血清总IgE和过敏原特异性IgE在支气管哮喘患者中的表达特征

Expression characteristics of serum total IgE and allergen specific IgE in patients with bronchial asthma

目的探讨血清总免疫球蛋白E(tIgE)及过敏原特异性免疫球蛋白E(sIgE)在支气管哮喘(简称哮喘)患者中的分布特征及其临床意义。方法选择2017年3月至2020年7月江苏省第二中医院肺病科收治的进行过sIgE和tIgE检测的住院患者694例,根据临床诊断将患者分为哮喘组(102例)和非哮喘组(592例)。分析血清tIgE及过敏原sIgE在患者中的表达特征。结果哮喘组sIgE的总阳性率高于非哮喘组,sIgE阳性种数≥3种的sIgE阳性率高于非哮喘组,差异均有统计学意义(P<0.05);哮喘组中tIgE>100 IU/mL的患者比例高于非哮喘组,差异有统计学意义(P<0.05)。全部患者中吸入性过敏原sIgE阳性频数构成比高于食物性,哮喘组中吸入性过敏原sIgE阳性频数构成比同样高于食物性,差异均有统计学意义(P<0.05);全部患者中食物性过敏原sIgE阳性频数构成比前3位依次为蟹、海鱼组合、鸡蛋白,吸入性过敏原前3位依次为尘螨组合、蟑螂、猫毛。哮喘组中食物性过敏原sIgE阳性率前3位依次为蟹、鸡蛋白、海鱼组合,吸入性过敏原前3位依次为尘螨组合、猫毛、屋尘。哮喘组食物性过敏原蟹、羊肉、黄豆、鸡蛋白和吸入性过敏原狗上皮、猫毛、屋尘、尘螨组合的sIgE阳性率高于非哮喘组,差异均有统计学意义(P<0.05)。全部患者中过敏原sIgE阴性、单一阳性、多重阳性患者间的tIgE水平两两比较,差异均有统计学意义(P<0.05);食物性与混合性、吸入性与混合性过敏原sIgE阳性患者间的tIgE水平比较,差异均有统计学意义(P<0.05)。全部患者和哮喘组患者的过敏原sIgE阳性种数与tIgE水平均呈正相关(r=0.502、0.563,P<0.05)。过敏原sIgE阳性者患哮喘风险的比值比(OR)=2.517,而tIgE≥100 IU/mL者患哮喘风险的OR=3.417。结论过敏原sIgE和tIgE的检测有助于患者过敏原的甄别和过敏状态的判断,对过敏性哮喘的诊断、预防发作和治疗有重要指导意义。

Objective To investigate the distribution characteristics and clinical significance of serum total immunoglobulin E(tIgE)and allergen-specific immunoglobulin E(sIgE)in patients with bronchial asthma.Methods A total of 694 inpatients who had undergone sIgE and tIgE testing were selected from March 2017 to July 2020 and were admitted to the department of pulmonology,the Second Traditional Chinese Medicine Hospital of Jiangsu,they were divided into bronchial asthma group(102 cases)and non-asthmatic groups(592 cases)based on clinical diagnosis.The expression characteristics of serum tIgE and allergen sIgE in patients were analyzed.Results The total positive rate of sIgE in the asthma group was higher than that in the non-asthmatic group,and the positive rates of sIgE with≥3 kinds of sIgE positive species were higher than those in the non-asthmatic group,and the differences were statistically significant(P<0.05);The proportion of patients with tIgE>100 IU/mL in the asthma group was higher than that in the non-asthma group,and the difference was statistically significant(P<0.05).The frequency component ratio of inhaled allergen sIgE positive frequency in all patients was higher than that of food,and the frequency component ratio of inhaled allergen sIgE positive frequency in the asthma group was also higher than that of food,and the differences were statistically significant(P<0.05);Among all patients,the top three food allergen sIgE positive frequency components were crab,sea fish combination and egg white,the top three inhaled allergens were dust mite combination,cockroach,and cat hair.In the asthma group,the top three food allergen sIgE positive rates were crab,egg white and sea fish combination,the top three inhaled allergens were dust mite combination,cat hair and house dust.The positive rates of sIgE in food allergen crab,mutton,soybean,egg white and inhalation allergen dog epithelium,cat hair,house dust and dust mite combination in the asthma group were higher than those in the non asthma group,and the difference was statistically significant.Academic significance(P<0.05).The tIgE levels of allergen sIgE negative,single-positive,and multiple-positive patients were compared in pairs in all patients,and the differences were statistically significant(P<0.05);There were statistically significant differences in tIgE levels between food and mixed,inhaled and mixed allergen sIgE positive patients(P<0.05).The number of allergens sIgE positive in all patients and the asthma group was positively correlated with tIgE level(r=0.502,0.563,P<0.05).The odds ratio(OR)of the risk of bronchial asthma for allergen sIgE positive patients was 2.517,and the OR of the risk of bronchial asthma for those with tIgE≥100 IU/mL was 3.417.Conclusion The detection of allergens sIgE and tIgE is helpful for the identification of allergens and the judgment of the allergic state of patients,and has important guiding significance for the diagnosis,prevention and treatment of allergic asthma.