苏皖地区变应性鼻炎患者气传变应原皮肤点刺试验和血清特异性IgE检测的一致性及相关性分析

Agreement and association analyses of skin prick testing and serum specific IgE assay for aeroallergen detection in patients with allergic rhinitis from Jiangsu and Anhui areas

目的基于皮肤点刺试验(SPT)和血清特异性IgE(sIgE)检测方法分析变应性鼻炎(AR)患者常见气传变应原,评估该两种检测方法所得结果的一致性及相关性。方法纳入苏皖地区AR患者101例,其中男53例,女48例;4~68岁,平均(38.5±14.8)岁。均同时进行10种气传变应原SPT和sIgE检测,包括6种常年性室内变应原(粉尘螨、户尘螨、猫毛、狗毛、德国小蠊、链格孢霉)和4种季节性花粉变应原(桦树、豚草、葎草和蒿草)。采用SPSS 24.0软件对检测结果进行一致性及相关性分析。结果101例AR患者中,10种气传变应原SPT和sIgE检测结果的一致率(符合率)分别为粉尘螨75.28%、户尘螨72.09%、链格孢霉39.13%、猫毛36.84%、狗毛11.11%、葎草14.29%、德国小蠊12.50%、豚草22.22%、蒿草13.33%、桦树15.38%。Cohen's kappa系数分析显示,kappa值介于0.146~0.484之间,链格孢霉、猫毛、粉尘螨的kappa值分别为0.484、0.471、0.413,具有中等强度一致性;户尘螨、豚草、桦树的kappa值分别为0.398、0.330、0.215,一致性强度一般;其余4种变应原的kappa值均<0.20,一致性强度差。Spearman秩相关性分析显示,10种气传变应原的SPT分级与sIgE分级均呈正相关,rs值介于0.174~0.548之间,其中粉尘螨、链格孢霉、猫毛、户尘螨的rs值分别为0.548、0.532、0.483、0.440,具有中等程度相关;葎草、桦树、狗毛的rs值分别为0.240、0.239、0.210,为弱相关;其余3种变应原的rs值均<0.20,为极弱相关。结论苏皖地区AR患者常见气传变应原SPT和sIgE检测结果的一致性、相关性存在较大差异,建议进行变应原体内外联合检测以提高临床诊断的准确性。

Objective To assess the agreement and association between skin prick testing(SPT)and serum specific IgE(sIgE)in detecting common aeroallergens in patients with allergic rhinitis(AR).Methods The study included 101 patients(53 males and 48 females;age range:4 to 68 years,average age:38.5±14.8 years)from the Jiangsu and Anhui Provinces who received treatment for AR in the First Affiliated Hospital of Nanjing Medical University from November 2018 to December 2019.All the patients simultaneously underwent SPT and sIgE for the detection of 10 aeroallergens;these included 6 perennial indoor allergens(Dermatophagoides farina,Dermatophagoides pteronyssinus,cat dander,dog dander,Blattella germanica,and Alternaria alternate)and 4 seasonal pollen allergens(birch,ragweed,humulus,and Artemisia[A.annua or A.argyi]).Meanwhile,the results of the allergen detection were analyzed by SPSS 24.0 software.Results The agreement percentages of the detections of D.farina,D.pteronyssinus,A.alternata,cat dander,dog dander,humulus,B.germanica,ragweed,Artemisia,and birch by SPT and sIgE were 75.28%,72.09%,39.13%,36.84%,11.11%,14.29%,12.50%,22.22%,13.33%,and 15.38%,respectively.Cohen's kappa statistics showed that theκ-coefficients were between 0.146 and 0.484.Among them,theκ-coefficients of A.alternata,cat dander,and D.farina were 0.484,0.471,and 0.413,respectively,which indicated moderate agreements.Theκ-coefficients of D.pteronyssinus,ragweed,and birch were 0.398,0.330,and 0.215,respectively,which indicated lower agreements.All theκ-coefficients of the other four allergens were less than 0.20,indicating poor agreement.Spearman's rank correlation analysis showed positive correlations between the SPT and sIgE results for the detection of the 10 aeroallergens(rs ranged from 0.174 to 0.548).The rs values of D.farina,A.alternata,cat dander,and D.pteronyssinus were 0.548,0.532,0.483,and 0.440,respectively,indicating moderate correlations.The rs values of humulus,birch,and dog dander were 0.240,0.239,and 0.210,respectively,indicating poor correlations.The rs values of the other three allergens were all<0.20,indicating very poor correlation.Conclusion This study demonstrated large discrepancies in the agreement and association between the SPT and sIgE detections of common aeroallergens in patients with AR in the Jiangsu and Anhui areas.The combination of in vivo and in vitro methods for allergen testing is recommended to improve the accuracy of the clinical diagnosis of AR.