血清嗜酸粒细胞阳离子蛋白水平与变应性鼻炎及慢性鼻-鼻窦炎关系的探讨

目的 探讨变应性鼻炎(allergic rhinitis,AR)和慢性鼻-鼻窦炎伴鼻息肉(chronic rhinosinusitis with polyps,CRSWP)患者血清中嗜酸粒细胞阳离子蛋白(eosinophil cationic protein,ECP)的水平及其与患者鼻部过敏症状的关系.方法 用UniCAP100系统进行吸入物变应原过筛试验Phadiatop和检测血清ECP水平.取87例吸人性AR患者、49例CRSWP患者和20例健康人静脉血,采用荧光酶免疫分析法,检测血清ECP水平.对87例吸入性AR患者进行症状评分.结果 ①吸入性AR组和CRSWP过筛阳性组Phadiatop[中位数(M)和四分位间距[25%,75%]表示,以下同]分别为5185.0[983.0,14469.0]Fu和317.5[125.0,526.8]Fu,健康对照组和CRSWP过筛阴性组分别为43.5[29.0,105.0]Fu和30.0[28.0,43.0]Fu;②吸入性AR组血清ECP为24.8[14.6,49.1]μg/L,CRSWP过筛阳性组和阴性组分别为7.7[3.3,25.6]μg/L和12.5[6.7,16.7]μg/L,健康对照组为8.8[5.4,20.2]μg/L.吸入性AR组ECP明显高于CRSWP过筛阳性组、阴性组和健康对照组,行秩和检验示(z值分别为-2.821,-4.449和-4.028,P值均＜0.05),差异有统计学意义.CRSWP过筛阳性组和阴性组血清ECP较正常对照组无明显升高;③吸入性AR组患者鼻部症状评分(x-±s)为(9.139±1.892),与Phadiatop值呈明显正相关(r=0.854,P＜0.05);与血清ECP水平有一定相关性(r=0.434,P＜0.05).血清ECP和Phadiatop值有一定相关性(r=0.392,P＜0.05).结论 吸入性AR患者症状发作期血清ECP明显升高,且和疾病严重程度有相关性.血清ECP是一种较好且方便的吸入性AR辅助筛查工具,同时还可作为判断患者病情严重程度和预后的客观指标之一.而CRSWP患者血清ECP无明显升高.     

Comparison of pre- and post-operative stress levels in patients with allergic rhinitis and non-allergic rhinitis

The effects of stressful events, such as surgery, on patients with allergic diseases are unclear. The aim of this study was to evaluate whether patients with allergic rhinitis (AR) are more susceptible to stress and oxidative stress than non-allergic individuals. 20 AR patients and 20 non-allergic rhinitis (NAR) patients were recruited to this study and underwent nasal septoplasty. To evaluate the degrees of stress and oxidative stress, we collected urine and blood samples 1?day before and 1?day after surgery. Stress was assessed by measuring urine cortisol levels. Oxidative stress was assessed by calculating the balance of reactive oxygen metabolites (ROM) measured by the diacron reactive oxygen metabolites test, and antioxidant capacity (AC) was measured by the biological antioxidant potential test. In both groups, the level of post-operative urine cortisol was significantly higher than the pre-operative level, with no significant difference between the two groups. ROM levels were significantly higher in both groups after surgery than before surgery. The antioxidant capacity of the AR group was lower after surgery than before surgery, while it was greater in the NAR group after surgery. There were no significant differences in pre- or post-operative ROM or AC levels between the two groups. The ROM/AC ratio was significantly higher after surgery in the AR group than it was in the NAR group. The post-operative ROM/AC imbalance of AR patients suggests that these patients might be vulnerable to stress, especially oxidative stress.     

