老年变应性鼻炎的临床特征及危险因素

Clinical characteristics and risk factors of the elderly with allergic rhinitis

目的研究老年变应性鼻炎(AR)的临床特征及危险因素。方法将2018年1月至2022年12月北京王府中西医结合医院诊治的236例AR患者纳为研究组,根据患者年龄,将其分为中青年组(年龄18~59岁,102例)及老年组(年龄≥60岁,134例);同时将医院同期接收的160例与老年组AR患者性别、年龄相似,但无变应性临床症状的老年志愿者作为对照组。首先比较中青年组及老年组AR患者的临床特征,再以对照组为参照,通过二元logistic回归模型分析影响老年AR发病的相关因素。采用SPSS 19.0软件进行数据分析。组间比较采用χ^(2)检验。结果不同年龄段AR患者性别比例及发病高峰期比较,差异均无统计学意义;老年AR患者变应原检出阳性率为32.09%(43/134),低于中青年组的68.63%(70/102),差异有统计学意义(P<0.05)。老年组患者AR分型多为间歇性(53.73%,72/134),严重程度多为轻度(63.43%,85/134);中青年组患者AR分型多为持续性(60.78%,62/102),轻度和中-重度严重程度各占50.00(51/102),差异有统计学意义(P<0.05)。老年AR患者伴随症状咽喉不适/咳嗽发生率为29.85%(40/134),低于中青年组的46.08%(47/102),差异有统计学意义(P<0.05);其余伴随症状比较,差异无统计学意义。二元logistic回归分析提示,饲养宠物、职业接触粉尘、AR家族史以及哮喘史是影响老年AR发病的独立危险因素(OR=1.752、2.036、1.992、3.916;P<0.05)。结论与中青年相比,老年AR患者变应原阳性率更低、临床表现及病情严重程度更轻,临床应注重老年AR的筛查及诊断,减少漏诊误诊率;此外,还应注重具有饲养宠物、职业性接触粉尘、AR家族史及哮喘史等AR危险因素且具备临床症状的老年人的AR筛查。

Objective To investigate the clinical characteristics and risk factors of allergic rhinitis(AR)in the elderly.Methods A total of 236 AR patients treated in Beijing Royal Hospital of Integrative Chinese Medicine from January 2018 to December 2022 were enrolled into the study group.According to the age,they were divided into a young and middle-aged group(aged 18-59 years old;n=102)and an elderly group(age≥60 years old;n=134).A control group enrolled 160 elderly volunteers treated in the same hospital during the same period,who matched the elderly AR group in age and gender but without allergic disease.Firstly,the young and middle-aged AR group and the elderly AR group were compared in the clinical characteristics,and then a binary logistic regression model was used to analyze the factors affecting the AR onset in the elderly in reference to the control group.SPSS 19.0 was used for data analysis.Comparison between two groups was performed usingχ^(2)test.Results There were no statistically significant differences in the gender ratio and incidence peak among the AR patients in different age groups.The rate of positive allergen tests in elderly AR patients(32.09%,43/134)was lower than that in the young and middle-aged AR group(68.63%,70/102)and the difference was statistically significant(P<0.05).The AR type in elderly group was mostly intermittent(53.73%,72/134)and the severity was mostly mild(63.43%,85/134);the AR type in young and middle-aged group was mostly persistent(60.78%,62/102),and the severity was equally mild(50.00%,51/102)and moderate-to-severe(50.00%,51/102),the differences being statistically significant(P<0.05).The incidence of throat discomfort/cough in elderly AR patients(29.85%,40/134)was lower than that in young and middle-aged group(46.08%,47/102)with statistically significant difference(P<0.05),but there were no statistically significant differences in other accompanying diseases.Binary logistic regression analysis indicated that pet ownership,exposure to occupational dust,family history of AR,and history of asthma were independent factors affecting the onset of AR in the elderly(OR=1.752,2.036,1.992,3.916;P<0.05).Conclusion Compared with the young and middle-aged patients,the elderly AR patients have lower positive rate of allergen tests and milder clinical manifestations and disease.It is clinically necessary to pay attention to the screening and diagnosis of AR in the elderly to reduce the rates of the missed diagnoses and misdiagnoses.It is also necessary to emphasize the screening for AR in the elderly with clinical symptoms and high risk factors such as pet ownership,exposure to occupational dust,family history of AR and history of asthma.