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.     

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.     

细胞因子与变应性鼻炎

变应性鼻炎发病机理十分复杂,涉及到多种细胞和生物分子。近年来,细胞因子在其中所起的作用逐渐受到重视,学者们对其作了大量研究,本文就相关文献作一综述。     

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.     

变应性鼻炎局部炎症客观指标初探

目的:探索鼻分泌物中可以辅助诊断变应性鼻炎(AR)以及可用于临床治疗效果评估参考的客观标志物.方法:纳入33例AR患者(AR组)和21例健康对照者(健康对照组).收集健康对照及AR患者治疗前后的鼻分泌物,检测鼻细胞学、细胞因子(IL-5、IL-6、IL-8、IL-33、IFN-γ)和炎症因子(ECP、MPO)的浓度,比...     

非变应性鼻炎与变应性鼻炎患者临床特征分析

目的 分析和比较非变应性鼻炎(non-allergic rhinitis,NAR)与变应性鼻炎(allergic rhinitis,AR)的临床特征以及伴随疾病.方法 以2010年1月至2011年6月期间,主诉鼻塞、流涕、喷嚏和鼻痒症状中至少有2个症状的门诊患者556例作为研究对象,根据病史、体征和变应原检测结果进行诊断,其中NAR患者206例、AR患者350例.通过调查问卷详细记录患者一般信息、鼻部症状、伴发症状和各种合并症等,采用记分法评价症状严重程度.以SPSS13.0软件对数据进行统计学分析.结果 NAR患者的平均(x±s,下同)年龄(31.8±16.7)岁,高于AR患者的(26.3±14.8)岁,差异有统计学意义(t=4.01,P=0.0001);而性别构成比的差异无统计学意义(x2=0.12,P=0.73).在各种临床表现中,NAR和AR患者鼻塞症状出现率(分别为89.8％和92.0％)的差异无统计学意义(x2 =0.26,P=0.611),但AR患者的流涕、喷嚏、鼻痒、眼痒、流泪、喘息和咳嗽症状出现率均明显高于NAR患者,差异均有统计学意义(P值均＜0.05).而且这些症状(咳嗽除外)在AR患者中尤为严重,其症状评分明显高于NAR患者,差异均有统计学意义(P值均＜0.05).NAR和AR患者中大多数为中-重度持续性,分别占67.0％和62.9％,差异无统计学意义(x2=1.25,P =0.264).AR患者合并支气管哮喘明显多于NAR患者(分别为12.6％和2.4％),NAR患者合并高血压明显多于AR患者(分别为7.3％和1.7％),差异均有统计学意义(P值均＜0.05).结论 NAR和AR是两类具有不同临床特征的疾病,两者的合并症也存在某些差异,故值得进一步加强对鼻炎表型的临床研究.     

幼儿变应性鼻炎临床特征分析

目的 分析1～3岁变应性鼻炎(allergic rhinitis,AR)患儿的特应性分布状态及其临床特征.方法 采集2009年8月至2010年11月96例1～3岁具有AR症状患儿病史资料,包括就诊年龄、性别、出现症状年龄、病史月数、个人过敏史、父母过敏史.采用敏筛定量过敏原检测系统( Allergy Screen)筛查共计19类吸入组和食物组变应原特异性lgE( specific IgE,sIgE)及血清总IgE水平.归纳该组患儿吸人性变应原和食物变应原致敏的分布状态,按月龄(A组,≥12月龄;B组,≥24月龄;C组,≥36月龄,但不满48月龄)、变应原类别及湿疹或哮喘任一阳性分组分析各临床特征因子的影响作用,Logistic回归方法分析各临床特征与变应原致敏的相互关系.结果 变应原筛查总阳性率为81.3％;吸入组变应原、食物组变应原阳性率分别为62.5％、53.1％;混合真菌阳性率最高(50.0％),其次为牛奶(34.4％)、羊肉(31.3％)、牛肉(26.0％)、屋尘螨(21.0％)、小麦(18.8％)、艾蒿(12.5％)、鸡蛋白或鸡蛋黄(11.5％).62.5％可确诊为AR,其余可暂视为非变应性鼻炎.按月龄分组进行临床特征的单因素分析提示:吸入组变应原(x2=13.699,P=0.001)、父亲患AR(x2=14.060,P=0.001)和父亲或母亲患AR(x2=7.396,P=0.025)在3个月龄组的差异均有统计学意义.个人湿疹史(P=0.034,OR =3.143)可增加变应原致敏的可能性;个人湿疹史(P=0.015,OR=3.125)和总IgE ＞200 IU/ml(P=0.030,OR =3.119)则增加吸入组变应原致敏的可能性;未筛选出对食物组变应原致敏有统计学意义的临床特征;食物组和吸人组阳性率差异无统计学意义.吸入组变应原阳性(P=0.046,OR=3.594)、有蚊虫叮咬性皮炎(P=0.002,OR=11.941)为出现湿疹或哮喘任一阳性的危险因素.结论 1～3岁具有AR症状的幼儿中,吸入组和食物组变应原均可致敏,且吸入组阳性率略高;湿疹史是患儿变应原筛查阳性的危险因素之一,血清总IgE水平升高与吸人性变应原筛查阳性率升高有关;吸入组变应原阳性、有蚊虫叮咬性皮炎和父亲患AR与出现湿疹或哮喘病史有关.     

