鼻腔局部变态反应的临床和免疫学特征

Clinical symptoms and immunology inspection characteristics of nasal cavity local allergy

目的:探讨鼻腔局部变态反应的临床和免疫学检查的特征。方法:选取仅有鼻腔局部变态反应症状、变应原皮肤点刺试验(SPT)和血清变应原特异性IgE检测均为阴性的患者60例作为研究组,另选取变应性鼻炎(AR)患者(AR组)和健康志愿者(正常组)各40例作为对照组。分别进行症状评分及VAS评分,并进行外周血嗜酸粒细胞检测、SPT、血清变应原特异性IgE(SIgE)检测、鼻分泌物变应原SIgE检测、变应原鼻黏膜激发试验、鼻分泌物嗜酸粒细胞检测等免疫学检测,并将研究组与AR组的数据进行统计学分析。结果:研究组与AR组的症状评分和VAS评分无显著性差异(P>0.05);研究组与AR组、研究组与正常组之间的血清嗜酸粒细胞计数均有显著性差异(P<0.05);研究组鼻分泌物尘螨及花粉变应原的阳性检出率为90%(54/60);研究组尘螨或花粉变应原激发试验后,54例激发试验阳性。研究组与AR组的鼻分泌物嗜酸粒细胞百分比无显著性差异(P>0.05),研究组与正常组的鼻分泌物嗜酸粒细胞百分比有显著性差异(P<0.05)。研究组60例患者中鼻分泌物SIgE和鼻腔黏膜变应原激发试验均为阴性者6例,诊断为NAR,结合外周血及鼻分泌物嗜酸粒细胞检测结果,4例诊断为血管运动性鼻炎,2例诊断为NAR伴嗜酸粒细胞增多综合征;其余54例患者诊断为局部AR(LAR)。研究组在入组3年后重新进行变应原SPT和血清SIgE检测发现,5例(12%)患者变应原检测为阳性,均为之前诊断为LAR的患者,6例之前诊断为NAR的患者变应原检测仍为阴性。结论:具有典型AR的病史和症状,但变应原SPT和血清变应原SIgE检测却为阴性的患者,鼻腔黏膜局部存在变应原特异性超敏反应,但这种反应并不伴有全身的致敏。结合鼻分泌物变应原SIgE检测或变应原鼻腔黏膜激发试验阳性,可确诊为LAR。

Objective：To investigate the clinical symptoms and immunology inspection characteristics of nasal cavity local allergy. Method： Selected 60 patients as observation group, who had only nasal local allergy symptoms, allergen skin prick test and serum allergen specific IgE（SIgE） test were negative, 40 allergic rhinitis（AR） patients and 40 healthy volunteers as control groups. To detect Symptom scores and VAS scores, and eosinophilia counts in venous blood, allergen skin prick test（SPT）, serum allergen SIgE test, nasal secretions allergen SIgE test, nasal mucous membrane excitation test in both observation group and AR group, eosinophilia counts in nasal secre- tion, taked the data for statistical analysis. Result：There was no difference（P〈0.05） in the symptom scores and VAS scores of observation group and the AR group. The eosinophilia counts in venous blood in the AR group were higher than in the observation group（P〈0.05）. The eosinophilia counts in venous blood in the observation group were higher than in the healthy volunteers group（P〈0.05）. The positive rate of nasal secretions dust mites and pollen allergen was 90% （54/60） in observation group. There was no significant difference（P〉0.05） in the eosinophilia percentages in nasal secretion in the observation group and the AR group. There was significant difference（P〈0.05） in the eosinophilia percentages in nasal secretion in the observation group and the healthy vol- unteers group. There were 6 patients in observation group whose nasal secretions allergen SIgE test and nasal mu cous membrane excitation test were both negative, could be diagnosised as non-allergic rhinitis （NAR）. According to eosinophilia counts in venous blood and nasal secretions, 4 patients were diagnosised as vasomotor rhinitis and 2 patients were diagnosised as NAR with eosinophilia syndrome. There were 54 patients in observation group whose nasal secretions allergen SIgE test and（or）nasal mucous membrane excitation test were positive, could be diagno- sised as local allergic rhinitis. After three years,all of the observation group patients were detected with SPT and serum allergen SIgE test. Five patients diagnosed as local allergic rhinitis before three years were positive. Six pa- tients diagnosed as NAR before three years were negative. Conclusion： For patients with the typical medical history and symptoms of AR, but allergen SPT and serum allergen SIgE test were negative, there was local specific hy- persensitivity in nasal mucosa, but the reaction was not accompanied by systemic sensitization. Combined with na- sal secretions allergen SIgE test or allergen nasal mucosa proocation tests positive, could be diagnosed as local al- lergic rhinitis.