变应性鼻炎的分类和诊断专家共识(2022,成都)

变应性鼻炎(AR)是特应性个体暴露于变应原后主要由免疫球蛋白E(IgE)介导的鼻黏膜慢性炎症。目前AR的分类和诊断还存在一些争议性问题,诸如分类标准、临床检查要点和诊断依据等。有鉴于此,中国鼻病研究协作组召集国内中青年鼻科专家,基于循证医学证据和临床经验制订了AR的分类和诊断专家共识,旨在指导并规范临床医师开展AR的诊断,以便优化治疗策略,提高临床疗效。     

内蒙古中西部地区变应性鼻炎疑似患者变应原分布的分析

目的调查内蒙古中西部地区变应性鼻炎(AR)患者变应原的分布情况。方法在制定纳入标准的基础上,对2015年1月～2017年10月就诊于我院的本地1 296例疑似AR患者进行皮肤点刺试验(SPT),根据检测结果分析比较主要变应原在性别、年龄及季节方面的分布特征。结果本组AR疑似患者中,1 127例(86. 95%) SPT阳性;阳性率居前几位的变应原依次为艾蒿(80. 12%)、豚草(67. 96%)、禾本科(62. 73%)、树Ⅰ(30. 43%)、粉尘螨(28. 48%)、刺槐(22. 18%)、禾本科/谷类(21. 21%)、德国小蠊(19. 52%)及蒲公英(17. 21%)等,均为吸入性变应原;双重变应原阳性者最多(42. 77%),2～4种变应原过敏者占比较大(73. 03%);男、女AR患者的变应原SPT阳性率分别为88. 54%与85. 55%,差异无统计学意义;患病率以12～19岁(96. 92%)为最高,20～39岁次之; AR全年均有发病,在4月和7～9月迎来2个就诊高峰且以8月最高,不同季节阳性率差异有统计学意义(χ~2=16. 039,P=0. 017)。结论艾蒿、豚草、禾本科花粉、树类花粉是内蒙古中西部地区的主要变应原,常见吸入性变应原SPT阳性率与患者性别无关,与年龄有关,年龄较小者阳性率更高,夏秋季是内蒙古地区AR高峰季节。     

变应性鼻炎特异性免疫治疗近期疗效及安全性分析

目的探讨单一屋尘螨变应原特异性免疫治疗(SIT)对变应性鼻炎(AR)的近期疗效及安全性。方法将65例常年性AR患者分为SIT组和药物治疗组。SIT组30例,根据皮肤点刺试验分为SIT-1组(仅对屋尘螨过敏)和SIT-2组(对包括屋尘螨在内的2种或以上变应原过敏),均接受皮下注射屋尘螨变应原进行SIT;药物治疗组35例,按变应性鼻炎及其对哮喘的影响指南给予抗组胺药及糖皮质激素等规范药物治疗。记录所有患者治疗前及开始治疗至疗程达1年后的症状评分和药物评分;以及治疗期间的不良反应发生情况。结果治疗1年后,SIT组症状及药物评分均较治疗前明显减少(P<0.01),但SIT-1组和SIT-2组间疗效未见明显差异(P>0.05);SIT组的症状及药物评分均明显低于药物治疗组(P<0.01)。治疗过程中未发生严重不良反应。结论单一屋尘螨变应原SIT对AR短期是安全、有效的。     

舌下含服粉尘螨滴剂治疗变应性鼻炎疗效及安全性评估

目的探讨舌下含服粉尘螨滴剂治疗以尘螨过敏为主合并多种变应原过敏的变应性鼻炎（AR）的疗效及安全性。方法采用病例自身对照方法,对122例AR患者,使用粉尘螨滴剂舌下特异性免疫治疗,对完成治疗1年的患者症状、体征积分进行统计,与治疗前的症状、体征积分进行比较,观察药物的疗效及不良反应。结果93例患者完成1年以上的舌下免疫治疗（SLIT）,治疗1年后的症状、体征积分（10．58±2．60）较治疗前症状、体征积分（3．88±2．45）明显减少,差异有统计学意义。结论舌下含服标准化粉尘螨滴剂可以明显改善对尘螨或合并多种变应原过敏的AR患者鼻部症状和体征,用于治疗以尘螨过敏为主合并多种变应原过敏的AR临床有疗效,安全性较高,值得临床推广。     

