eosinophil（ EOS） counts were collected from finger tip blood and measured by routine method.Results The top sensitization allergen was dust mite with a sensitization rate of 56. 7%（ 72 /127）,followed by mold（ 31. 5%） and animal dander（ 29. 1%）. The FeNO levels and EOS counts were significantly higher in sensitization allergen of dust mite were all higher than those of the other four allergens（ all P 〈0. 05）. No significant differences were found in the lung function variables（ FEV1,FVC and FEV1/ FVC） among the non-sensitized group（ n = 29）,poly-sensitized group（ n = 39） and mono-sensitized group（ n = 59）（ all P〉 0. 05）. The FeNO levels and EOS counts in the poly-sensitization group was higher than those in the non-sensitized group and the mono-sensitized group（ all P〈 0. 05）. FeNO levels were positively related with EOS counts in asthmatic children with sensitization to dust mites,animal dander and pollen（ γ= 0. 688,0. 279 and 0. 202,respectively; all P〈 0. 05）. Conclusions The response of airway inflammation are more serious in asthmatic children with poly-sensitization. No relationship is found between the sensitization patterns,sensitized allergen types and lung function variables.