呼吸道病毒感染过敏性鼻炎患儿的嗜酸性粒细胞阳离子蛋白-髓过氧化物酶阳性率检测及联合抗病毒治疗  

Detection of positive rate of eosinophil cationic protein-myeloperoxidase and antiviral combination therapy for children with respiratory virus infection and allergic rhinitis

作　　者：王美兰[1,2] 高映勤[1] 肖洋[1,2] 李正才 张婷[1,2] 梁燕 梁燕琪[1,4] 刘凯铮 郭磊 Wang Meilan;Gao Yingqin;Xiao Yang;Li Zhengcai;Zhang Ting;Liang Yan;Liang Yanqi;Liu Kaizheng;Guo Lei(Department of Otolaryngology,Head and Neck Surgery,Kunming Children’s Hospital,Kunming 650103,China;Kunming Medical University,Kunming 650500,China;School of Health Nursing,Yunnan Open University,Kunming 650101,China;Yunnan Institute of Pediatrics,Kunming Children’s Hospital,Kunming 650103,China)

机构地区：[1]昆明市儿童医院耳鼻咽喉头颈外科,昆明市650103 [2]昆明医科大学,昆明市650500 [3]云南开放大学健康护理学院,650101 [4]昆明市儿童医院,云南省儿科研究所,昆明市650103

出　　处：《中华实验和临床感染病杂志(电子版)》2024年第6期327-334,共8页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：云南省重点研发计划-国际科技合作专项(No.202103AF140008);昆明市卫生科技人才培养医学技术中心项目[No.2022-SW(技术)-05/09];云南省教育厅科学研究基金项目(No.2023J0300);云南省科技厅科技计划项目-昆医联合专项(No.202001AY070001-272)。

摘　　要：目的探讨鼻腔嗜酸性粒细胞阳离子蛋白(ECP)和髓过氧化物酶(MPO)阳性率检测对过敏性鼻炎(AR)患儿合并呼吸道病毒感染的诊断价值,并评估鼻喷激素联合干扰素的疗效。方法收集2022年4月至2023年4月于昆明市儿童医院就诊的362例患儿的鼻灌洗液样本,应用RT-PCR检测6种常见呼吸道病毒,采用视觉模拟量表评分(VAS)评估患儿症状,应用胶体金试纸检测样本ECP-MPO阳性率;给予呼吸道病毒阳性患儿鼻喷激素联合干扰素治疗,分析患儿症状改善程度。计数资料采用χ^(2)检验,计量资料(VAS评分)根据是否正态分布采用非配对t检验或Mann-Whitney U检验行组间比较。结果362例入组患儿呼吸道病毒总检出率达48%(174/362),主要检出病毒为鼻病毒(40%、145/362)。未接受过敏原特异性免疫治疗(AIT)患儿中呼吸道病毒阳性者VAS评分显著高于呼吸道病毒阴性患儿(4.776±1.229 vs.4.193±1.392),差异有统计学意义(t=2.776、P=0.006)。未接受AIT治疗且呼吸道病毒检出阳性的AR患儿接受糠酸莫米松联合干扰素α2b者鼻喷治疗7天后VAS评分显著低于糠酸莫米松单独治疗者(3.380±0.801 vs.2.705±0.696),差异有统计学意义(t=2.414、P=0.015)。接受AIT患儿ECP-MPO双阳性率(38%)显著低于未接受AIT患儿(69%)(χ^(2)=20.473、P<0.001)。呼吸道病毒阳性患儿MPO阳性率(84%)显著高于呼吸道病毒阴性患儿(61%)(χ^(2)=15.08、P<0.001),且在未接受AIT患儿中呼吸道病毒阳性者MPO阳性率为99%(66/67),显著高于呼吸道病毒阴性患儿(67%、41/61),差异有统计学意义(χ^(2)=22.80、P<0.001)。结论过敏性鼻炎患儿呼吸道病毒检测阳性率接近50%,主要为鼻病毒。合并呼吸道病毒感染AR患儿过敏症状更为严重,糠酸莫米松联合干扰素治疗能够显著缓解AR症状,ECP-MPO检测对于AR患儿合并呼吸道病毒感染具有一定诊断价值。Objective To investigate the diagnostic value of nasal eosinophil cationic protein(ECP)and myeloperoxidase(MPO)positive rate detection for viral respiratory infection in children with allergic rhinitis(AR),and to evaluate the efficacy of nasal spray hormone combined with interferon.Methods Nasal lavage fluid was collected from enrolled children in Kunming Children’s Hospital from April 2022 to April 2023,and 6 common respiratory viruses were detected through reverse transcription PCR(RT-PCR).The severity grade of symptoms in those patients were assessed by Visual analogue scale(VAS)and the positive rate of ECP-MPO in the samples were detected by colloidal gold test paper.Nasal sprays of mometasone furoate combined with interferon were used to treat respiratory virus positive children with AR,and the degree of symptom improvement among children were analyzed.The count data were analyzed using Chisquare test,while the quantitative data(VAS score)were compared between groups using non-paired t-test or Mann Whitney U test based on whether distributed normally.Results The total detection rate of respiratory viruses among 362 enrolled children was 48%(174/362),with the main virus detected being rhinovirus(40%,145/362).VAS scores of respiratory virus positive children who did not receive allergen specific immunotherapy(AIT)were significantly higher than those of virus negative children(4.776±1.229 vs.4.193±1.392),with significant difference(t=2.776,P=0.006).Among the children with AR who did not receive AIT treatment and positive detection for respiratory viruses,those who received mometasone furoate combined with interferon alpha 2b and received nasal spray treatment for 7 days had significantly lower VAS scores than those who received mometasone furoate alone(3.380±0.801 vs.2.705±0.696),with significant difference(t=2.414,P=0.015).The double positive rate of ECP-MPO among children who received AIT(38%)was significantly lower than that of children who did not receive AIT(69%),with significant difference(χ^(2)=20

关 键 词：儿童 过敏性鼻炎 呼吸道病毒 嗜酸性粒细胞阳离子蛋白 髓过氧化物酶 过敏原特异性免疫治疗 

分 类 号：R765.21[医药卫生—耳鼻咽喉科] R725.6[医药卫生—临床医学]