福建东南沿海地区变应性鼻炎变应原特点分析

变应性鼻炎（allergic rhinitis,AR）已严重影响人们的生活质量而成为全球性的健康问题,特别在儿童已是最常见的慢性变应性疾病。变应原的皮肤点刺试验（skin prick test,SPT）简便易行、敏感可靠,是我国AR诊断和治疗指南（2009年,武夷山）中确诊AR的检测手段之一。引起AR的变应原随着地理位置的不同以及天气、气候的变化而有所差异。本文通过对961例临床诊断AR患者的SPT结果进行分析,了解福建东南沿海地区AR变应原的分布特点。     

呼和浩特市气传花粉监测与变应性鼻炎变应原谱的研究

目的观察呼和浩特市2020年气传花粉的种类、数量、变化规律,获得同时期变应性鼻炎(AR)患者的变应原谱,与本地区2012年研究数据对比分析,为有效防治AR提供研究支持。方法采用重力沉降法收集2020年3~10月呼和浩特市区监测点每日气传花粉并记录花粉的种类和数量。对同时期就诊于内蒙古自治区人民医院耳鼻喉科的170例AR患者的血清特异性免疫球蛋白E(sIgE)检测结果进行分析,明确呼和浩特市与AR相关的主要气传致敏花粉。将本次研究结果与呼和浩特市2012年的研究数据进行对比。结果2020年3~10月共收集到花粉曝片207张,共计花粉15698粒,其中15093粒花粉可鉴别出14个科属,有605粒难以鉴别科属。观察期间花粉飘散出现2个高峰期,分别是3月和8月。AR患者血清s Ig E检测出现频率最多的4种变应原为:蒿属、尘螨、榆属、猫毛。结论呼和浩特市2020年花粉播散存在春季和秋季2个明显的高峰期,且春季花粉高峰以树本类为主,秋季花粉高峰以草本类为主。AR的主要致敏花粉为蒿属,秋季草本类变应原强阳性率明显高于春季树本类变应原。与2012年相比气传花粉种类有所改变。     

变应性鼻炎患者血清特异性IgE分析

目的 观察变应性鼻炎(allergic rhinitis,AR)患者46种常见变应原血清特异性IgE(SIgE)的阳性检出率,以及合并有哮喘和(或)特应性皮炎等个人过敏史对其阳性检出率的影响.方法 应用UniCAP100E免疫荧光定量分析系统检测80例AR患者SIgE.结果 AR患者粉尘螨、屋尘螨的SIgE阳性检出率分别为68.75%,67.50%;粉尘、屋尘检出率分别为41.25%,38.75%;昆虫类中飞蛾、蟑螂、蜂毒检出率分别为47.50%,38.75%,20.00%;垫料类中蚕丝、棉花检出率分别为31.25%,15.00%;花粉以苋科为主,检出率为18.75%;真菌类以交链孢霉、白色念珠菌、蠕孢霉、烟曲霉为主,检出率分别为13.75%,13.75%,12.50%,10.00%;猫、狗毛的检出率分别为12.50%,8.75%;食物以虾、蟹为主,检出率分别为38.75%,36.25%.合并哮喘和(或)特应性皮炎等个人过敏史的AR患者SIgE阳性检出率与无此病史的AR患者差异有统计学意义(P＜0.01).结论 螨、灰尘、昆虫、垫料、花粉、猫狗皮毛、部分真菌及食物虾、蟹是AR常见变应原;合并有哮喘和(或)特应性皮炎等个人过敏史AR患者SIgE阳性检出率明显高于无个人过敏史患者.     

