儿童非变应性鼻炎与变应性鼻炎患者生活质量的对比研究

目的：分析比较儿童非变应性鼻炎（NAR）患者与变应性鼻炎（AR）患者生活质量之间的差异,探讨NAR对患儿生活质量的影响。方法2011年6月～2012年6月在门诊首次确诊的52例NAR患儿和69例AR患儿（6～12岁）,指导患儿及家长采用视觉模拟量表（VAS）评价患儿的鼻、眼及胸部症状,并采用儿童鼻结膜炎生活质量调查表（RQLQ）评估并比较NAR与AR患儿的生活质量有无差异。统计结果采用SPSS13.0软件进行分析。结果 NAR组与AR相比,VAS评分无明显差异（P〉0.05）;RQLQ两组评分无明显差异（P〉0.05）。NAR组内,各项症状VAS评分比较差异有统计学意义（P〈0.01）,“鼻堵”为首要症状;RQLQ各项目以及各方面间比较差异均有统计学意义（P〈0.01）,各项鼻部症状相比差异有统计学意义（P〈0.05）,“鼻堵”和“流涕”为首要症状,各项非鼻眼部症状相比差异也有统计学意义（P〈0.01）,“注意力难以集中”为首要症状。结论 NAR对患儿的生活质量有着明显的影响,值得临床护理工作中重视。     

儿童变应性鼻炎T细胞亚群检测分析

观察正常儿童与变应性鼻炎患儿外周血Ｔ细胞亚群分布的差异。方法用间接免疫荧光法随机检测儿童变应性鼻炎组１６例和正常对照组２０例,并进行统计学分析。结果变应性鼻炎组外周血中ＣＥ３、ＣＤ４、ＣＤ８较对照组均有明显下降。结论Ｔ细胞亚群分布的改变是变态反应性疾病免疫功能紊乱的重要环节,可以作为变应性疾病的监测指标。     

Differences in leisure activities between children with allergic rhinitis and healthy peers

Objective

The symptoms of allergic rhinitis (AR) are frequently evoked when individuals with AR perform daily activities. Thus, AR may interfere the optimal participation in daily life, negatively impact the patient's productivity and quality of life (QOL). While most studies refer to adult with AR, this pilot study examined participation of children with AR as expressed in their daily activity preferences.

Methods

Participants were 31 children with AR and 31 healthy children, aged 5-11 years. All children completed the Preference for Activities of Children (PAC).

Results

Children with AR showed significantly lower preference to participate in skill-based, social and informal activities, as compared to their healthy peers (F_(7,53) = 2.61, p = 0.02, ES-η² = 0.27). Children with AR showed 5-20% lower preference to participate in activity than their typical peers.

Conclusions

AR may negatively impact children's preference to participate in daily activities. Treatment of children with AR should consider a multi-disciplinary intervention for encouraging their optimal development, improve their well-being and QOL.     

变应性鼻炎儿童蒿花粉变应原组分诊断

目的 本文旨在对季节性变应性鼻炎（AR）患儿进行变应原组分筛查,了解AR患儿代表性蒿属植物花粉变应原致敏组分。方法 采集黄花蒿和大籽蒿花粉,提取花粉蛋白,以临床确诊为AR且艾蒿特异性免疫球蛋白E （sIgE）检测为阳性患儿血清为一抗,通过蛋白质免疫印迹法筛查花粉中变应原组分。结果 蛋白质免疫印迹显示2种蒿属植物花粉蛋白提取物中主要有3条带能与血清IgE特异性结合,相对分子量（Mr）分别为12、25和70 kDa。黄花蒿花粉中70 kDa变应原为AR儿童最常见的变应原分子,阳性检出率为85.19%,25 kDa和12 kDa变应原分别为37.04%和14.81%。大籽蒿花粉中70 kDa变应原阳性检出率低于黄花蒿（P<0.05）,为51.85%,25 kDa和12 kDa变应原阳性检出率与黄花蒿相似（P>0.05）。另外,同一个体血清对2种蒿属植物同源变应原阳性反应存在差异,不同患儿对1种或多种变应原分子敏感。结论 AR患儿黄花蒿花粉致敏率更高,推荐增加黄花蒿花粉组分蛋白进行诊断和免疫治疗,尤其是70 kDa变应原分子。     

