肠道微生物菌群对变应性鼻炎的影响

变应性鼻炎(AR)主要是由免疫球蛋白E(IgE)介导的多种免疫细胞及细胞因子参与的I型变态反应。目前AR的患病率呈逐年上升的趋势,临床治疗中存在诸多问题,其发病机制有待进一步的研究。近年来,随着对肠道菌群研究的深入,人们发现肠道菌群及其代谢物可通过神经、免疫及内分泌通路与多个器官发生交互作用,如通过调节免疫系统进而影响哮喘、AR等变应性疾病,因此肠道菌群紊乱或许是AR发病的机制之一。故本文将从肠道菌群、肠道菌群对免疫系统的影响、肠道菌群与AR的关系以及应用益生菌、益生元、细菌裂解产物改善菌群失调治疗AR的相关研究进行综述,为治疗AR提供新的参考依据。     

基于肺与大肠相表里探讨针刺联合艾灸干预变应性鼻炎相关肠道菌群的研究进展

变应性鼻炎(AR)是一种非感染性慢性炎症疾病,其发病率在我国逐年上升,已成为全球关注的疾病。机体肠道内有大量菌群维持肠道免疫稳定,当肠道菌群失衡时易诱发AR在内的多种炎性疾病。本文基于“肺与大肠相表里”的相关理论,根据“肺-肠轴”的关系研究肺-鼻-肠间的机制,并整理总结针刺联合艾灸干预AR相关肠道菌群、机体免疫防御机制的研究进展,以期为针灸治疗AR提供新依据及思路。     

肠道微生态在儿童变应性鼻炎中的研究现状

随着对肠道微生态结构与功能研究的不断深入,肠道菌群与变应性疾病的发生、发展与病情转归的联系被证实。在儿童的生长发育过程中,肠道内各种菌群不断发生动态演变,不同年龄阶段肠道微生态的不同特征及其与变应性鼻炎(AR)之间都有其相对应的互动关系。AR作为最为常见的儿童慢性呼吸道疾病之一,针对其治疗的临床药物种类有限,而免疫治疗方式疗程长被接受度低。除以上两种主要治疗模式外,目前已有学者开展了以探究调整肠道微生态对AR儿童进行干预的有效收益评估的临床研究。综述对儿童群体中与AR相关的肠道微生物群临床研究与干预进展进行整理总结,以期评估肠道微生物群在AR发生、治疗方面的相关理论与机制的应用价值。     

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。     

高脂饮食诱导肠道菌群改变参与变应性鼻炎发病机制研究进展[综述]

肠道菌群与人体多种疾病的发生、发展存在密切的联系。大量研究表明气道变应性疾病同样与肠道菌群的变化存在关联。肠道菌群菌属以及其代谢物均可参与气道变应性疾病进程,影响其发生发展。另一方面,高脂饮食会改变肠道菌群结构甚至可导致肠道菌群的紊乱,其部分代谢产物参与了疾病发展的过程,影响了疾病的炎症程度。本文重点对肠道菌群、变应性鼻炎以及高脂饮食三者的关联性进行研究,同时提供菌群组学和代谢组学联合应用的方法思路,旨在为高脂饮食对肠道菌群的改变以及如何参与变应性鼻炎的发生机制和治疗提供新的研究思路。     

儿童变应性鼻炎的特点及其治疗进展

变应性鼻炎是危害小儿呼吸健康的常见病,有报道儿童变应性鼻炎占儿童耳鼻咽喉疾病的40%[1].其主要的临床表现有鼻塞、流鼻涕、鼻痒、打喷嚏以及嗅觉功能障碍等.     

儿童变应性鼻炎的诊断与治疗

变应性疾病如变应性鼻炎(allergic rhinitis,AR)、哮喘和湿疹等的发病率逐年上升。根据世界变态反应组织公布来自30个国家的流行病学调查显示,变应性疾病的患病率高达21%,而世界卫生组织估计全球大约有6亿人罹患AR〔1〕;这与工业化进程导致空气污染、人类生活方式的改变以及心理压力增大有着密切的关系〔2〕。研究显示AR在发达国家18岁以下青少年儿童中的患病率高达40%〔3-4〕;国内不同地区、不同年龄段儿童和青少年的调查结果差异较大,AR的患病率波动在3.3%~43.0%〔5〕。儿童AR的发病具有以下特点:同年龄段男性儿童发病率高于女性;6~18岁儿童青少年中,年幼儿童发病率高于年长儿童;城镇儿童比农村儿童更易罹患AR〔5〕。当前AR呈现     

儿童青少年常年性变应性鼻炎的流行现状

目的 为观察儿童青少年常年性变应性鼻炎的流行现状,自１９９５年超对江苏省大、中、小学学生进行流行病学调查。方法 调查方法包括问卷调查、鼻腔检查及变应原（屋尘、尘螨）皮肤划痕试验。结果 屋尘、尘螨的致敏率分别为２２．９％和２８．８％,两种变应原同时致敏占１９．１％,至少一种致敏占３２．６％。变应原致敏率随年龄增长而上升（Ｐ〈０．００１）;变应性鼻炎患病率为１．８％,各年龄组间无统计学差异（Ｐ〉０．     

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.     

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.     

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。     

Prenatal risk factors and occurrence of allergic rhinitis among elementary school children in an urban city

Objectives

To investigate the incidence and prenatal risk factors for allergic rhinitis among elementary school children in an urban city.

Study design

Risk factor data were collected by questionnaire and direct physical examination. Multiple logistic regression analysis was used to calculate the odds ratios of developing allergic rhinitis among children 6-13 years of age.

Methods

From January 2006 to December 2006, we enrolled 1368 elementary school children in the study. Sampling was done by a multi-stage clustered-stratified random method to determine the study subject. All the children studied attended 12 elementary schools located in the six districts in Taipei, with two schools in each district. Odds ratios were adjusted for the confounding effects of gender, parity, maternal age at childbirth, maternal education, gestational complications, tobacco smokers in the residence, pets, carpets, molds, and air pollution.

Results

The incidence of allergic rhinitis in the study was 50.1% (685/1368). Factors like gender (p < .001), parity (p < .05), carpets (p < .025), and air pollution (p < .001) increased risk, while the other factors did not (p > .05 for all).

Conclusion

Gender, parity, carpets, and air pollution increased the risk of developing allergic rhinitis among elementary school children. Other potential factors such as low birth weight, maternal age at childbirth, parental education, gestational complications, presence of tobacco smokers, and exposure to pets and molds did not significantly increase risk of developing allergic rhinitis.     

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...     

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。