深海盐水鼻腔灌洗在慢性鼻窦炎治疗中的临床应用价值评估

目的探讨深海盐水鼻腔灌洗在慢性鼻窦炎治疗中的临床应用价值。方法对96例慢性鼻窦炎患者行深海盐水鼻腔灌洗,比较治疗前后的鼻腔环境及症状情况。结果 96例患者经深海盐水鼻腔灌洗治疗,治愈62例(64.58%)、显效15例(15.63%)、有效8例(8.33%)、无效11例(11.46%),总有效率为88.54%(85/96)。患者鼻塞、流脓涕和鼻源性头痛等症状均有不同程度改善。结论深海盐水鼻腔灌洗具有疗效确切、操作简便、安全、价廉、患者易接受等优点,值得临床推广。     

鼻声反射测量法及应用

鼻声反射(AR)是一种客观检测鼻腔通气功能的方法,随着研究的深入。AR被广泛应用在鼻功能的基础和临床研究中,同时结合其他检查方法在鼻咽甚至口咽疾病的研究中也得到了应用。本文对AR的原理、在鼻功能研究中的应用及其扩展应用进行综述。     

新型冠状病毒肺炎疫情下变应性鼻炎患者皮下注射特异性免疫治疗的临床操作指引

变应原特异性免疫治疗(AIT)是变应性鼻炎唯一的、有根治性可能的对因治疗手段。受新型冠状病毒肺炎疫情(简称新冠疫情)影响,很多处于封控状态的患者无法按期到医院接受皮下注射AIT,需要酌情调整剂量。有鉴于此,中国鼻病研究协作组召集国内中青年鼻科专家,制订了新冠疫情下皮下注射AIT的临床操作指引,旨在指导受封控影响的皮下注射AIT进行相应的剂量调整,确保免疫治疗的安全性和有效性。     

Validity and limitations of the Nidek NT-4000 non-contact tonometer: a clinical study

Using Goldmann applanation tonometry (GAT) as a gold standard, we evaluated the accuracy of Nidek NT-4000 pneumotonometry (NPT) in adults without corneal disease. Bland and Altman analysis of serial intra-ocular pressures (IOPs) measured with NPT and GAT in 10 healthy subjects revealed that the repeatability coefficients for the two methods were similar. NPT, GAT and ultrasonic pachymetry were then performed in 100 patients. Bland and Altman analysis showed that NPT yielded significantly higher readings than GAT [mean biases for right and left eye measurements were 1.37 mmHg (95% limits of agreement: -3.02-5.76) and 1.17 mmHg (95% limits of agreement: -2.76-5.11) respectively] and was more affected by corneal thickness variations. For detection of IOPs > or =21 mmHg, NPT displayed very high sensitivity (0.90) and good specificity (0.95). NPT may be useful in screening and clinical settings but borderline-high IOP readings should be confirmed with GAT.     

从EURETINA最新指南看视网膜静脉阻塞诊疗策略的变化

视网膜静脉阻塞(retinal vein occlusion,RVO)是严重危及视功能的常见疾病,在临床治疗策略和方案上并未完全形成共识,国内至今也未见相关指南和共识发表,近期新的国际指南发布对RVO治疗方法和管理策略有了更为全面、清晰的推荐和建议,了解并解读相关指南可为临床实践提供参考,对规范和指导诊疗提供帮助。     

改良型非穿透性小梁切除术远期临床效果观察

目的:研究改良型非穿透性小梁切除术治疗原发性青光眼的临床效果。方法:原发性青光眼21例30眼施行改良型非穿透性小梁切除术,切除小梁网和Schlemm管外壁组织1.0mm×3.0mm,保留最内层组织,于术后1wk;1,6mo;1a及5a以上(最长10a)观察临床效果。结果:早期随访不用抗青光眼药物眼压低于2.7kPa者28眼,有效率达93%,长期随访眼压低于2.7kPa者27眼,有效率达90%。术后无严重并发症发生。结论:改良型非穿透性小梁切除术在早期和平均5a随访中能有效降低原发性开角型和闭角型青光眼患者眼压,因不穿透前房而术后并发症少,是一种理想的原发性青光眼手术方法。     