多重致敏儿童变应性鼻炎患者sIgE特征分析

目的 了解大连地区多重致敏的儿童变应性鼻炎(AR)患者血清特异性IgE(sIgE)特点,为本地区AR精准防控提供参考。 方法 回顾性分析272例多重致敏的儿童AR患者sIgE结果,按性别、年龄、变应原种类和强度、吸入性和食入性变应原例次和强度进行分组,比较不同组间变应原分布情况。 结果 应用Pearson相关分析(r=0.587,P=0.035)在所有入组AR儿童中,多重致敏占比与年龄呈正相关,且相关性较高;多重致敏患者变应原种类数量与相应人数之间呈负相关(r=-0.913,P<0.001),且相关性较高。将患儿按年龄段分成3个组,2~5岁组、6~9岁组和10~14岁组,行统计学分析结果显示各组变应原阳性例数与变应原种类呈负相关,且相关性较高。变应原阳性例次及变应原总强度最高的前5位依次为屋尘螨/粉尘螨、艾蒿、猫、蛋清、普通豚草。吸入性和食入性变应原平均强度(t=2.410,P=0.038)差异有统计学意义。按年龄分组,6~9岁组中吸入性与食入性变应原例次差异(t=2.275, P=0.048)及平均强度差异(t=2.361, P=0.035)有统计学意义,10~14岁组中吸入性与食入性变应原平均强度差异有统计学意义(t=3.658, P=0.002)。吸入性变应原中春季、秋季及常年的例次、总强度、平均强度差异均无统计学意义。 结论 随着年龄增大,接触变应原种类增多,多重致敏患者也随之增多,故应定期复查过敏原。屋尘螨/粉尘螨、艾蒿、猫、蛋清、普通豚草是大连地区多重致敏的AR患儿主要致敏原,应注意重点防控。在6~9岁时应着重关注吸入性变应原致敏情况。     

儿童变应性鼻炎的可视化分析和热点研究

目的 探究儿童变应性鼻炎的研究概况,并整理研究热点和创新点.方法 以中国知网核心数据库作为研究平台,以"儿童"和"变应性鼻炎"为检索关键词,使用CiteSpace软件对相关文献进行可视化分析.结果 通过筛选,共纳入相关文献1242篇,可视化分析结果显示我国在儿童变应性鼻炎领域的研究从初期缓慢探索到近二十年的快速起步,再...     

新疆地区变应性鼻炎儿童常见变应原的分布

目的分析新疆地区变应性鼻炎(AR)儿童常见变应原的分布,为该区AR儿童的诊治及流行病学研究提供参考依据。方法将2017年1月—2021年6月就诊并具有典型AR症状及体征的566例AR患儿纳入研究,将患者的血清变应原分布,就诊时间,不同年龄段及性别等进行分析。结果425例(75.1%)AR患儿至少一种变应原阳性,吸入性变应原主要致敏因素。9月和4月为AR发病最高的月份。艾蒿、屋尘螨、粉尘螨、柳树、屋尘等为是最常见的5种吸入性变应原。牛奶、小麦面粉、鸡蛋、花生、牛肉等为主要的5种食入性变应原。艾蒿、柳树、豚、牛奶在不同年龄段分布差异具有统计学意义(P＜0.05),不同性别儿童中部分变应原阳性率存在差异,屋尘阳性率在男性中明显高于女性,而在女性中羊肉的阳性率高于男性(P＜0.05)。结论新疆地区AR患儿变应原以吸入性变应原阳性居多,不同季节变应原分布,在不同年龄段、不同性别中变应原存在部分差异。     

The effect of regular versus on-demand desloratadine treatment in children with allergic rhinitis

