内蒙古三个城市及农村地区的变应性鼻炎蒿属花粉致敏特征分析

Analysis of pollen sensitization characteristics of artemisia allergic rhinitis in three urban and rural areas of Inner Mongolia

目的探讨内蒙古自治区3个中心城市及农村地区蒿属花粉的播散规律以及所诱导的变应性鼻炎(allergic rhinitis,AR)的临床致敏特征。方法2019年3—10月期间,在内蒙古3个中心城市(赤峰、呼和浩特、鄂尔多斯)及农村地区采用多阶段分层随机抽样和面对面问卷调查相结合的流行病学调查方法,进行疑似AR患者的筛选,并为其进行皮肤点刺试验(skin prick test,SPT)以确诊,同时对3个地区进行花粉监测,分析蒿属花粉的分布规律以及临床致敏特征。采用SPSS 26.0统计学软件对全部数据进行处理。不同年龄、性别、地区、民族之间率的比较用卡方检验,采用Spearman检验描述相关性分析,多个样本阳性率的两两比较用Bonferroni法。结果6393名被调查者中有1093例被确诊为AR,确诊AR患病率为17.10%(1093/6393),其中蒿属花粉诱导型鼻炎(pollen-induced allergic rhinitis,PiAR)的患病率为10.97%(701/6393),占比为64.14%(701/1093);高发年龄在青年组(20~39岁),占比46.94%(329/701);女性确诊患病率高于男性(11.35%vs.10.64%,χ^(2)值为12.304,P<0.001);少数民族患病率高于汉族(13.01%vs.10.65%,χ^(2)值6.296,P=0.008);城市患病率也明显高于农村(18.40%vs.5.50%,χ^(2)值10.497,P<0.001);内蒙古3个地区患病率的差异有统计学意义(赤峰6.06%、呼和浩特13.46%、鄂尔多斯16.39%,χ^(2)值为70.054,P<0.001);蒿属PiAR的临床症状以喷嚏(95.58%)、鼻塞(91.73%)和鼻痒(89.30%)为主;合并疾病中,过敏性结膜炎占79.60%(558/701),慢性鼻窦炎占55.63%(390/701),哮喘占23.25%(163/701);蒿属花粉致敏模式主要是多重致敏,其合并其他过敏原过敏诱发的临床症状频次及临床疾病占比较单一蒿属花粉致敏的多;3个地区蒿属花粉的播散期均为6—10月份,于夏季8月份呈现峰值状态;蒿属PiAR患者临床症状出现频次高峰时间比花粉浓度高峰时间提早约2周,且二者呈显著正相关性(R=0.7671,P<0.001)。结论蒿属植物花粉是内蒙古地区夏末秋初的主要优势花粉,蒿属PiAR患病率较高,控制蒿属花粉的播散对AR的预防与治疗具有重要意义。

Objective To investigate the distribution rules of artemisia pollen and the clinical sensitization characteristics of allergic rhinitis(AR)induced by artemisia pollen in three urban and rural areas of Inner Mongolia.Methods From March to October 2019,in 3 central cities(Chifeng,Hohhot,Ordos)and rural areas of Inner Mongolia,an epidemiological investigation method combining multi-stage stratified random sampling and face-to-face questionnaire survey was adopted to screen suspected AR patients,and skin prick test(SPT)was applied for diagnosis.At the same time,pollen monitoring was carried out in 3 areas to analyze the distribution and clinical sensitization characteristics of artemisia pollen.SPSS26.0 statistical software was used to process all the data.Chi-square test was used to compare rates among different age,sex,region and nationality,Spearman test was used to describe correlation analysis,and pairwise comparison of positive rates among multiple samples was used Bonferroni method.Results Among the 6393 subjects,1093 cases were diagnosed with AR,and the prevalence of AR was 17.10%(1093/6393).Among them,pollen-induced allergic rhinitis,the prevalence of PiAR was 10.97%(701/6393),accounting for 64.14%(701/1093).The highest incidence was in the youth group(20-39 years old),accounting for 46.94%(329/701).The diagnosed prevalence was higher in females than in males(11.35%vs.10.64%,χ^(2) value 12.304,P<0.001).The prevalence rate of ethnic minority was higher than that of Han nationality(13.01%vs.10.65%,χ^(2) value 6.296,P=0.008).The prevalence in urban areas was also significantly higher than that in rural areas(18.40%vs.5.50%,χ^(2) value 10.497,P<0.001).There was significant difference in prevalence rate among the three regions in Inner Mongolia(6.06%in Chifeng,13.46%in Hohhot,16.39%in Ordos,χ^(2) value 70.054,P<0.001).The main clinical symptoms of artemisia PiAR were sneezing(95.58%),nasal congestion(91.73%)and nasal itching(89.30%).Allergic conjunctivitis accounted for 79.60%(558/701),chronic sinusitis for 55.63%(390/701),asthma for 23.25%(163/701).The pattern of artemisia pollen sensitization was mainly multiple sensitization,and the frequency of clinical symptoms and clinical diseases induced by hypersensitization with other allergens accounted for more than that caused by single artemisia pollen.The spread period of Artemisia pollen in the three regions was from June to October,and the peak state was in August in summer.The peak time of clinical symptoms in artemisia PiAR patients was about 2 weeks earlier than the peak time of pollen concentration,and the two were significantly positively correlated(R=0.7671,P<0.001).Conclusion Artemisia pollens are the dominant pollens in late summer and early autumn in Inner Mongolia,and the prevalence of artemisia PiAR is high.Controlling the spread of Artemisia pollens is of great significance for the prevention and treatment of AR.