糖皮质激素治疗特发性视神经炎是否有效

糖皮质激素(以下简称激素)是治疗重要神经眼科疾病的主要措施之一.然而长期以来,激素治疗特发性视神经炎是否有效一直是争论的焦点.笔者认为应权衡利弊,结合患者的视功能、MRI等检查情况给出个体化的治疗方案,对于类似美国视神经炎治疗试验中特发性视神经炎的患者应采用其推荐方案.不建议局部注射治疗.目前激素应用仍有许多临床问题尚...     

Postoperative results of non-penetrating trabeculectomy for primary open-angle glaucoma

PURPOSE: To estimate the postoperative results of non-penetrating trabeculectomy(NPT), the success rate of postoperative intraocular pressure(IOP) and the clinical factors affecting postoperative IOP were evaluated. SUBJECTS AND METHODS: 32 eyes of 32 primary open-angle glaucoma(POAG) patients who underwent NPT as the first filtering surgery were enrolled in the study. We evaluated postoperative IOP using the Kaplan-Meier method, a proportional hazard model, and multiple logistic analysis. RESULTS: 53.2% of all patients had an IOP of less than 16 mmHg without antiglaucoma medication, and 63.8% had an IOP of less than 16 mmHg with antiglaucoma medication 36 months postoperatively. The performance of Nd:YAG trabeculopuncture(YLT) was indicated as a significant factor affecting postoperative IOP by the proportional hazard model(p = 0.037). 72.2% of patients who did not undergo YLT had an IOP of less than 16 mmHg without antiglaucoma medication, and 36.5% who underwent YLT had a postoperative IOP of less than 16 mmHg. There was significant difference between the both groups(log rank test, p = 0.045). Preoperative IOP with antiglaucoma medication was indicated as a significant factor affecting performance of YLT by multiple logistic analysis. CONCLUSION: These results suggest that NPT may be useful to reduce the use of antiglaucoma medication in patients with POAG whose preoperative IOP is controllable with antiglaucoma medication.     

Midterm Results and the Problems of Nonpenetrating Lamellar Trabeculectomy with Mitomycin C for Japanese Glaucoma Patients

PURPOSE: To present midterm results and problems pertaining to nonpenetrating lamellar trabeculectomy (NPT) with mitomycin C (MMC) for Japanese glaucoma patients. METHODS: Thirty-nine patients (39 eyes) with primary open-angle glaucoma or normal-tension glaucoma underwent NPT. The results were compared with those in patients treated by penetrating trabeculectomy (PT) with MMC. In addition, the NPT patients were classified into two groups (group A, 24 patients treated between April 1998 and April 1999; group B, 21 patients treated from May 1999 onward), and the results were compared. RESULTS: The average intraocular pressure (IOP) was 12.6 +/- 2.8 mmHg with NPT and 12.4 +/- 3.0 mmHg with PT. No statistical differences between NPT and PT were identified with respect to IOP at any time after surgery. A life-table analysis showed that the probability of success (good IOP control) was 37.2% with NPT and 62.5% with PT. No significant difference was detected in postoperative IOP change or in the probability of success between NPT groups A and B. CONCLUSIONS: While postoperative IOP is similar between PT and NPT, the probability of success is better with PT than with NPT. Postoperative laser treatment after NPT is effective but sometimes has a negative influence on IOP control.     

