内蒙古通辽地区过敏性鼻炎流行病学调查研究

Epidemiology of Allergic Rhinitis in Tongliao Grassland of Inner Mongolian

背景近年来全球过敏性鼻炎(AR)的患病率不断增加,但有关中国内蒙古东部草原地区的相关研究甚少。目的调查内蒙古通辽地区AR的患病情况,并分析临床症状、过敏原因,为后期AR的预防、诊断及卫生管理部门制定有关政策提供依据。方法2015年5-8月,采用分层随机抽样法抽取通辽市、扎鲁特旗、开鲁县常住居民2013例。由专科医生对居民进行问卷调查及变应原皮肤点刺试验(对草原地区常见的10种吸入性过敏原进行检测)。AR的诊断主要依据相关指南进行判定。调查问卷主要包括居民的社会学资料(年龄、性别、民族、居住地、地区),临床症状(鼻部症状、眼部症状、其他症状),合并疾病情况及食物、药物过敏情况,临床症状随季节变化情况。分析确诊的AR患者变应原皮肤点刺试验结果。结果共发放问卷2013份,回收有效问卷1 954份,回收有效率为97.1%。1 954例居民中,自报AR患病率30.8%(601例),确诊AR患病率18.1%(353例)。353例AR患者平均年龄(45.3±15.0)岁;男161例,女192例,男女比例1∶1.2;汉族193例,蒙古族143例,汉族、蒙古族比例1.3∶1。不同年龄、居住地、地区居民AR患病率比较,差异有统计学意义(P<0.05);不同性别、民族居民AR患病率比较,差异无统计学意义(P>0.05)。AR患者鼻部症状以打喷嚏(95.8%)、鼻痒(92.4%)、流鼻涕(85.3%)为主,眼部症状以眼痒(61.8%)为主,其他症状以乏力(42.5%)、嗜睡(40.5%)为主。在AR患者合并的疾病中,以合并结膜炎(64.0%)、荨麻疹(29.5%)、高血压(17.8%)为主。AR合并食物过敏患者占17.3%(61/353),AR合并药物过敏患者占24.9%(88/353)。该地区2015年AR患者临床症状的高峰期为4月份和7月份,花粉高峰期出现在4月份和8月份。该地区春季4月份AR临床症状的高峰期与花粉的高峰期高度吻合,但是夏季AR临床症状的高峰期在7月份,较花粉的高峰期提前1个月。变应原皮肤点刺试验阳性率居前3位的吸入性过敏原为蒿属花粉(21.96%)、藜科花粉(21.49%)、葎草花粉(20.06%);且多为3种及以上花粉致敏[71.10%(251/353)]。结论内蒙古通辽地区AR患病率处于较高水平,患者鼻部症状以打喷嚏、鼻痒为主,眼部症状以眼痒为主,其他症状以乏力、嗜睡为主。在AR患者合并的疾病中以结膜炎、荨麻疹为主,同时花粉暴露是引发AR最重要的因素之一,且春、夏季蒿属花粉的影响不容忽视。

Background In recent years,the prevalence of allergic rhinitis(AR) is increasing all over the world,but little research has been done on grassland areas in eastern Inner Mongolia,China.Objective To investigate the prevalence of AR and to analyze the clinical symptoms and allergic causes in Tongliao,Inner Mongolia,so as to provide the basis for the prevention,diagnosis and health management departments to formulate relevant policies.Methods A total of 2 013 permanent residents in Tongliao City,Jarud Banner and Kailu County were selected by stratified random sampling method from May to August 2015.Questionnaire survey and skin prick test of allergens were conducted by specialists(10 common inhalation allergens were detected in grassland areas).The diagnosis of AR was mainly based on the related guideline.The questionnaire mainly included basic sociological data(age,sex,nationality,place of residence,region),clinical symptoms(nasal symptoms,eye symptoms,other symptoms),combined diseases,food and drug allergies,and seasonal changes of clinical symptoms.The skin prick test results of allergens in patients with confirmed AR were analyzed.Results A total of 2 013 questionnaires were sent out,and 1 954 valid questionnaires were recovered,with a recovery rate of 97.1%.Among 1 954 residents,the self-reported AR prevalence rate was 30.8%(601 cases) and the confirmed AR prevalence rate was 18.1%(353 cases).The average age of 353 AR patients was(45.3±15.0) years;161 were male,192 were female,and the ratio of male to female was 1∶1.2;193 were Han,143 Mongolian,and Han and Mongolian ratio was 1.3∶1.There were significant differences in AR prevalence among residents of different ages,places of residence,and regions(P<0.05).There were no significant differences in gender and ethnic group in terms of AR prevalence(P> 0.05).The main nasal symptoms of AR patients were sneezing(95.8%),itching(92.4%) and running nose(85.3%).Eye itching was the main symptom(61.8%)of eye symptoms.Other symptoms were fatigue(42.5%) and drowsiness(40.5%).In AR patients,conjunctivitis(64.0%),urticaria(29.5%) and hypertension(17.8%) were main complications.Patients with AR complicated with food allergy accounted for 17.3%(61/353),and those complicated with drug allergy accounted for 24.9%(88/353).The peak period of clinical symptoms of AR patients in this area in 2015 was April and July,and the peak period of pollen appeared was April and August.The peak period of AR clinical symptoms in April in this area coincided with the peak period of pollen in Spring,but the peak period of AR clinical symptoms in summer was July,which was one month ahead of the peak period of pollen.The first three allergens with positive rate of allergen skin prick test was Artemisia pollen(21.96%),Chenopodiaceae pollen(21.49%)and Humulus pollen(20.06%).Most patients were allergic to three or more pollens[71.10%(251/353)].Conclusion The prevalence of AR in Tongliao,Inner Mongolia stays at a high level.Sneezing and itching are the main symptoms of nasal symptoms,itching is the main symptom of eye symptoms,and fatigue and sleepiness are the main symptoms of other symptoms.Conjunctivitis and urticaria are the main complications associated with AR.Pollen exposure is one of the most important factors causing AR,and the influence of Artemisia pollen in spring and summer can not be ignored.