Serum 25-hydroxyvitamin D3 levels in children with allergic or nonallergic rhinitis

ObjectivesThe relationship between vitamin D and allergic diseases such as asthma and atopic dermatitis is shown in several studies. But there is a lack of knowledge about vitamin D status in children with allergic rhinitis (AR). We aimed to investigate serum vitamin D levels of children with AR or nonallergic rhinitis (NAR), to compare with normal subjects and to evaluate the relationship between vitamin D and the severity of AR.MethodsThe study included a total of 141 children (76 patients with rhinitis and 65 control subjects), who applied to the Pediatric allergy immunology outpatient. Skin prick tests were performed using the same antigens for all patients. Serum 25-hydroxyvitamin D3 (25OHD3) levels were measured. AR was classified according to the ARIA guidelines.ResultsMean 25OHD3 levels were 18.07 ± 6.1 ng/mL in the AR group, 14.81 ± 4.86 in the NAR, and 24.03 ± 9.43 ng/mL in the control group. These differences among groups were statistically significant (p = 0.001). Vitamin D status was determined as deficient in 32 (66.7%) patients, insufficient in 14 (29.2%) and normal in 2 (4.2%) of the AR group. These frequencies for NAR and control groups are 25 (89.3%), 3 (10.7%), 0, and 25 (38.5%), 32 (49.2%), 8 (12.3%), respectively. Vitamin D status was found to be different among groups (p = 0.001). There were not any association between 25OHD3 levels and allergen sensitivity (p > 0.05). The comparison of the mean 25OHD3 levels according to the severity and duration of AR did not detect statistically significant difference among groups (respectively, p = 0.384, p = 0.23 Denburg J, Fokkens WJ, Togias A5).ConclusionsThe mean serum 25OHD3 levels of the children both with AR and NAR were lower than control group. No association between 25OHD3 levels and allergen sensitivities was found in our study. We did not find any relationship between 25OHD3 levels and the severity and duration of allergic rhinitis     

变应性鼻炎患者可溶性白细胞介素-2受体的测定

为探讨可溶性白细胞介素－２受体（ｓｏｌｕｂｌｅｉｎｔｅｒｌｅｕｋｉｎ２ｒｅｃｅｐｔｏｒ，ＳＩＬ－２Ｒ）在变应性鼻炎中的作用机理，采用双抗体夹心酶联免疫吸附测定（ＥＬＩＳＡ）法测定３９例变应性鼻炎患者、１９例慢性鼻炎患者和１５例健康人血清及鼻分泌物ＳＩＬ－２Ｒ水平。结果发现变应性鼻炎患者血清ＳＩＬ－２Ｒ水平高于慢性鼻炎患者及健康人（Ｐ＜０．００１）。提示ＳＩＬ－２Ｒ在变应性鼻炎的发病中起重要作用     

变应性鼻炎患者可溶性白细胞介素—2受体的测定

为探讨可溶性白细胞介素－２受体在变应性鼻炎中的作用机理，采用双抗体夹心酶联免疫吸附测定（ＥＬＩＳＡ）法测定３９例变应性鼻炎患者，１９例慢性鼻炎患者和１５例健康人血清及鼻分泌物ＳＩＬ－２Ｒ水平。结果发现变应性鼻炎患者血清ＳＩＬ－２Ｒ水平高于慢性鼻炎患者及健康人（Ｐ〈０．００１）。提示ＳＩＬ－２在变应性鼻炎的发病中起重要作用。     

Clinical findings in patients with allergic rhinitis

Clinical observations, X-ray findings and results of laboratory tests were evaluated in 770 patients with allergic rhinitis. Anamnestic data and results of the allergological examination of these patients have been presented elsewhere (Holopainen et al., 1979b; Binder et al., 1982). Allergic symptoms were seasonal in 54.5% and perennial in 45.5% of the patients. Mucosal changes as seen on rhinoscopy were significantly more common among patients with perennial than among patients with seasonal rhinitis. Watery discharge was the most common nasal finding, observed in 90% of all patients. Nasal smears showed increased numbers of eosinophilic leucocytes in 70% of the cases. Relationships between the cellular population of the nasal secretion, other laboratory test results and clinical findings are described. X-ray examination revealed pathological changes in the paranasal sinuses in 53.4% of the patients.     

