中青年过敏性鼻炎患者皮肤点刺试验与血清特异性IgE检测的对比研究

Comparative study on skin prick test and serum specific IgE detection in middle-aged and young patients with allergic rhinitis

目的比较中青年过敏性鼻炎(AR)患者的皮肤点刺试验(SPT)和血清特异性IgE(sIgE)检测在诊断过敏原方面的效果,并分析两种检测方法的相关性。方法回顾性选取2018年9月至2019年9月秦皇岛市第二医院门诊就诊的150例中青年AR患者,均行SPT及血清sIgE检测,记录检测结果。将SPT阳性结合临床症状与体征作为诊断AR的参考标准,比较SPT不同阳性界值(“+”、“2+”)下血清sIgE的诊断价值。使用Spearman等级相关性分析法分析SPT结果与血清sIgE检测结果的相关性。结果SPT和血清sIgE检测结果均显示每例患者有2种及以上吸入性过敏原阳性。其中,粉尘螨过敏原在两种检测方法中的阳性率最高(分别为80.67%、76.67%和75.33%)。除豚草外,其他过敏原的阳性率比较,差异无统计学意义(P>0.05)。当SPT的阳性界值设为“+”时,针对不同过敏原,血清sIgE检测的敏感性范围为50.00%(豚草)~91.30%(屋尘螨),特异性范围为89.66%(粉尘螨)~100%(动物毛发、屋尘螨、艾蒿),阳性预测值范围为70.00%(霉菌I)~100%(动物毛发、屋尘螨、艾蒿),阴性预测值范围为70.27%(粉尘螨)~96.18%(藜科),准确度范围为76.00%(豚草)~94.67%(藜科)。相对比,当SPT的阳性界值设为“2+”时,血清sIgE检测除了动物毛发、屋尘螨、艾蒿、豚草、藜科的阴性预测值与SPT的阳性界值设为“+”时比较,差异无统计学意义(P>0.05),其余过敏原的敏感性、特异性、阳性预测值、阴性预测值、准确度均下降(P<0.05)。SPT结果与血清sIgE检测结果的分级状况呈正相关(r_(s)=0.753,P<0.05)。结论SPT结果为阴性~+时,血清sIgE的诊断价值较高,可优先选择血清sIgE检测;SPT结果为2+~4+时,可不用检测血清sIgE。两种方法在过敏原检测中的相关性较高,可互相参考,提高过敏原检测的准确性。

Objective To compare the effectiveness of skin prick test(SPT)and serum specific IgE(sIgE)detection in the diagnosis of allergens in middle-aged and young patients with allergic rhinitis(AR),and to analyze the correlation between the two detection methods.Methods A total of 150 middle-aged and young AR patients who visited Department of Outpatient,Second Hospital of Qinhuangdao from September 2018 to September 2019 were retrospectively selected for SPT and serum sIgE testing,and the test results were recorded.SPT positive combined with clinical symptoms and signs was used as a reference standard for diagnosing AR,the diagnostic value of serum sIgE under different positive thresholds("+","2+")of SPT was compared.Spearman rank correlation analysis was used to analyze the correlation between SPT results and serum sIgE detection results.Results The results of SPT and serum sIgE tests showed that each patient had positive results for 2 or more types of inhaled allergens.Among them,the positive rate of dust mite allergen was the highest among the two detection methods(80.67%,76.67%,and 75.33%,respectively).There was no statistically significant difference in the positive rates of other allergens except for ragweed(P>0.05).When the positive threshold of SPT was set to"+",the sensitivity range of serum sIgE detection for different allergens was 50.00%(ragweed)~91.30%(house dust mite),the specificity range was 89.66%(dust mite)~100%(animal hair,house dust mite,mugwort),the positive predictive value range was 70.00%(mold I)~100%(animal hair,house dust mite,mugwort),and the negative predictive value range was 70.27%(dust mite)~96.18%(chenopodiaceae),the accuracy range was 76.00%(ragweed)to 94.67%(chenopodiaceae).In contrast,when the positive cutoff value of SPT was set to"2+",the serum sIgE detection showed no statistically significant difference(P>0.05),except for the negative predictive value of animal hair,house dust mites,Artemisia argyi,ragweed,and Chenopodiaceae,and when the positive cutoff value of SPT was set to"+".The sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of other allergens decreased(P<0.05).The SPT results were positively correlated with the grading status of serum sIgE detection results(r_(s)=0.753,P<0.05).Conclusion When the SPT result is negative~+,the diagnostic value of serum sIgE is higher,and serum sIgE detection can be prioritized;when the SPT result is 2+-4+,there is no need to test serum sIgE.two types.The two methods have a high correlation in allergen detection and can be mutually referenced to improve the accuracy of allergen detection.