Advanced nonpenetrating trabeculectomy (advanced NPT) and combined surgery of advanced NPT and phacoemulsification and intraocular lens implantation

We have devised a new glaucoma surgery combining deep sclerectomy with nonpenetrating trabeculectomy (NPT); we call this surgery advanced NPT. We evaluated intraocular pressure (IOP) control, postoperative complication and visual acuity after combined advanced NPT and phacoemulsification and intraocular lens implantation (combined surgery), and advanced NPT alone. The mean preoperative IOP for the trabeculectomy only group was 22.4 +/- 6.3 mmHg(bleb+), 23.0 +/- 4.9 mmHg(bleb-), and that of the combined surgery group was 18.1 +/- 4.5 mmHg(bleb+), 18.5 +/- 2.6 mmHg(bleb-). Mean postoperative IOP for the two groups were 13.0 +/- 2.3 mmHg(bleb+), 15.0 +/- 1.5 mmHg(bleb-) and 12.9 +/- 2.7 mmHg(bleb+), 13.3 +/- 2.4 mmHg(bleb-), respectively. After 15 months, the success probability for postoperative IOP control were 63%(bleb+), 23%(bleb-) in the advanced NPT only group (相似文献   

中国合并白内障的原发性青光眼手术治疗专家共识(2021年)

合并白内障的原发性青光眼作为我国比较常见的眼部疾病,手术是其主要的治疗方法。随着医疗技术的不断进步,其手术方式的选择出现较大争议,国内尚缺乏具有普遍指导意义的共识性意见。为规范临床治疗工作,中华医学会眼科学分会青光眼学组经过认真讨论,结合临床实践经验制定本共识,对具有白内障手术指征的不同类型、不同时期的原发性青光眼的手术方式及围手术期和随访的管理等提出指导性意见。(中华眼科杂志,2021,57:166-170)     

The pattern of the ocular late phase reaction induced by allergen challenge in hay fever conjunctivitis

The purpose of this study was to describe the pattern of the ocular late phase reaction in patients with ocular hay fever. The authors monitored the clinical and cytological conjunctival response after topical allergen challenge. A conjunctival provocation test was performed in six ryegrass-sensitive patients and six healthy volunteers with 320,000 Biological Units (Pharmacia, Uppsala) of ryegrass antigen, diluted in albumin, in one eye; albumin diluent alone was used in the second (control) eye. Clinical symptoms were evaluated before challenge after 20 min, then hourly for 12 hours and 24 hours after challenge. Cell counts in the tear fluid were performed at the same time interval The results obtained show a significant clinical reaction during the entire period, differing in peaks in individual cases. This reaction was associated with a persistent inflammation, with neutrophils in the early phase and eosinophils and lymphocytes in the late phase period The data thus show that ocular challenge with high allergen doses induces clinical and cellular evidence of an ocular late phase reaction and suggest that the conjunctival provocation test may be used for a better understanding of the pathogenesis of mild but persistent ocular inflammation in ocular hay fever.     

Visual acuity norms in young children

There are no universally accepted standards for visual acuity tests or norms in young (3-6-year-old) children, although acuity measurement is important in both clinical and screening settings. This review outlines the requirements for such standards. Although more research is needed, available data suggest that a standard test should meet the following requirements. It should utilize a letter optotype (tumbling E, Landolt C, or HOTV variant of the STYCAR), and single optotype with contour interaction bar surround. It should permit nonverbal pointing responses in younger children and verbal responses in older children. If an orientation-specifying method is followed, as with the E or Landolt C, the test should use a three-alternative choice--up, down, and sideways with a nondifferentiated left-right--rather than the traditional four alternative choice. A C-like O pseudo-optotype should be considered in a paired-comparison test format when the Landolt C is utilized, with a similar format for the tumbling E if a suitable pseudo-optotype can be derived. The optical grating test, which is widely used in infant testing, may underestimate acuity deficits and so is not a test of choice for determination of Snellen-equivalent acuity. A letter-based variant of the grating test may hold promise. Reduction in testing distance from 6 to 3 or 4 meters is recommended.