变应原皮肤点刺试验阳性的过敏性结膜炎患者特征分析

Characteristics of allergic conjunctivitis with positive skin prick test

目的了解变应原皮肤点刺试验阳性的过敏性结膜炎患者的临床特点。方法回顾性系列病例研究。收集2015年4月至10月就诊于北京协和医院的40例变应原皮肤点刺试验阳性患者，男性18例，女性22例；平均年龄33．7岁。通过病史采集和眼科检查确定过敏性结膜炎的类型，并对眼部瘙痒、眼睑水肿、结膜充血、球结膜水肿等症状体征进行评价计分。采用皮肤点刺试验检测22类吸入性变应原阳性与过敏性结膜炎的关系，符合正态分布的计量资料采用方差分析，非正态分布的计数资料采用卡方检验，计量资料采用组间比较采用Mann-WhitneyU检验，多组比较KmskM-Wallis H检验，相关性分析采用Spearman相关性分析。结果40例变应原皮肤点刺试验阳性的过敏性结膜炎患者，其中季节性过敏性结膜炎18例，常年性过敏性结膜炎14例，春季角结膜炎5例，特应性角膜炎2例，巨乳头性结膜炎1例；不同类型过敏性结膜症状和体征评分差异无统计学意义。变应原阳性数量范围分别为0～5、6～10、11—15、16—22个时，眼部瘙痒的评分分别为3．0（0．5，3．5）、3．3（3．0，3．5）、3．5（0．8，3．5）、4．0（3．5，4．5）（H=0．74，P〈0．05），结膜充血的评分分别为1．8（0.8，2．8）、1．5（0．8，2．3）、2．0（1．5，2．5）、2．5（1．5，2．5）（H=0．96，P〈0．05），差异有统计学意义。室内尘土、夏秋季花粉Ⅰ、春季花粉Ⅱ、粉尘螨、春季花粉Ⅲ是最常见的变应原；季节过敏性结膜炎以花粉为主要变应原，而室内尘土、粉尘螨是常年过敏过敏性结膜炎最常见变应原。结论季节过敏性结膜炎是最常见的过敏性结膜炎类型，过敏性结膜炎变应原以室内尘土和花粉为主，不同类型的过敏性结膜炎变应原不同，同一患者可同时对多种过敏原过敏。

Objective To observe the clinical characteristics of allergic conjunctivitis, and the correlations with skin prick test results. Methods A retrospective study. Forty patients with positive skin prick test result were included. Patients underwent an ophthalmologic examination to identify their primary presenting signs and symptoms. The allergy types were divided into 5 groups. All dates were analyzed for the dependence, normality and homogeneity of variance. Chi-square test, Mann-Whitney U test, Kruskal-Wallis H test and Spearman correlation analysis were performed accordingly. Results Among 40 patients, 18 （45.0%） had a clinical diagnosis of seasonal allergic conjunctivitis, 14（35.0% ） had perennial allergic conjunctivitis, 5（12.5%） had vernal keratoconjunctivitis, and 2（5.0%） had atopic keratoconjunctivits, and 1 （2.5%） had giant papillary conjunctivitis. There was no significant difference in the number of symptoms and signs score among different types of allergic conjunctivitis, the score of itching and hyperemia had a positive relationship with the number of positive allergens （r=0.74, P〈0.05. r=0.96, P〈0.05）. The primary symptoms and signs are itching and hyperemia; dust and pollens are the most common allergens. The more positive result of the test of the allergen, the more symptoms and signs encountered in terms of severity. Conclusion Seasonal allergic conjunctivitis was the most prevalent disorder, the most important clinical characteristics of allergic conjunctivitis are itching and conjunctival congestion, the main allergens are dust and pollens, patients may be sensitive to multiple allergens. （Chin J Ophthalmol, 2017, 53： 689-693）