变应性鼻炎的流行病学研究

变应性鼻炎(allergic rhinitis, AR)是最常见的呼吸道慢性疾病之一,目前已成为一个全球性健康问题,影响到10%～25%的人群.AR虽不危及生命,但可不同程度地影响患者的生活质量,并可能导致其他相关疾病如鼻窦炎、哮喘等的发生及发展.本文就AR的流行病学研究的相关问题作一阐述.     

变应性鼻炎治疗的进展

变应性鼻炎(allergic rhinitis，AR)是由变应原激发的、由IgE介导的鼻部炎性疾病。近年来，全球变应性疾病的发病率呈上升趋势，引起社会越来越多的重视。2001年，世界：EL组织参与，由37位学者起草的包含2776篇参考文献的“变应性鼻炎及其对哮喘的影响”(allergic rhinitis and its impact on asthma，ARIA)发表，系统地介绍了AR相关基础和临床研究现状。有关AR与支气管哮喘以及与慢性鼻窦炎、中耳炎和睡眠疾病等关系的研究方兴未艾。     

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.     

维生素D治疗变应性鼻炎的研究进展

变应性鼻炎是一种由IgE介导的多种免疫细胞及细胞因子参与的鼻黏膜非感染性慢性炎性疾病,近年研究表明,维生素D作为一种新型的免疫调节剂,参与调节变应性鼻炎的固有免疫(抗菌活性、抗原呈递作用及炎症介质释放等)和适应性免疫(活化T、B细胞的调节),有关维生素D影响变应性鼻炎的免疫调节机制及其在变应性鼻炎中辅助治疗的新作用,正受到越来越多的关注。本文就维生素D参与变应性鼻炎发病机制及在治疗上的新价值作一综述。     

变应性鼻炎特异性免疫治疗疗效的预测指标

特异性免疫治疗是从病因治疗变应性鼻炎的方法,但免疫治疗的疗程长,费用较高,效果因人而异。目前评价免疫治疗疗效主要是根据症状评分、药物评分、特异性皮肤指数等临床指标,但评价患者在免疫治疗期间以及疗程结束后全身免疫反应及局部炎症的动态变化缺乏可靠的免疫学指标。因此,寻找新的免疫指标为特异性免疫治疗提供可靠佐证具有重要的临床意义。本文就变应性鼻炎特异性免疫治疗疗效的预测指标研究进展做一综述。     

Pathogenic mechanisms underlying the clinical symptoms of allergic rhinitis

This paper reviews our previous studies on an objective evaluation of nasal symptoms, a quantitative determination of biochemical mediators, and inflammatory cells in nasal secretions of atopic patients after nasal allergen challenge (NAC) and during natural allergen exposure. The use of the microsuction technique has proved to be a useful and reliable nasal sampling method permitting quantitative analysis of important mediators in nasal secretions. This has provided accurate data on the activity of some important inflammatory cells such as mast cells, basophils, and eosinophils in allergic rhinitis. Our studies demonstrate that a significant increase in the concentrations of histamine, tryptase, and LTC4 in nasal secretions occurs within seconds or minutes after NAC, and this is accompanied by itching, sneezing, rhinorrhea, and nasal obstruction. The infiltration and activation of eosinophils are found to be the predominant condition during the late-phase reaction (LPR), which is mainly characterized by unilateral and/or bilateral nasal obstruction with little sneezing and rhinorrhea. The latter condition is found to be very much similar to the pathophysiology of patients with ongoing allergic rhinitis. In conclusion, our studies demonstrate that patients with ongoing allergic rhinitis seem to be in a continuous late phase state of eosinophilia and increased mediator release, a condition that can explain priming and nonspecific hyperreactivity of the nasal mucous membrane.     

Up-date on neuro-immune mechanisms involved in allergic and non-allergic rhinitis

Non-allergic rhinitis (NAR) is a common disorder, which can be defined as chronic nasal inflammation, independent of systemic IgE-mediated mechanisms. Symptoms of NAR patients mimic those of allergic rhinitis (AR) patients. However, AR patients can easily be diagnosed with skin prick test or allergen-specific IgE measurements in the serum, whereas NAR patients form a heterogeneous group and are difficult to diagnose because of an extensive list of different phenotypes, all varying in severity, underlying etiology and type of inflammation. Characterization of those phenotypes, mechanisms and management of NAR represents one of the major unmet needs in the field of allergic and non-allergic diseases. This review aims at providing a comprehensive overview of the state of the art in classifying the NAR patients and focuses on the neuro-immune mechanisms involved in allergic and non-allergic rhinitis, including reflections on the pathophysiology and the currently available treatment options.     