广州地区变应性鼻炎与非变应性鼻炎临床特征的研究

目的　了解广州地区变应性鼻炎和非变应性鼻炎患者在年龄、性别和发病季节的特征和差异,并且探讨近10年两者比例的变化趋势。方法　5486例鼻高反应症状患者分为变应性鼻炎组和非变应性鼻炎组,对两组患者的临床特征资料进行分析。结果　广州地区近10年变应性鼻炎与非变应性鼻炎的比例无明显变化趋势。变应性鼻炎与非变应性鼻炎均以男性患者为主,性别差异有统计学意义。变应性鼻炎患者年龄小于非变应性鼻炎患者年龄,变应鼻炎男性患者发病年龄低于女性患者,而非变应性鼻炎发病年龄在性别分布上无明显差异。随年龄增加变应性鼻炎患者比例逐渐下降而非变应性鼻炎比例逐渐增加。本地区变应性鼻炎在夏季高发,而非变应性鼻炎则高发于冬季。结论　广州地区变应性鼻炎与非变应性鼻炎患者在年龄、性别和发病季节等临床特征方面存在明显差异,但近10年两者比例无明显变化趋势。     

Autoanti-IgE antibodies in patients with allergic and idiopathic rhinitis

The pathophysiology of idiopathic rhinitis is unknown although evidence is accumulating to suggest that, in a proportion of patients, it may be a more localized form of allergic rhinitis in the absence of other atopic symptoms and markers. Anti-IgE is thought to be a systemic marker of atopy. This study compared serum IgG autoanti-IgE levels in patients with idiopathic rhinitis, perennial allergic rhinitis and normal controls. Serum samples were obtained from 19 patients with idiopathic rhinitis, 17 patients with perennial allergic rhinitis and 10 normal non-rhinitic controls. The presence or absence of IgG1 and IgG4 anti-IgE antibodies was detected using enzyme-linked immunosorbent assays. Eighty-eight percent of the patients with perennial allergic rhinitis had raised levels of autoanti-IgE antibodies in their serum. None of the controls or patients with idiopathic rhinitis showed raised levels (P < 0.001). Although patients with idiopathic rhinitis may exhibit clinical and pathological features of allergy, they do not show raised levels of anti-IgE in their serum.     

Association of PPAR polymorphisms with cytokine levels in allergic rhinitis

Our aim was to study the association of Pro12Ala and exon6 C161T polymorphisms of PPARgamma and intron7 G/C polymorphisms of PPAR-alpha with clinical symptoms, peak nasal inspiratory flow values, serum soluble TNF-alpha, TNF-R1, Fas, Fas ligand and IgE concentrations in patients with seasonal allergic rhinitis during and after pollen season. We performed a follow-up study of 66 Hungarian patients with seasonal allergic rhinitis and 180 healthy referent subjects. We used PCR-RFLP technique and ELISA. The distribution of mutant alleles of PPAR-gamma and -alpha did not differ in patients and referent subjects. Patients carrying the mutant 12Ala, exon6 161T alleles of PPAR-gamma and intron7 C allele of PPAR-alpha had significantly higher clinical symptom score values, TNF-alpha and IgE levels and lower peak nasal inspiratory flow values during and after pollen season. The results indicated that nuclear receptors PPAR-gamma and PPAR-alpha are involved in the regulation of inflammatory mediator production in patients with seasonal allergic rhinitis and polymorphisms of the receptors are very likely to contribute to the heterogeneity of clinical and immunological parameters of allergic patients.     

Serum levels of advanced oxidation protein products in response to allergen exposure in allergic rhinitis

Patients with asthma, allergic rhinitis, or atopic dermatitis experience increased oxidative stress. We conducted a prospective study to examine the levels of advanced oxidation protein products (AOPPs) as an indicator of oxidative stress in 97 patients with allergic rhinitis who were followed in our clinic during a 3.5-month period. Of these 97 patients, 51 were treated with subcutaneous immunotherapy (SCIT), and 46 did not receive any treatment until the study was concluded. In each patient, allergic rhinitis and allergic sensitization were documented by the history, the findings on clinical examination, and the results of blood and skin-prick tests. Blood samples from each patient were analyzed to determine AOPP levels. We found that the mean serum AOPP level was significantly higher in the SCIT group than in the non-SCIT group (258.55 vs. 163.83 μmol/L; p = 0.0015). We conclude that as a known indicator of protein oxidation, the serum AOPP level is a marker of increased oxidative stress in response to allergen exposure in allergic rhinitis.     

