职业性变应性哮喘患者哮喘控制现状及影响因素分析

Current status of asthma control and influencing factors of occupational sensitizer-induced asthma

目的探讨职业性变应性哮喘(OSIA)患者的哮喘控制现状及其影响因素。方法采用判断抽样方法选择50例OSIA患者为研究对象,采用《哮喘控制测试(ACT)评分表》《哮喘生命质量问卷》调查患者的哮喘控制情况和生命质量,检测患者呼出气一氧化氮(FeNO)水平、肺功能、周围血嗜酸性粒细胞比率(EOS%)和血清总免疫球蛋白E(IgE)水平。结果 50例患者中,哮喘良好控制组患者27例(占54.0%),未完全控制组23例(占46.0%)。患有变应性鼻炎、未使用糖皮质激素(ICS)治疗、药物依从性差均是OSIA未完全控制的危险因素(P值均<0.05)。与良好控制组比较,未完全控制组患者ACT得分、生命质量得分、第1秒用力呼气容积占预计值的百分比(FEV1%)均降低(P值均<0.05),FeNO水平升高(P<0.05)。2组患者EOS%和血清总IgE水平分别比较,差异均无统计学意义(P值均>0.05)。结论患有变应性鼻炎、未使用ICS治疗、药物依从性差是影响OSIA控制的因素。联合ACT、生命质量评分、FeNo、FEV1%等多个指标可全面反映OSIA现况及评估哮喘控制水平,有助于指导调整OSIA诊断治疗方案。

Objective To investigate the asthma control status of occupational sensitizer-induced asthma(OSIA) and explore the influencing factors. Methods A total of 50 OSIA patients were selected as study subjects by judgment sampling method. Asthma Control Test(ACT) and Asthma Quality of Life Questionnaire were used to investigate the asthma control status and the quality of life of patients. The fractional exhaled nitric oxide(FeNO) level, pulmonary function, peripheral blood eosinophil ratio(EOS%)and serum total immunoglobulin E(IgE) level of the patients were measured. Results Among the 50 cases of OSIA patients, 27(54.0%) cases were well controlled, and 23(46.0%) cases were non-fully controlled. The patients with allergic rhinitis, with no inhaled corticosteroids treatment and with poor compliance were risk factors of the non-fully controlled OSIA(all P<0.05). The scores of ACT and the quality of life, and the percentage of the first second forced expiratory volume(FEV1%) decreased(all P<0.05), while the level of FeNO increased(P<0.05) in the non-fully controlled group compare with the well-controlled group. There was no statistical significance in EOS% and serum total IgE level between the two groups(both P>0.05).Conclusion Allergic rhinitis, lack of inhaled corticosteroids treatment and poor compliance are the influencing factors that affect the control of OSIA. The combinational scores of ACT and quality of life, FeNO, FEV1% and other indicators can reflect the status of OSIA and assess the level of asthma control, and help guiding OSIA diagnosis and treatment plans.