变应性鼻炎患者下气道异常特征研究  

Lower airway abnormalities in patients with allergic rhinitis

作　　者：季俊峰[1] 王秋萍[1] 张勇[1] 王志颐[1] 谢燕清[2] 关伟杰[2] 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] Ji Junfeng Wang Qiuping Zhang Yong Wang Zhiyi Xie Yanqing Guan Weijie Wu Kunmin Xu Li Chen Wei Xue Fei Jiang Manjie Wang Tianyou Zhong Nanshan(Department of Otolaryngology Head and Neck Surgery, Nanjing General Hospital of Nanjing Military Command, PLA, Nanjing, Jiangsu 210002, China)

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

出　　处：《中华结核和呼吸杂志》2016年第11期856-861,共6页Chinese Journal of Tuberculosis and Respiratory Diseases

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

摘　　要：目的 通过系统性研究变应性鼻炎（AR）患者下气道检测指标的变化,了解其下气道的异常特征.方法 自2008年6月至2012年12月募集AR不伴下气道疾病及症状患者377例（AR组）,健康对照组264名.所有受试者均采集病史,行皮肤点刺试验,检测外周血嗜酸粒细胞（Eos）、血清总IgE、呼出气一氧化氮（FeNO）,行肺通气功能、乙酰甲胆碱支气管激发试验以及诱导痰Eos比例检查.结果 AR组支气管激发试验阳性率为12.2％（46/377）;FeNO中位数为35.0（21.8,65.9）ppb,阳性率为49.2％（185/377）;诱导痰Eos比例为2.0（0.0,7.5）％,阳性率为39.0％（147/377）;外周血Eos比例为2.9（1.8,4.5）％,阳性率为15.6％（40/377）;血清总IgE为178.4（63.1,384.0）kU/L,阳性率为55.4％（209/377）,均明显高于健康对照组（均P＜0.01）.肺通气功能测试示FEV1/FVC、最大呼气中段流量（MMEF）占预计值％、MEF75占预计值％、MEF25占预计值％指标明显低于对照组（均P＜0.05）.FeNO、诱导痰Eos比例以及外周血Eos比例之间均存在显著的相关性（r值分别为0.247、0.235、0.355,均P＜0.01）.结论 部分单纯AR患者存在与支气管哮喘类似的以FeNO、诱导痰Eos增高为特征的下气道炎症、小气道功能异常以及支气管高反应性等下气道异常表现.Objective To investigate the characteristics of lower airway abnormalities in allergic rhinitis（AR） patients without asthma.Methods Between June 2008 and December 2012,377 consecutive AR patients and 264 healthy subjects were recruited.All subjects underwent meticulous history taking,nasal examination,allergen skin prick test,blood routine test,serum total immunoglobin E assay,induced sputum cell count and differentials,measurement of fractional exhaled nitric oxide （FeNO） and bronchial challenge test.Results The positive rates in AR patients was 12.2％ （46/377） for bronchial provocation test,49.2％ （185/377） for FeNO,39.0％ （147/377） for sputum eosinophilia,15.6％ （40/377） for peripheral blood eosinophilia and 55.4％ （209/377） for increased serum total IgE levels,which were consistently and statistically higher than those of healthy controls （P ＜ 0.01）.The levels of FeNO [35.0 （21.8,65.9）ppb],induced sputum eosinophil percentage [2.0 （0.0,7.5） ％],peripheral blood eosinophil percentage [2.9 （1.8,4.5）％] and serum total IgE [178.4 （63.1,384.0）kU/L] in AR patients were also higher （P ＜ 0.01）.Compared with healthy controls,patients with AR demonstrated lower levels of FEV1/FVC％,MMEFpred％,MEF75 pred％,MEF25pred％ （all P ＜ 0.05）.Statistical analysis showed that FeNO,ratio of induced sputum eosinophil percentage and peripheral blood eosinophil percentage had significant correlations with each other（P ＜ 0.01）,the r value being 0.247,O.235,0.355 respectively.Conclusion AR without asthma is characterized by lower airway inflammation,small airway impairment and bronchial hyperreactivity,features similar to those of asthma.

关 键 词：鼻炎 哮喘 支气管高反应性 气道炎症 

分 类 号：R765.21[医药卫生—耳鼻咽喉科]