OBJECTIVE: Desloratadine is a potent antihistamine. Whether regular or on-demand use of desloratadine influences its therapeutic efficacy in allergic rhinitis is unknown. The aim of the study was to compare the clinical efficacy and the anti-inflammatory activity of regularly administered desloratadine to its on-demand use in children with allergic rhinitis due to pollen allergy. METHODS: Thirty-seven patients with allergic rhinitis with or without mild intermittent asthma were enrolled in a prospective parallel group study. Patients were treated with desloratadine regularly or on-demand during pollen season. Rescue medications and symptom scores were recorded on a diary card. Nasal flow rate and inflammatory markers were recorded, and methacholine (Mch) challenge test was administered before and within the pollen season. RESULTS: Though symptoms were lower in the evening than in the morning (p<0.001), there was no difference between the two groups. There was no difference between the groups with respect to medication score except that the salbutamol use was lower in the regular treatment group during the fourth week (p=0.032) in the pollen season. Nasal flow rate and inflammatory markers failed to show any difference between the groups. A significant reduction in PC20 values (provocative concentration of Mch causing a 20% fall in FEV(1)) was observed in regular (p=0.016) and on-demand (p=0.005) treatment groups compared to the pre-season measurements. The number of children with a PC20 below 8 mg/ml increased significantly in the on-demand group. CONCLUSION: Our study demonstrates that on-demand use of desloratadine during the pollen season is clinically as effective as regular treatment. However, regular treatment may provide better control of lower airway symptoms and airway reactivity.     

Prevalence and risk factors for allergic rhinitis in primary school children

OBJECTIVE: Allergic rhinitis is a common chronic illness of childhood. The aim of the study was to evaluate the prevalence and risk factors of allergic rhinitis in 6-12-year-old schoolchildren in Istanbul. METHODS: A total of 2500 children aged between 6 and 12 years in randomly selected six primary schools of Istanbul were surveyed by using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire between April and May 2004. RESULTS: Of them 2387 (1185 M/1202 F) questionnaires were appropriately completed by the parents with an overall response of 95.4%. The prevalence of physician-diagnosed allergic rhinitis was 7.9% (n=189). A family history of atopy (aOR=1.30, 95% CI=1.00-1.68), frequent respiratory tract infection (aOR=1.36, 95% CI=1.08-1.70) and sinusitis (aOR=2.29, 95% CI=1.64-3.19), antibiotic use in the first year of life (aOR=1.26, 95% CI=1.01-1.57), cat at home in the first year of life (aOR=2.21, 95% CI=1.36-3.61), dampness at home (aOR=1.31, 95% CI=1.04-1.65) and perianal redness (aOR=1.26, 95% CI=1.01-1.57) were significant for increased risk for allergic rhinitis. Frequent consumption of fruits and vegetables were inversely, and frequent consumption of lollipops and candies were positively associated with allergic rhinitis symptoms. CONCLUSION: Our study reconfirmed that family history of atopy, frequent respiratory tract infections, antibiotics given in the first year of life, cat at home in the first year of life, dampness at home, perianal redness and dietary habits are important independent risk factors for AR. Researchers worldwide should be focused to these factors and try to develop policies for early intervention, primary and secondary preventions for allergic diseases.     

肠道菌群改变与儿童变应性鼻炎的相关性研究

目的 探讨肠道菌群改变与儿童变应性鼻炎(AR)的相关性。方法 纳入2021年10月—2022年6月确诊为AR的患儿38例,男21例,女17例,年龄5～7岁,平均年龄5.85岁;另纳入正常儿童38例作为健康儿童组,男23例,女15例,年龄5～7岁,平均年龄5.80岁。分别收集两组粪便进行高通量测序,并对两组的临床资料进行统计学分析。结果 AR患儿肠道菌群Alpha多样性Chao1、Observed species、Shannon、Simpson、Faith’s pd、Pielou_e指数较健康儿童明显降低。两组Beta多样性存在差异。两组在门水平放线菌门、拟杆菌门等,属水平拟杆菌属、双歧杆菌属等存在差异。体重(P=0.024)、被动吸烟(P=0.006)、变应性家族史(P＜0.001)、家庭居住地(P=0.017)、有无湿疹(P=0.011)、新生儿期是否使用抗生素(P＜0.001)、是否母乳喂养＞3个月(P=0.003)、是否为剖腹产(P=0.043)均有可能作为AR发病的影响因素。结论 AR患儿肠道菌群多样性与健康儿童相比发生了变化,肠道菌群生态系统的多样性、稳定性降低,多种特定菌种丰度显著改变。肠道菌群失衡可能是促进儿童AR发生发展的一个重要因素。     

