腺样体肥大伴霉菌过敏患儿的临床特征及药物疗效

Clinical characteristics and efficacy of adenoid hypertrophy with fungi allergy among children

目的探讨腺样体肥大伴霉菌过敏患儿霉菌变应原致敏情况及药物治疗疗效。方法选择确诊为腺样体肥大(adenoid hypertrophy,AH)的患儿,检测血清常见吸入性变应原sIgE,根据结果分为霉菌过敏组(霉菌sIgE≥2级,且其他变应原sIgE<2级)和非霉菌非尘螨过敏组,记录患儿主要临床症状并评估腺样体肥大程度,应用糠酸莫米松鼻喷剂联合孟鲁司特进行药物治疗,3个月后随访评估,应用统计学方法分析霉菌过敏组和非霉菌非尘螨过敏组间各指标差异。结果 121例AH患儿中霉菌sIgE阳性率为46.3%(56/121),与非霉菌非尘螨过敏组比较,霉菌过敏组张口呼吸和睡眠呼吸暂停症状轻,鼻痒症状重,纤维鼻咽镜检查腺样体分级高,BMI指数高(卡方值或t值分别为5.193、4.317、4.118、5.306、2.49,P值均小于0.05);药物保守治疗3个月后,霉菌过敏组腺样体纤维鼻咽镜分级改善更明显,接受腺样体切除术的患儿更少,且均具有统计学差异(卡方值分别为7.462、4.107,P值均小于0.05);两组患儿性别、年龄、鼻塞、睡眠打鼾、近期症状加重、流涕及打喷嚏比较均无统计学差异。霉菌分级与BMI、纤维鼻咽镜分级呈正相关(r值分别为0.280和0.317,P值均<0.05),与张口呼吸呈负相关(r=-0.305,P<0.05)。结论霉菌是AH患儿的常见致敏变应原之一,在霉菌高发季节针对霉菌致敏的AH患儿可以优先应用鼻用糖皮质激素联合白三烯受体拮抗剂治疗。

Objective To investigate the prevalence of fungi allergy and the efficacy of medication in children with adenoid hypertrophy (AH). Methods Children patients with AH were enrolled in this study. Based on the results of serum sIgE, the children patients were divided into fungi allergy group (fungi sIgE ≥ grade 2 and the other allergens sIgE < grade 2) and non-fungi non-dust mite allergy group. The clinical symptoms and adenoid hypertrophy grade were recorded. Mometasone furoate (Nasonex) combined with montelukast (Singulair) were prescribed to all patients for 3 months treatment. The difference between fungi allergy and non-fungi non-dust mite allergy group was compared. Results The positive rate of fungi sIgE detection among 121 children patients with AH was 46.3%(56/121). Compared to non-fungi non-dust mite allergy group, fungi allergy group patients showed milder symptoms on mouth breathing and sleep apnea, more severe nasal itching, higher grade of adenoids evaluated by fiberoptic nasopharyngoscope and higher BMI index (both P <0.05). The grade of adenoids reduced in fungi allergy group, and fewer children underwent adenoidectomy after 3 months treatment. Positive correlation between fungi sIgE level and BMI, the grade of adenoids by fiberoptic nasopharyngoscope was documented ( r 1=0.280, r 2=0.317, both P <0.05), while negative correlation between fungi sIgE level and mouth breathing was also documented ( r =-0.305, P <0.05). Conclusions Fungi is one of the common sensitized allergens among children patients with AH. Children AH patients with fungi allergy can be prescribed mometasone furoate combined and montelukast as prophylaxis before fungi season.