Posture-induced nasal obstruction in patients with allergic rhinitis

Nasal resistance is affected by posture. In this study, the effects of supine and lateral recumbent positions were investigated in eight normal subjects and 31 patients with allergic rhinitis. Of the 31 patients with allergic rhinitis, five showed unilateral complete nasal obstruction and one patient showed bilateral complete obstruction during the change of posture. Total nasal resistance had a tendency to increase with repeating the change of posture (a paired t-test, P < 0.05). The supine and lateral recumbent positions did not induce variable changes in total nasal resistance in normal subjects. Posture induces complete nasal obstruction in the supine or lateral recumbent positions in some patients with allergic rhinitis.     

Immunoelectron microscopic findings in patients with allergic rhinitis

BACKGROUND: In middle Europe the prevalence of allergic rhinitis is up to 15 % to 25 %. Allergic rhinitis is characterised by an inflammation of the nasal mucosa induced by different allergens. The patients suffer from symptoms like sneezing, rhinorrhea and nasal airway obstruction caused by morphological changes of the nasal mucosa. This symptomatology is considered to be a result of accumulation and activation of inflammatory cells. Further some neuropeptides like Calcitonin Gene Related Peptide (CGRP) and Substance P (SP) play an additional role in pathophysiology of allergic rhinitis. PATIENTS AND METHODS: Tissue samples from 28 human turbinates of patients with perennial rhinitis were taken during nasal surgery and preserved in phosphate-buffered glutaraldehyde or paraformaldehyde. Ultrathin sections were cut. The samples were dehydrated and embedded in Araldit. After polymerization an immunocytochemical staining-technique using a gold-labeled antibody was carried out. Immunostained structures were photodocumented by using a transmission electron microscope. RESULTS: In the lamina propria mucosae an extensive edema and several inflammatory cells like lymphocytes, plasma cells, eosinophiles and macrophages was found. The capillaries showed an activated endothelium. Immunoreactive nerve fibers were found in the periglandular tissue around the acini, ducts and in the glandular connective tissue. Neuroglandular synapses with dense core vesicles and positive immunoreactions to CGRP and SP could be detected. Neuropeptidergic axons were often observed near to plasma cells. CONCLUSIONS: In the edematous nasal mucosa an infiltration with different inflammatory cells was found. Using electron microscopical techniques nerve structures near the submucosal glands could be demonstrated. Immunoreactions to the neuropeptides CGRP and SP were detected in the periglandular nerves and in neuroglandular synapses. These findings demonstrate the direct nerve control of glandular functions in allergic rhinitis. CGRP is generally known to have a vasodilatatory effect and to stimulate the secretion of nasal seromucous glands. In addition, SP as a short-acting vasodilatator may induce vascular permeability and glandular secretion. These immunoelectron microscopical findings further elucidate pathomorphological mechanisms in allergic rhinitis.     

Electrophoretic evaluation of nasal discharge in patients with allergic rhinitis and vasomotor rhinitis

BACKGROUND: Allergic rhinitis and vasomotor rhinitis are two common diseases that have similar symptoms and physical findings. This study was designed to assess the efficacy of electrophoretic analysis of nasal discharge for the differential diagnosis of allergic rhinitis and vasomotor rhinitis. METHODS: Two different groups of patients with allergic rhinitis (n = 18) and with vasomotor rhinitis (n = 18) diagnosed by current methods and 10 healthy subjects as a control group were included in this study. Component analyses of proteins in nasal wash were made by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. RESULTS: The mean levels of total protein, 66-kDa proteins and 26-kDa proteins (277.2 +/- 9 microg/mL, 114.5 +/- 9 microg/mL, and 67.0 +/- 4 microg/mL, respectively), in nasal washing samples of patients with allergic rhinitis were found to be higher than in the samples, (222.0 +/- 6 microg/mL, 65.6 +/- 6 microg/mL, and 42.9 +/- 4 microg/mL respectively) obtained from patients with vasomotor rhinitis. The control group showed the lowest rate of these proteins (167.8 +/- 7 microg/mL 34.3 +/- 3 microg/mL, and 25.0 +/- 3 microg/mL, respectively). The differences between mean levels of these proteins in all groups were statistically significant (p < 0.05). CONCLUSIONS: These findings indicate that electrophoretic analysis of nasal discharge can be used for the diagnosis of allergic rhinitis and vasomotor rhinitis. However, further studies are needed to standardize the technique of nasal wash and to determine the range of proteins in nasal secretions that will confirm the diagnosis.     