儿童变应性鼻炎患者新型冠状病毒疫苗接种专家共识

面对新型冠状病毒（简称新冠病毒）疫情世界大流行的严峻局面,全社会接种疫苗构建完整的免疫屏障已经成为抗击疫情最经济、最有效的手段之一。截至2021年11月初,我国各地累计报告接种新冠病毒疫苗23亿剂次。近来全国多地已经陆续开始为3~11岁的儿童接种新冠疫苗。变应性鼻炎（AR）是一种常见的儿童呼吸道慢性炎症性病变,需要鼻喷或口服抗过敏药（抗组胺药和糖皮质激素等）进行对症治疗,和/或进行变应原特异性免疫治疗（AIT）建立免疫耐受。为了顺利推进和实施新冠病毒疫苗在AR儿童的接种工作,东方过敏联盟牵头组织了国内知名的耳鼻咽喉科、变态反应科和儿科专家,在系统复习国内外文献证据的基础上,结合专家的临床经验制订了本共识,旨在指导儿童AR患者,特别是接受AIT的患者,进行安全有效的新冠疫苗接种,构建群体免疫的屏障。     

影响儿童变应性鼻炎舌下脱敏疗效的临床分析

目的分析螨虫相关儿童变应性鼻炎舌下脱敏的疗效及影响因素。方法回顾分析2017年1月～2017年7月就诊于湖南省儿童医院耳鼻咽喉头颈外科门诊、经皮肤点刺试验诊断为螨虫相关变应性鼻炎并进行舌下脱敏治疗的532例儿童病例资料,按性别、病程长短、是否单一螨虫（粉尘螨）过敏、是否合并哮喘、治疗依从性好坏、是否采取个性化治疗、用药疗程、皮肤点刺实验等因素进行分组比较。结果采用单因素分析方法,532例脱敏治疗病例中,在10%的置信水平下（P<0.10）,变应原种类、病程、合并哮喘、个性化治疗、治疗依从性、用药疗程是舌下脱敏疗效的影响因素。随后采用多因素分析方法,结果532例脱敏治疗病例中,在5%的置信水平下（P<0.05）,病程、变应原种类、合并哮喘、治疗依从性、个性化治疗、用药疗程是舌下脱敏疗效的影响因素。结论变应性鼻炎舌下脱敏患儿病程越短、疗程足够疗效越好;未合并哮喘者疗效较好;治疗依从性好、个性化治疗的疗效较好;单一粉尘螨过敏者疗效较好。患儿性别、皮肤点刺试验对疗效无影响。     

变应性鼻炎对儿童中耳的影响

目的探讨变应性鼻炎对中耳听功能的影响。方法对变应性鼻炎患儿100例和正常儿童50例行耳镜检查、声导抗和纯音听阈的测定。分别对正常儿童组．轻度与中重度变应性鼻炎组的鼓膜异常率、鼓室导抗图异常率、听力损失率、昕阈值进行对比分析,并进行病程与各项观察指标的分析。结果轻度变应性鼻炎组与中重度鼻炎组、中重度鼻炎组与正常儿童组中耳病变和功能异常的发生率相比。差异有统计学意义（P〈O．01）,而轻度变应性鼻炎组与正常儿童组相比,无统计学意义（P〉0．05）;轻度变应性鼻炎组和中重度变应性鼻炎组症状持续时间均与听力损失程度有相关性,病程越长听力损失越重,Spearman相关性检验,r值分别为0．86（P〈0．01）和0．79（P〈O．01）;三组纯音听阈均数经配对t检验,差异均有统计学意义户〈0．01）。结论儿童变应性鼻炎引起的中耳病变和听功能异常发生率较正常儿童显著提高,症状越重。病程越长,发生率越高。     