Th-2 type cytokine receptors in allergic rhinitis and in response to topical steroids

OBJECTIVES: Th-2 type cytokine production (Interleukin-4 [IL-4] and interleukin-5 [IL5]) has been demonstrated to play a significant role in the pathophysiology of allergic rhinitis (AR), and the treatment of AR with topical corticosteroids has been shown to reduce the expression of Th-2 type cytokines in vivo. However, the contribution and expression of Th-2 type cytokine receptors in AR and their response to corticosteroid treatment remain to be clarified. Objectives of the current study are 1. To examine the expression of the cytokine IL-4 and IL-5 receptors (IL-4R and IL-5R) in a nasal allergen challenge model and to contrast this with the expression of the receptor for the Th-1 type cytokine, interferon-gamma receptor (IFN-gammaR), and 2. to examine the effects of pretreatment with topical corticosteroid before allergen challenge on the expression of these same receptors. STUDY DESIGN: Randomized prospective study involving 14 ragweed-allergic subjects evenly divided between placebo and corticosteroid pretreatment. METHODS: Immunocytochemistry (alkaline phosphatase-antialkaline phosphatase labeling [APAAP] technique) was used to stain nasal biopsy specimens before and after allergen challenge. Antibodies used included anti-CD3, CD4, CD8, major basic protein (MBP), IL-4R, IL-5R, and IFN-gammaR. RESULTS: Following allergen challenge, we observed a significant increase in the Th-2 type cytokine receptors (IL-4R and IL-5R; P<.05), as well as a significant decrease in the expression of the Th-1 type cytokine receptor (IFN-gammaR; P<.05). Pretreatment with topical corticosteroids before nasal allergen challenge resulted in decreased expression of IL-4R (P<.05) and IL-5R (P<.05) and increased expression of IFN-gammaR (P<.05). Further, IL-4R and IL-5R expression correlated with eosinophil infiltration in the tissues. CONCLUSIONS: We have demonstrated that in AR, cytokine receptors for IL-4, IL-5, and IFN-gamma follow a similar pattern to their ligands. In addition, pretreatment with topical corticosteroids was shown to alter the cytokine receptor expression pattern from a Th-2 profile more toward a Th-1 profile.     

Th-2 type cytokine receptors in allergic rhinitis and in response to topical steroids

Objectives: Th-2 type cytokine production (inter-leukin-4 [IL-4] and interleukin-5 [IL-5]) has been demonstrated to play a significant role in the pathophysiology of allergic rhinitis (AR), and the treatment of AR with topical corticosteroids has been shown to reduce the expression of Th-2 type cytokines in vivo. However, the contribution and expression of Th-2 type cytokine receptors in AR and their response to corticosteroid treatment remain to be clarified. Objectives of the current study are 1. To examine the expression of the cytokine IL-4 and IL-5 receptors (IL-4R and IL-5R) in a nasal allergen challenge model and to contrast this with the expression of the receptor for the Th-1 type cytokine, interferon-gamma receptor (IFN-γR), and 2. to examine the effects of pretreatment with topical corticosteroid before allergen challenge on the expression of these same receptors. Study Design: Randomized prospective study involving 14 ragweed-allergic subjects evenly divided between placebo and corticosteroid pretreatment. Methods: Immunocytochemistry (alkaline phosphatase-antial-kaline phosphatase labeling [APAAP] technique) was used to stain nasal biopsy specimens before and after allergen challenge. Antibodies used included anti-CD3, CD4, CD8, MBP, IL-4R, IL-5R, and IFN-γR. Results: Following allergen challenge, we observed a significant increase in the Th-2 type cytokine receptors (IL-4R and IL-5R; P < .05), as well as a significant decrease in the expression of the Th-1 type cytokine receptor (IFN-γR; P < .05). Pretreatment with topical corticosteroids before nasal allergen challenge resulted in decreased expression of IL-4R (P < .05) and IL-5R (P < .05) and increased expression of IFN-γR (P < .05). Further, IL-4R and IL-5R expression correlated with eosinophil infiltration in the tissues. Conclusions: We have demonstrated that in AR, cytokine receptors for IL-4, IL-5, and IFN-γ follow a similar pattern to their ligands. In addition, pretreatment with topical corticosteroids was shown to alter the cytokine receptor expression pattern from a Th-2 profile more toward a Th-1 profile. Laryngoscope, 108:1528–1533,1998