非变应性鼻炎与变应性鼻炎临床特点初步分析

目的 探讨高反应性非变应性鼻炎(hyperreactivity non-allergic rhinitis,HNAR)与变应性鼻炎(allergic rhinitis,AR)在性别、年龄分布、发病季节、诱因及临床表现的差异.方法 选择2009年1-8月398例以高反应性鼻部症状首诊的诊断为HNAR及AR的连续患者,以SPSS 17.0软件对其性别、年龄、发病季节、分型、诱发因素及临床症状等因素进行统计分析.结果 HNAR与AR的性别分布差异有统计学意义(χ2=6.415,P=0.01),HNAR女性患者居多,AR以男性为主;在发病年龄上,HNAR以中青年为主,高发年龄在30～39岁(χ2=51.533,P=0.00),AR以青少年为主,高发年龄在10～19岁(χ2=12.772,P=0.00);HNAR发病无明显季节性,AR发病多在秋季.AR变应原以艾蒿和豚草为主.AR以中-重度持续性为主(χ2=123.991,P=0.00),HNAR以中-重度间歇性为主(χ2=97.420,P=0.00);除鼻痒外,AR较HNAR鼻部及眼部的临床症状重(P值均<0.05);非特异性诱发因素在AR与HNAR患者发病过程中的作用大致相似(统计值,P>0.05).结论 AR与HNAR在性别构成、主要发病年龄、鼻炎分型及发病季节上有明显差异,除鼻痒外AR鼻部及眼部临床症状较HNAR重,但在发病诱因上呈一致性.     

非变应性鼻炎与变应性鼻炎患者患病相关因素比较

目的 调查和比较非变应性鼻炎(non-allergic rhinitis,NAR)与变应性鼻炎(allergic rhinitis,AR)患者的年龄、性别、发病季节以及相关环境因素的差异.方法 收集2010年1-8月在门诊首次确诊的NAR患者111例与AR患者112例,通过调查问卷详细记录患者的一般资料、病史经过及患病相关因素.采用SPSS 13.0软件进行统计学分析.结果 相对于AR而言,NAR随着年龄增加患病人数有增加的趋势.NAR的好发年龄为21～30岁,而AR的好发年龄处于11～20岁.在18岁以上成年人中,NAR和AR患者的平均年龄((-x)±s)分别为(38.6±14.5)岁和(32.8±13.0)岁,差异有统计学意义(t=2.58,P=0.024).NAR在30岁前以男性居多,30岁后则女性病例数上升;而AR患者在20岁前以男性居多,20岁后则以女性多见.NAR在冬季高发(χ2=27.57,P=0.000),AR则高发于春季(χ2=13.75,P=0.003);冬季NAR的发病例数明显多于AR(χ2=12.34,P=0.000).在相关环境因素中,居住地或工作场所靠近交通干道者NAR的发病风险是AR的1.94倍,而居住地或工作场所位于建筑物底层或每天日照<2 h者AR的发病风险分别是NAR的1. 77倍和1.91倍.当患者有过敏性疾病个人史或家族史时,可使AR的发病风险升高至NAR的2.14～4.06倍.NAR患者自报的发病诱因主要为温度变化(56.3%)、经常上呼吸道感染(52.8%)、气候改变(32.4%)和刺激气味(31.1%)等,但与AR患者比较,这些非特异性诱发因素差异均无统计学意义(P值均>0.05).结论 NAR与AR患者在年龄、性别和发病季节分布,个人和家族过敏史,以及某些与发病相关的环境因素等方面存在明显差异.