Nasal fluid secretory immunoglobulin A levels in children with allergic rhinitis

ObjectivesThere is growing knowledge about the immunoregulatory and possibly preventative roles of immunoglobulin A (IgA) in allergic diseases. This study aimed to investigate secretory immunoglobulin A (SIgA) levels in the nasal fluid of children who were either being treated for their allergic rhinitis (AR) with intranasal mometasone furoate or were not receiving treatment.MethodsThe study population contained 55 children with persistent AR. Group I included 27 newly diagnosed AR patients not taking any medication and group II included 28 patients treated with intranasal steroids for at least 6 months. 27 healthy control subjects were also enrolled in the study. Total symptom scores (TSS) were calculated for each patient. Nasal secretions were obtained using a new modified polyurethane sponge absorption method, and samples were analysed by ELISA.ResultsThe median value for nasal fluid SIgA level in each group was 127.2 μg/ml (interquartile range; 67.3–149.6) in group I, 133.9 μg/ml (102.1–177.8) in group II and 299.8 μg/ml (144.5–414.0) in the control group. Groups I and II both had statistically significant reductions in nasal fluid SIgA levels compared to the control group (p < 0.001). However, there was no statistically significant difference between groups I and II (p = 0.35). A statistically significant and negative correlation also existed between TSS and nasal fluid SIgA levels in both groups I and II (p = 0.006, rho = −0.512 and p = 0.01, rho = −0.481, respectively).ConclusionsSIgA levels in the nasal fluid are significantly reduced in children with AR independent of treatment and are negatively correlated with the TSS.     

Effectiveness of montelukast in pediatric patients with allergic rhinitis

Allergic rhinitis (AR) is one of the most common chronic diseases of childhood and carries significant morbidity as well as physical and psychosocial consequences. Therapy aims to alleviate clinical symptoms, prevent complications and improve psychosocial consequences. Leukotrienes which are amongst the main mediators in pathogenesis of AR have chemotactic properties and lead to increased vascular permeability. Thus, leukotriene antagonism may be an effective therapeutic option in treatment of allergic diseases, specifically AR. Montelukast which is a leukotriene receptor type I inhibitor has variable efficacy in children with AR and the guidelines recommend its use in children with seasonal AR aged six years and above. Although its efficacy is inferior to anti-histamines and intranasal corticosteroids, combination treatment may warrant clinical efficacy. Therefore, montelukast may be considered to be a well-tolerated therapeutic option for children with AR with minor side effects though long term results need to be assessed.     

变应性鼻炎对儿童阻塞性睡眠呼吸暂停低通气综合征的影响

目的 探讨变应性鼻炎(AR)对儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的影响。方法 经多导睡眠监测(PSG)明确诊断的OSAHS患儿91例, 对其进行血清学过敏原检测。依据病史、查体及过敏原检测结果将其分成非AR组及AR组, 比较两组的呼吸暂停低通气指数(AHI)及最低血氧饱和度(LSaO₂)。统计学方法为两独立样本t检验, P<0.05为差异有统计学意义。结果 AHI结果AR组高于非AR组, LSaO₂结果AR组低于非AR组。结论 变应性鼻炎可能是加重OSAHS严重程度的因素之一。     

Elevated B cell-activating factor (BAFF) in children with allergic rhinitis

ObjectiveTo evaluate the possible role of B cell-activating factor (BAFF) in children with allergic rhinitis (AR).MethodsTwenty-four AR children and 20 normal children were enrolled in this study and nasal lavage and serum were collected. The nasal and serum levels of BAFF were measured using enzyme-linked immunosorbent assay (ELISA). The relationship between serum BAFF and immunoglobulin A (IgA) was evaluated in AR children.ResultsOur results showed that the nasal and serum levels of BAFF were significantly increased in AR children compared with controls (p < 0.05). The nasal and serum levels of BAFF in AR children were significantly associated with disease severity (p < 0.05). Moreover, the level of serum BAFF was negatively related to serum IgA level (p < 0.05).ConclusionOur findings show BAFF expression was significantly increased and related to disease severity, indicating BAFF may be implicated in new treatment modalities for AR children.     

