天津地区4 488例儿童过敏性鼻炎吸入性变应原谱分析

Analysis of the inhalant allergen spectrum in 4488 children with allergic rhinitis in Tianjin

目的探讨天津地区儿童过敏性鼻炎(AR)吸入性变应原种类及特点,为儿童AR预防与诊疗提供依据。方法回顾性收集2016年3月至2022年2月天津医科大学第二医院儿科哮喘和过敏专病门诊AR患儿4488例的临床资料,分析儿童AR的吸入性变应原分布特点,探讨吸入性变应原阳性率及变应原种类与性别、年龄以及共患其他过敏性疾病的关系。采用UniCAP100系统(荧光酶联免疫法)测定血清变应原特异性IgE(sIgE)。计数资料以例数及百分率(%)表示,组间比较采用χ^(2)检验。结果1.4488例AR患儿中吸入性变应原阳性3116例,阳性率69.43%。单一变应原阳性比例28.47%(887/3116)、双重变应原阳性比例25.22%(786/3116)、3种变应原阳性比例19.67%(613/3116)、4种及4种以上变应原阳性比例26.64%(830/3116)。最常见吸入性变应原为霉菌类(45.72%,2052/4488),其次依次为粉尘螨(34.71%,1558/4488)、艾蒿(33.95%,313/922)、屋尘螨(31.13%,1397/4488)、豚草(30.97%,227/733)等。2.学龄前组、学龄组、青少年组吸入性变应原阳性率依次为56.15%(1132/2016)、79.26%(1624/2049)、85.11%(360/423)(χ^(2)=309.72,P<0.001)。在学龄前组、学龄组首位吸入性变应原均为霉菌类(40.23%、50.85%),在青少年组首位吸入性变应原为粉尘螨(56.74%),其次为屋尘螨(53.66%)、霉菌类(47.04%)。3组吸入性变应原阳性种类比较差异有统计学意义(χ^(2)=466.99,P<0.001)。在学龄前期组以单一变应原阳性为主,学龄组、青少年组吸入性变应原阳性种类增多,以4种及4种以上变应原为主。3.男童组吸入性变应原阳性率达73.28%(2139/2919),明显高于女童组阳性检出率62.40%(979/1569)(χ^(2)=58.28,P<0.001),男童和女童组常见吸入性变应原前3位均为霉菌类、艾蒿、粉尘螨。吸入性变应原阳性种类在男童与女童组比较差异有统计学意义(χ^(2)=75.02,P<0.001),女童组以单一变应原为主(20.78%),男童组变应原阳性种类增多,以4种及4种以上变应原阳性为主(20.45%)。4.AR共患支气管哮喘和特应性皮炎组吸入性变应原阳性率最高,达79.21%,其次AR共患支气管哮喘阳性率73.67%,AR共患特应性皮炎组阳性率61.05%,单纯AR组阳性率57.05%,组间比较差异有统计学意义(χ^(2)=178.57,P<0.001)。结论天津地区儿童AR主要吸入性变应原依次为霉菌类、粉尘螨、艾蒿、屋尘螨、豚草,不同年龄、性别及共患不同过敏性疾病吸入性变应原分布特征存在差异。应尽早为AR患儿检测变应原,做到提前预防,减少药物使用量,也为开展变应原免疫治疗提供依据。

Objective To investigate the types and characteristics of inhalant allergens in children with allergic rhinitis(AR)in Tianjin,and to provide foundation for the prevention and treatment of AR in children.Methods The data of 4488 patients with AR at the Pediatric Asthma and Allergy Clinic of the Second Hospital of Tianjin Medical University from March 2016 to February 2022 were collected and analyzed retrospectively in this study.The distribution features of inhalant allergens in AR children were explored.The relationship between the positive results of inhalant allergens and the gender,age and other comorbid allergic diseases was discussed.Serum allergen-specific immunoglobulin E(sIgE)was determined using the UniCAP100 system(fluorescent enzyme-linked immunoassay).Enumeration data were expressed as the number of cases and percentage(%),and data were compared between groups byχ^(2) test.Results(1)In the serum of 4488 AR patients,3116 cases were positive for inhalant allergens,with a positive rate of 69.43%.There were 28.47%(887/3116)AR patients positive for 1 allergen,25.22%(786/3116)positive for 2 allergens,19.67%(613/3116)positive for 3 allergens,and 26.64%(830/3116)positive for 4 or more allergens.The most common inhalant allergens were moulds(45.72%,2052/4488),followed by dermatophagoides farinae(34.71%,1558/4488),mugwort(33.95%,313/922),dermatophagoides pteronyssinus(31.13%,1397/4488),and ragweed(30.97%,227/733).(2)The positive rates of inhalant allergens in preschool,school age and adolescent groups were 56.15%(1132/2016),79.26%(1624/2049)and 85.11%(360/423),respectively(χ^(2)=309.72,P<0.001).The most common inhalant allergen in the preschool and school age groups was moulds(40.23%,50.85%).In the adolescent group,dermatophagoides farina(56.74%)was the predominant inhalant allergen,followed by dermatophagoides pteronyssinus(53.66%)and moulds(47.04%).There were significant differences in the types of positive inhalant allergens among the 3 groups(χ^(2)=466.99,P<0.001).Children in the preschool group were mostly positive for single allergens,while those in the school age and adolescent groups were positive for 4 or more inhalant allergens.(3)The positive rate of inhalant allergens in boys reached 73.28%(2139/2919),significantly higher than that in girls(62.40%,979/1569)(χ^(2)=58.28,P<0.001).The top 3 common inhalant allergens in boys and girls were moulds,dermatophagoides farinae,and dermatophagoides pteronyssinus.There were significant differences in the types of positive inhalant allergens between boys and girls(χ^(2)=75.02,P<0.001).About 20.78%of the girls were positive for single allergens,and 20.45%of the boys were positive for 4 or more allergens.(4)The AR group complicated with asthma and atopic dermatitis had the highest positive rate(79.21%)of inhalant allergens,followed by AR patients with asthma(73.67%),AR patients with atopic dermatitis(61.05%)and AR patients(57.05%)successively.There were significant differences between the groups(χ^(2)=178.57,P<0.001).Conclusions The main inhalant allergens in AR children in Tianjin are moulds,dermatophagoides farinae,mugwort,dermatophagoides pteronyssinus,and ragweed.The distribution characteristics of inhalant allergens vary with the age,gender and combined allergic diseases.Allergens should be detected for AR children as soon as possible,so as to prevent AR in advance,reduce drug use,and provide evidence for specific allergen immunotherapy.