不同程度非变应性鼻炎对下气道炎症指标的影响  

Influences of non-allergic rhinitis with different levels on inflammation indices of lower airway

作　　者：季俊峰[1] 王秋萍[1] 张勇[1] 王志颐[1] 吴昆旻[1] 许莉[1] 陈伟[1] 薛飞[1] 江满杰[1] 王天友[1] 钟南山[2] 

机构地区：[1]南京军区南京总医院耳鼻咽喉头颈外科,江苏南京210002 [2]广州呼吸疾病研究所呼吸疾病国家重点实验室广州医科大学附属第一医院,广东广州510120

出　　处：《中国耳鼻咽喉颅底外科杂志》2016年第1期14-18,共5页Chinese Journal of Otorhinolaryngology-skull Base Surgery

基　　金：呼吸疾病国家重点实验室开放课题(2007DA780154F0907)

摘　　要：目的通过比较不同程度非变应性鼻炎(non-allergic rhinitis,NAR)患者全身及下气道各项测量指标的差异,探索他们系统性炎症、下气道炎症及下气道高反应性的特征和差异。方法募集门诊NAR患者262例,参照ARIA指南根据鼻炎症状对患者生活质量的影响将受试者分为两组,轻度组145例、中-重度组117例,均行外周血嗜酸粒细胞(eosinophil,EOS)比率、诱导痰EOS比例、呼出气一氧化氮(fractional exhaled nitric oxide,Fe NO)检测及乙酰甲胆碱支气管激发试验,比较两组患者全身及下气道炎症、下气道高反应性的特征和差异。结果 1中-重度组患者外周血EOS比率、支气管激发试验、Fe NO阳性率与轻度组患者的差异均具有统计学意义(6.2%vs2.1%;10.3%vs 2.8%;72.6%vs 29.0%;P<0.01),两组间诱导痰EOS比例阳性率差异无统计学意义(14.5%vs17.9%,P>0.05);2中-重度组患者外周血EOS比率、Fe NO与轻度组患者的差异有统计学意义[2.0(4.0)%vs 1.5(2.1)%;35.8(25.9)ppb vs 16.3(17.0)ppb,P<0.01],两组间诱导痰EOS比例无统计学差异[1.0(1.8)%vs 0.5(1.3)%,P>0.05]。结论 1不同程度NAR患者全身及下气道炎症、气道高反应性存在差异,中-重度NAR患者呈现出更高水平的全身及下气道异常;2中-重度NAR患者更易出现下气道异常,临床医师应予重视。Objective To explore characteristics and differences of systemic and airway inflammatory indices in systemic inflammation,airway inflammation and airway hyperresponsiveness by comparing their differences in different levels of non-allergic rhinitis（ NAR）. Methods From June 2008 and Dec 2012,262 NAR subjects were recruited and allocated to mild NAR group（ 145 cases） and moderate-severe NAR group（ 117cases） according to the ARIA guide. All subjects underwent blood routine test and induced sputum examination for eosinophil ratio,measurement of fractional exhaled nitric oxide（ Fe NO） and bronchial challenge test. Results① The positive rates of blood eosinophil ratio,bronchial provocation test and Fe NO in moderate-severe NAR group were higher than those of mild NAR group（ 6. 2% vs2. 1%,10. 3% vs 2. 8%,72. 6% vs 29. 0%; all P〈 0. 01）. The difference of positive rate of induced sputum eosinophil ratio between both groups was statistically insignificant（ 14. 5% vs 17. 9%,P〉 0. 05）. ② Blood eosinophil ratio and Fe NO of moderate-severe NAR group were higher than those of mild NAR group[2. 0（ 4. 0） % vs 1. 5（ 2. 1） %; 35. 8（ 25. 9） ppb vs 16. 3（ 17. 0） ppb,P〈 0. 01],while the difference of induced sputum eosinophil ratio between the two groups was statistically insignificant[1. 0（ 1. 8） % vs 0. 5（ 1. 3） %,P〉 0. 05]. Conclusions Differences of systemic inflammation,airway inflammation and airway hyperresponsiveness exist among patients with NAR of different levels.Patients with moderate-severe NAR may have high level systemic and low airway inflammation. Clinical physicians should pay more attention to it.

关 键 词：非变应性鼻炎 气道炎症 气道高反应性 诱导痰 呼出气一氧化氮 

分 类 号：R765.21[医药卫生—耳鼻咽喉科]