鼻渊通窍颗粒联合孟鲁司特治疗儿童变应性鼻炎的疗效观察

目的探讨鼻渊通窍颗粒联合孟鲁司特治疗儿童变应性鼻炎（allergic rhinitis, AR）的疗效。方法将150例4～12岁变应性鼻炎儿童患者随机分成两组,对照组口服孟鲁司特2周,观察组在对照组基础上同时口服鼻渊通窍颗粒2周,比较两组患儿治疗前后的临床症状视觉模拟评分（VAS）、疗效及复发率。结果对照组治疗后临床症状VAS评分分别为：鼻塞（2.99±1.493）分、流涕（1.40±0.973）分、打喷嚏（1.37±1.583）分、总分（5.76±3.533）分;观察组治疗后临床症状VAS评分分别为：鼻塞（1.81±1.036）分、流涕（0.64±0.880）分、打喷嚏（0.71±0.969）分、总分（3.16±2.331）分。两组患儿治疗后临床症状VAS评分均低于治疗前,经比较差异均有统计学意义（P均＜0.05）;观察组与对照组比较,治疗前临床症状VAS评分差异均无统计学意义（P均＞0.05）,治疗后VAS评分差异均有统计学意义（P均＜0.05）。观察组总有效率为97.3%,明显高于对照组的89.3%（P＜0.05）,观察组复发率为4.0%,明显低于对照组的16.0%（P＜0.05）。结论孟鲁司特联合鼻渊通窍颗粒治疗儿童变应性鼻炎可进一步提高疗效。     

变应性鼻炎专栏·舌下特异性免疫治疗对不同年龄变应性鼻炎患儿的疗效分析

目的评估不同年龄组变应性鼻炎(allergic rhinitis, AR)患儿在经舌下特异性免疫治疗（sublinguul immunotherapy,SLIT）后的起效时间及客观指标变化。方法对282例接受2年舌下特异性免疫治疗的AR患儿的病例资料进行分析。所有患儿均为中重度粉尘螨AR患者,且均接受标准化舌下含服粉尘螨滴剂治疗,并辅以对症药物治疗。其中2~5岁年龄组83例,6~9岁年龄组102例、10~13岁年龄组97例。统计3组患儿在治疗前与治疗3、6、12、24个月时的鼻部症状总评分（total nasal symptom score, TNSS）、药物总评分（total medication score, TMS）、视觉模拟量表标尺（visual analogue scale, VAS）评分和嗜酸性粒细胞（eosinophil,EOS）水平。结果①全体患儿在接受SLIT治疗3个月后TNSS、TMS和VAS都显著降低,与治疗前比较差异具有统计学意义（P均<0.05）;而治疗6个月与治疗3个月比较,VAS差异无统计学意义（Z=2.70,P均>0.05）;②经各不同年龄组间比较,2~5岁组与10~13岁组在治疗3个月时,TNSS、VAS均具有统计学意义（Z=3.09、3.99, P<0.05）;③接受SLIT半年后的EOS较基线明显下降（Z=-4.544,P<0.05）。结论舌下粉尘螨滴剂治疗3个月后,不同年龄组患儿均观察到疗效,高龄儿童组起效更快;加强对3~12个月龄患儿宣传教育和管理有利于提升和巩固疗效;EOS水平的变化与免疫治疗相关。     

变应性鼻炎患者血浆P-选择素的测定及其意义

目的 :探讨变应性鼻炎 (AR)患者血浆P 选择素 (P selectin)在AR发病中的意义。 方法 :采用ELISA法对 5 8例AR患者 (AR组 )和 30例正常健康者 (对照组 )血浆P 选择素水平进行检测。结果 :AR组血浆P 选择素水平 (5 8.76± 16 .5 7)明显高于对照组 (2 1.4 3± 7.86 ) ,差异有极显著性意义 (P <0 .0 1)。结论 :血浆P 选择素水平与AR有一定关系 ,提示血浆P 选择素在AR的发病机制中可能起重要作用。