变应性鼻炎不同转归的临床指标研究

Research on biomarker of allergic rhinitis with different prognosis

目的本研究初步探讨变应性鼻炎不同转归的临床指标,分析对转归有判断意义的临床指标。方法回顾性分析2012年3月~2013年5月就诊于我院鼻科患者71例,分3组:A组变应性鼻炎组;B组变应性鼻炎合并慢性鼻窦炎组;C组变应性鼻炎合并哮喘组(包括伴或不伴鼻窦炎)。B组和C组患者病史中均为变应性鼻炎先发病。患者均行外周血嗜酸性粒细胞(Eosinophils,Eos)比值检测,血清总Ig E、皮肤点刺试验(skin prick test,SPT)、嗅觉功能、鼻分泌物嗜酸性粒细胞检查和上、下气道一氧化氮(NO)浓度、血清C反应蛋白(C response protein,CRP)检测。将A组与B、C组数据分别进行统计分析,寻找A组与B、C组间具有显著性差异的指标,再将该指标与变应性鼻炎的不同转归进行相关性分析。采用指标描绘曲线(receiver operating characteristic,ROC)计算曲线下面积及变应性鼻炎转归不良的诊断截断值。结果患者按照分类标准进行分组,A组24例,B组21例,C组26例。A组与B组间统计分析结果:Eos和嗅觉功能存在显著性差异(U值分别为20.5、2.0;P均<0.01),血清总IgE、鼻分泌物Eos检查、SPT、CRP、上和下气道NO浓度,两组间无显著性差异。A组与C组间统计分析结果:Eos、嗅觉功能和下气道NO浓度,存在显著性差异(U值分别为37.5、22.5、47.5;P分别为0.002、0.001、0.021);血清总IgE、鼻分泌物Eos检查、SPT、上气道NO浓度和CRP,两组间差异无统计学意义。ROC曲线下面积0.847,Eos>3.15%,为变应性鼻炎转归不良截断值。结论 Eos>3.15%可作为预后不良的判断指标,其他检测指标无助于判定变应性鼻炎转归。

ABSTRACT]OBJECTIVETo analyse the characteristic of different prognosis of allergic rhinitis (AR), and trying to find a useful clinic biomarker to evaluate the prognosis of AR.METHODSA retrospective analysis of 71 patients, who diagnosed AR with or without complications was carried out in this study. These patients were divided into three groups: group A was AR; group B was AR with chronic sinusitis; group C was AR with asthma. Patients in group B and group C had a history of AR before chronic sinusitis and asthma. The biomarkers such as peripheral blood Eosinophils, serum total IgE, skin prick test (SPT), olfactory function, nasal secretions smear Eosinophils cells staining, upper and lower airway concentration of nitric oxide (NO) and serum C response protein (CRP) were tested. The clinical data of group A, group B and group C were statistically analyzed, and the Receiver Operating Characteristic (ROC) curve was analyzed.RESULTSThere were 24 patients in group A, 21 patients in group B, and 26 patients in group C. The ratio of Eosinophils in peripheral blood and olfactory function scores between group A and group B were significant different (U values were 20.5, 2.0;P<0.01), and there were no significant difference in serum total IgE, nasal secretions smear, SPT, upper and lower airway NO concentration, serum CRP between the two groups (U values were 49.0, 57.5, 75.0, 54.5, 39.5, 58.0, P values were 0.67, 0.26, 0.91, 0.52, 0.11, 0.48). The ratio of Eosinophils in peripheral blood, olfactory function scores, and lower airway NO concentration were significantly different between group A and group C (U values were 37.5, 22.5, 47.5; P value were 0.002, 0.001, 0.021 respectively), and there were no <br> statistically significant difference in serum total IgE, nasal secretions smear, SPT, and upper airway NO concentration, serum CRP between the two groups (U values were 45.0, 105.0, 89.5, 64.0, 66.5, P value 0.125, 0.764, 0.332, 0.123, 0.059 respectively). The area under the ROC curve was 0.847, 3.15% of peripheral blood Eosinophil was <br> a prognostic cutoff value.CONCLUSIONRatio of Eosinophil in peripheral blood (more than 3.15%) may be used as biomarker to indicate the poor prognosis of AR, other tests are not helpful for the prognosis of AR.