动物皮屑过敏性哮喘患者的临床特征分析

Clinical characteristics of the patients with allergic asthma caused by pet allergens

目的分析研究动物皮屑过敏性哮喘患者的临床特征。方法本研究为回顾性研究。收集2019年6月至2022年6月清华大学附属北京清华长庚医院呼吸与危重症医学科门诊诊治的所有成人动物皮屑过敏性哮喘患者的临床资料,回顾性分析动物皮屑过敏性哮喘患者临床特征、过敏原特点、血嗜酸性粒细胞(EOS)计数及百分比、总IgE、呼出气一氧化氮(FeNO)、哮喘控制测试(ACT)评分、肺功能及脱离过敏原对哮喘控制的影响。结果动物皮屑过敏性哮喘患者共575例,占过敏性哮喘患者(共1701例)的33.8%。其中单一动物皮屑过敏者203例,占过敏性哮喘患者的11.9%;动物皮屑为多种吸入性过敏原之一者372例,占过敏性哮喘患者的21.9%。动物皮屑过敏性哮喘患者中,男、女比例为1∶1.75,平均年龄(38.68±14.07)岁,347例(60.3%)有宠物饲养史,轻度过敏反应者宠物饲养率更高,404例(70.3%)的患者有胸闷或喘息,合并尘螨类过敏原比例最高(345例,60.0%)。相较于单一动物皮屑过敏性哮喘患者,混合动物皮屑过敏性哮喘患者合并过敏性鼻炎和其他过敏性疾病比例明显增加(χ^(2)值分别为14.06、23.58,均P<0.001),合并胸闷或喘息者更多(χ^(2)=27.82,P<0.001),ACT评分更低(t=5.06,P<0.001),血EOS和总IgE更高(Z=2.18,P=0.029;Z=8.89,P<0.001),合并阻塞性通气功能障碍者更多(χ^(2)=12.42,P=0.001),第1秒用力呼气容积占预计值百分比更低(t=2.85,P=0.001)。单一动物皮屑过敏性哮喘患者中,重度过敏组血EOS、EOS%较轻度过敏组高(H值分别为9.44、12.69,P值分别为0.009、0.002),重度过敏组总IgE比轻度和中度过敏组高(H=28.68,P<0.001),重度和中度过敏组FeNO值较轻度过敏组高(H=18.02,P<0.001),但不同过敏严重程度组临床症状和肺功能比较差异无统计学意义。治疗随访3个月,脱离过敏原组较未脱离过敏原组和无明确过敏原接触组ACT评分改善、血EOS下降、FeNO下降更明显(均P<0.001),而未脱离过敏原组和无明确接触史组之间ACT评分改善、EOS下降比较差异无统计学意义。结论动物皮屑过敏性哮喘占过敏性哮喘患者的33.8%,以青年女性更常见,大部分有宠物饲养史;混合动物皮屑过敏性哮喘比单一动物皮屑过敏性哮喘患者临床症状更重,血EOS和总IgE更高,肺功能更差;重度单一动物皮屑过敏性哮喘患者血EOS、总IgE更高、嗜酸性气道炎症更重,但临床症状与及肺功能与过敏严重程度无关;脱离过敏原可使ACT评分、血EOS及嗜酸性气道炎症得到更好的改善。

Objective To analyze the clinical characteristics of the patients with allergic asthma caused by pet allergens.Methods This was a retrospective study.The clinical data of the adult outpatients with allergic asthma caused by pet allergens in Department of Pulmonary and Critical Care Medicine,Beijing Tsinghua Changgung Hospital,Tsinghua University from June 2019 to June 2022 were collected.The clinical characteristics,allergens,eosinophils(EOS)count and percentage,total IgE,FeNO,asthma control test(ACT)scores,pulmonary function,and the effects of allergen withdrawal on asthma control were analyzed retrospectively.Results There were 575 cases of allergic asthma caused by pet allergens,accounting for 33.8%of allergic asthma(1701 cases).Among them,203 cases were allergic to pet allergens single,accounting for 11.9%of allergic asthma.A total of 372 cases were allergic to at least two kinds of inhalation allergens including pet allergens,accounting for 21.9%of allergic asthma.Among patients with asthma caused by pet allergens,the ratio of men to women is 1∶1.75,with an average age of(38.68±14.07)years.A total of 347 cases(60.3%)have a history of pet ownership,with higher pet ownership for mildly allergic patients.A total of 404 cases(70.3%)have chest tightness or wheezing.A total of 345 cases(60.0%)are allergic to allergens combined with dust mite.Compared to asthma patients caused by pet allergens single,patients with multiple inhalation allergens including pet allergens are associated with higher proportion of allergic rhinitis and other allergic diseases(χ^(2)=14.06,23.58,both P<0.001),more patients with chest tightness or wheezing(χ^(2)=27.82,P<0.001),lower ACT scores(t=5.06,P<0.001),higher blood EOS and total IgE(Z=2.18,P=0.029;Z=8.89,P<0.001),more patients with obstructive ventilation dysfunction(χ^(2)=12.42,P=0.001),and lower FEV1/predicted value%(t=2.85,P=0.001).About asthma patients caused by pet allergens single,the blood EOS and EOS%in the severe allergic group were higher than those in the mild allergic group(H=9.44,P<0.009;H=12.69,P=0.002),the total IgE in the severe allergic group was higher than those in the mild and moderate allergic groups(H=28.68,P<0.001),and the FeNO value in the severe and moderate allergic groups was higher than that in the mild allergic group(H=18.02,P<0.001).However,there was no significant difference in clinical symptoms and pulmonary function among the different allergic severity groups.With a follow-up of 3 months,the ACT score increased,blood EOS and FeNO decreased in the allergens withdrawal group compared to the allergens non-withdrawal group and the allergens contact free group(all P<0.001).Conclusions Asthma patients caused by pet allergens account for 33.8%of allergic asthma cases.It is more common in young women,most of whom have pet ownership history.Patients with multiple inhalation allergens including pet allergens show more severe clinical symptoms,higher blood EOS and total IgE,and poorer lung function than those with pet allergens single.Patients severely allergic to pet allergens have higher serum EOS and total IgE,and more severe airway allergic reactions,but their clinical symptoms and pulmonary function are not related to allergy severity.Allergens withdrawal can increase ACT scores,decrease blood EOS,and improve eosinophilic airway inflammation more efficiently.