应用皮内试验和血清特异性IgE诊断蒿属花粉症的临床价值  

Value of intradermal skin test and serum sIgE detection in diagnosing artimisia pollinosis

作　　者：尹佳[1] 何海娟[1] 王瑞琦[1] 徐涛[2] 岳凤敏[1] 王良录[1] 张宏誉[1] 叶世泰[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院变态反应科,100730 [2]中国医学科学院基础医学研究所中国协和医科大学基础医学院流行病统计学系

出　　处：《中华医学杂志》2006年第25期1759-1763,共5页National Medical Journal of China

基　　金：科技部2002年科研院所社会公益研究专项基金重点项目(2002DIB40089);首都医学发展基金联合攻关项目(2002-1001)

摘　　要：目的评价应用皮内试验和血清特异性IgE(sIgE)检测方法诊断蒿属花粉症的临床价值方法对1150例(5-75岁)夏秋季变应性鼻炎和哮喘患者进行蒿属花粉等20种吸入过敏原皮内试验和蒿属花粉血清sIgE检测。皮内试验所用蒿属花粉和豚草花粉浸液浓度1:1000(w／v),其他变应原为1:100(w／v)。对所有入选者进行蒿属花粉sIgE检测。根据典型病史、皮内试验和sIgE检测结果建立临床综合诊断确诊标准并以此标准评价皮内试验和sIgE检测的临床价值结果以临床综合诊断为确诊标准时,皮内试验的敏感度(96．2％)、特异度(74．2％)、阳性预期值(93．5％)、阴性预期值(85．7％)和诊断的准确率(91．6％)等评价指标均高于单纯以sIgE≥0．35 kUa／L为参考标准时皮内试验的各项评价指标;sIgE检测的敏感度(97．6％)、特异度(94．9％)、阳性预期值(98．7%)、阴性预期值(91．1％)和诊断的准确率(97．0％)等评价指标高于单纯以皮内试验≥5 mm为参考标准时体外试验的各项评价指标。当以皮内试验≥10 mm或sIgE≥0．70 kUa／L为阳性标准时,皮内试验和sIgE检测的假阳性率分别从35．0％和22．7％降至25．6％和5。1％。结论皮内试验和sIgE检测有很好的相关性,但两者诊断蒿属花粉症均有假阳性的可能,皮内试验假阳性率高于sIgE检测。当单独使用皮内试验或sIgE检测诊断蒿属花粉症时,提高其阳性诊断标准可降低假阳性率。Objective To evaluate the value of intradermal skin test （IDT） and serum sIgE detection in diagnosing Artimisia sensitivity in Chinese patients with autumnal hay fever Methods 1150 patients with autumnal rhinitis or asthma, 504 males and 646 females, aged 5 - 77, were evaluated by experienced physicians , then underwent IDT by using 20 kinds of aeroallergen extracts. The concentrations of Artimisia and Ragweed extracts employed in skin test were 1：1000 （W/V） and the concentrations of other aeroallergens were all 1：100 （ W/V ）. Then ac sll patients underwent detection of Artimisia sIgE. Diagnostitandards were established based on the results of IDT and sIgE results respectively. A reference standard was established according to the typical history, symptoms, and an wheal with a diameter ≥5mm and a sIgE level≥ 0.35 kUA/L, an wheal with the diameter ≥10 mm alone; or a sIgE level ≥0. 70 kUa/L alone. Results When using the reference standard as criteria, using IDT had better sensitivity （96. 2% ）, specificity （74. 2% ）, positive predictive value （ ＋ PV, 93. 5% ）, negative predictive value （-PV, 85.7% ）, and efl3ciency （91.6%） than using sIgE ≥ 0. 35 kUa/L alone as the criteria of IDT; sIgE detection had better sensitivity （97.6%）, specificity （94.9%）, ＋ PV （98.7%）, -PV （91.1%）, and efficiency （97.0%） than using wheal diameter ≥ 5 mm alone as the criteria of sIgE detection. The false positive rate of IDT and sIgE detection decreased from 35% and 22.7% to 25.6% and 5.1% respectively when using the wheal diameter ≥ 10 mm or sIgE ≥ 0.70 kUa/L as a positive criteria. Conclusion IDT and sIgE detection are correlated with each other well in diagnosing Artimisia pellinosis, beth of them have the possibility of being false positive, but IDT has higher false positive rate than sIgE detection. The false positive rates of IDT and sIgE detection can be decreased by increasing the positive criteria to higher grading reaction.

关 键 词：花粉症 皮内试验 特异性IGE 蒿属 花粉 变应原 

分 类 号：R593.2[医药卫生—内科学]