非变应性鼻炎的诊断及临床特征分析  

Diagnosis and clinical characteristics of patients with non-allergic rhinitis

作　　者：王洪田[1] 张静[1] 尤少华[1] 奥彦云 白银[1] 石怀银[1] 籍灵超[1] 贾婧杰[1] 张悦[1] 

机构地区：[1]解放军总医院耳鼻咽喉头颈外科,北京100853

出　　处：《中华耳鼻咽喉头颈外科杂志》2014年第6期501-505,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：全军＂十一五＂科技攻关课题（08G128）

摘　　要：目的 探讨非变应性鼻炎（non-allergic rhinitis,NAR）的排除诊断方法,并分析其临床特征.方法 选择具有两种或以上变应性鼻炎（allergic rhinitis,AR）典型症状（鼻痒、喷嚏、清涕、鼻塞）的患者1 972例,采用4步排除法进行诊断.第一步排除不适合皮肤点刺试验（skin prick test,SPT）的患者,如妊娠、哺乳、哮喘发作期、近日口服抗组胺药物、严重皮肤病等;第二步排除SPT阳性者;第三步排除血清特异性IgE（specific IgE,sIgE）和总IgE 1级以上者;第四步排除感染性鼻炎、鼻腔结构明显异常、药物诱发和鼻腔有新生物者.最终患者被诊断为NAR.应用鼻腔分泌物细胞学检查和外周血嗜酸粒细胞数量对NAR患者进行鉴别诊断,分析患者的年龄、性别、发病年龄等临床特征.用视觉模拟量表（visual analogue scale,VAS）和鼻结膜炎相关生活质量问卷（rhinoconjunctivitis qualityof life questionaire,RQLQ）进行症状评分和生活质量评定.结果 第一步排除法后筛选到有类似AR典型症状患者1 437例.第二步排除法后筛选到SPT阴性者735例,其中302例再行sIgE检测,第三步排除法后筛选到sIgE和总IgE为O级者93例.第四步排除法后62例患者被最终诊断为NAR.单纯SPT阴性诊断NAR的诊断率为51.15％ （735/1 437）,SPT阴性＋sIgE和总IgE阴性（O级）的诊断率为29.06％（93/302）.62例NAR患者中血管运动性鼻炎（vasomotor rhinitis,VMR） 47例,占75.81％,嗜酸粒细胞增多性非变应性鼻炎（non-allergic rhinitis with eosinophilia syndrome,NARES）15例,占24.19％.62例NAR患者,年龄11～ 77岁;男23例,女39例;病程11 ～47个月.VMR和NARES患者人数在41 ～ 50岁年龄段最多,但发病年龄最高在21 ～ 30岁.VMR的鼻塞症状VAS评分最高,与其他症状的VAS评分相比差异有统计学意义（F=3.958,P=0.009）.NARES的喷嚏症状VAS评分最高,但与其他症状VAS评分差异无统计学意义.VMR和NARES两组之间在RQLQ的7个�Objective To explore a step-by-step exclusive diagnosis and analyze the clinical characters of non-allergic rhinitis （NAR）.Methods Patients with symptoms （nasal itching,sneezing,rhinorrhea,nasal congestion） were selected to take four-step exclusive diagnosis for NAR.The false NAR was eliminated and the true NAR was retained.First step was to exclude the patients who were not suitable for skin prick test （SPT,such as during pregnancy,breastfeeding,asthma,oral antihistamine medication in 7 day,severe skin diseases）.The second step was to exclude the patients with positive SPT and the third step was to exclude the patients with 1 level or above of specific seroimmunoglobulin E （sIgE）.The fourth step was to exclude the patients with infection rhinitis,clear abnormal nasal structure,drug-induced rhinitis,nasal neoplasm.The remained patients were finally diagnosed as NAR and who were further differential diagnosed as vasomotor rhinitis （VMR） or non-allergic rhinitis with eosinophilia syndrome （NARES） according to the eosinophilia counts in nasal secretion and venous blood.The common characters of patients with NAR were analyzed and their symptoms and quality of life were evaluated by visual analogue scale （VAS） and rhino-conjunctivitis quality of life questionnaire （RQLQ） separately.Results One thousand four hundred and thirty-seven patients were included after first step exclusion and 735 cases with negative SPT were remained after second step exclusion.Of 735 patients,302 were tested in vitro for sIgE and 93 cases with 0 level of sIgE and total IgE were remained after third step exclusion.Sixty-two patients were finally diagnosed as NAR after fourth step exclusion.The NAR diagnosis rate was 51.15％ （735/1 437） with negative SPT alone and the NAR diagnosis rate was 29.06％ （93/302） with combination of negative SPT and sIgE.Of 62 patients with NAR,47 patients （75.81％） were diagnosed as VMR and 15 cases （24.19％） as NARES.There were 23 males and 39 females in the 62 p

关 键 词：鼻炎 血管运动性 嗜酸粒细胞增多 诊断 生活质量 

分 类 号：R765.21[医药卫生—耳鼻咽喉科]