Rhinitis Symptom Utility Index (RSUI) in Chinese Subjects: A Multiattribute Patient-preference Approach

Background: The Rhinitis Symptom Utility Index (RSUI), originally developed in the United States, consists of a patient-preference weighting scheme and a 10-item questionnaire measuring the severity and frequency of rhinitis related symptoms over a 14-day period. This study aimed to determine whether the Chinese RSUI could adopt the US-based multi-attribute utility function (MAUF) in scoring rhinitis symptoms. Methods: In a Hong Kong study, 116 Chinese adults with allergic rhinitis completed the RSUI questionnaire and 36-item Short-Form Health Survey (SF-36) after they had been seen by two otorhinolaryngologists for disease-severity ratings. Respondents then completed computer-administered direct preference measures, i.e., visual analogue scale (VAS) and standard gamble (SG) assessments. The VAS and SG data were used to estimate a MAUF for the Chinese-based RSUI. Results: The derived MAUF was somewhat different than the one developed for the US RSUI. Test–retest reliability for the Chinese RSUI was satisfactory (ICC = 0.71, p<0.001). Scores differentiated among cases with mild, moderate, and severe symptoms (p<0.001); and between those who did and did not require medications to control symptoms (p = 0.031). Findings were significantly correlated with SF-36 domain scores (r = 0.19 to 0.37; p=0.041 to <0.001). When the US-based scoring function was applied to the Chinese subjects, the resulting mean RSUI score was significantly lower (p<0.001). Comparisons between directly measured VAS and SG scores between the US and Chinese samples, demonstrated significant differences (all p<0.05), with the US subjects consistently rating rhinitis symptoms as worse than Chinese subjects. Conclusions: The Chinese RSUI has good measurement properties that reflect patient preferences from the Chinese. Results suggest that there are differences in preference rating between US and Chinese subjects and that use of the US-based preference function for the RSUI would bias the measurement of rhinitis symptom outcomes in Chinese subjects.     

Allergen avoidance in the secondary and tertiary prevention of allergic diseases: does it work?

Although allergen avoidance is widely recommended as part of a secondary and tertiary prevention strategy for allergic diseases, a clear-cut demonstration of its effectiveness is still lacking. Ongoing observational secondary prevention cohorts show that sensitisation to mite can be prevented in the short term by allergen avoidance measures, but further follow-up of these children is needed to show if this effect can be sustained, as well as to ascertain its impact on allergic disease. More well-designed trials are still required before we can give any conclusive advice to our patients. Considering the management of allergy, current evidence suggests that interventions in children (either single or multifaceted) may be associated with some beneficial effect on asthma control, but no conclusive evidence exists regarding rhinitis or eczema. Conversely, there is little evidence to support the recommendation of allergen avoidance methods in adults with asthma and rhinitis. There is a need for an adequately designed trial assessing the effects of a multifaceted intervention in this age group.     

变应性鼻炎患者血清一氧化氮水平变化及临床意义

目的 :通过 5 6例变应性鼻炎患者血清一氧化氮 (NO)浓度的观察 ,研究内源性NO水平的变化与变应性鼻炎病理过程的关系及其临床意义。方法 :血清NO水平采用硝酸还原酶比色法测定。结果 :变应性鼻炎组血清NO水平显著高于正常对照组 (q =2 7.2 3,P <0 .0 1)及慢性鼻炎组 (q =15 .2 3,P<0 .0 1)。慢性鼻炎组与正常对照组血清NO浓度差异无显著性 (q =1.89,P >0 .0 5 )。结论 :变应性鼻炎患者血清中NO水平显著高于正常对照组及慢性鼻炎组 ,提示NO在变应性鼻炎的发病过程中可能起重要作用 ,对其机理的研究为变应性鼻炎的治疗提供新的方法。     

口腔径路曲安奈德蝶腭神经节封闭治疗变应性鼻炎（附415例报告）

目的：探讨口腔径路曲安奈德蝶腭神经节封闭治疗变应性鼻炎的效果。方法：变应性鼻炎患者415例，男270例，女145例。用自制封闭针头于口腔径路行曲安奈德蝶腭神经节封闭术。结果：415例中，有效250例，好转63例，总有效率为99．5％。结论：经口腔径路用曲安奈德行蝶腭神经节封闭术是治疗变应性鼻炎的有效疗法。     

How do topical nasal corticosteroids improve sleep and daytime somnolence in allergic rhinitis?

Therapy for rhinitis improves sleep quality and symptoms of daytime sleepiness. This improvement with therapy may be secondary to anti-inflammatory effects, leading to a reduction of inflammatory mediators, or to a mechanical reduction of congestion directly leading to improvement in sleep disturbance. We combined our data from 3 placebo-controlled studies of intranasal corticosteroids in patients with perennial rhinitis to determine whether a correlation between the reduction of congestion and improved sleep and daytime somnolence existed. The pooled data of budesonide, flunisolide, and fluticasone demonstrated significantly decreased nasal congestion, sleep problems, and sleepiness in treated patients. The data demonstrated a correlation between a reduction in nasal congestion and an improvement of sleep (P < .01) and daytime somnolence (P = .01). Thus, topical intranasal corticosteroids should be used to decrease nasal congestion and to improve sleep and daytime somnolence in patients manifesting these symptoms.     

Phdiatop检测在筛选变应性鼻炎中的价值

目的探讨Phadiatop检测在变应性鼻炎筛选诊断中的应用价值.方法对72例临床表现为变应性鼻炎症状及体征患者进行Phadiatop检测,同时采用5种常见过敏原作皮肤试验,并进行对比分析.结果72例中Phdiatop阳性47例(65.28%),皮肤试验阳性42例(58.33%),两者间无显著性差异(P＞0.05);Phadiatop阴性25例(34.72%),皮试阴性21例(29.17%),皮试可疑阳性9例,其中6例Phdiatop阳性.结论Phadiatop在变应性鼻炎的筛选诊断中具有重要价值.     

血管运动性鼻炎激光治疗鼻腔粘膜致敏区的筛选

目的 :随访和对比激光治疗血管运动性鼻炎鼻腔粘膜不同区域的致敏性 ,以明确最佳治疗点。方法 :随机选择确诊的血管运动性鼻炎 1 0 3例 ,分为下鼻甲、中鼻甲、中鼻甲前 1 /3段 3组进行激光治疗。结果 :下鼻甲组总有效率为 66.7% ,中鼻甲组为 97.1 % ,中鼻甲前 1 /3段为 94.4% ,两中鼻甲组与下鼻甲组总有效率差异有显著性 (P<0 .0 0 5) ,中鼻甲组与中鼻甲前 1 /3段组总有效率差异无显著性 (P>0 .0 5)。结论 :中鼻甲前 1 /3段是血管运动性鼻炎患者鼻粘膜最敏感的区域 ,是最佳激光治疗点。     

H1及H2受体阻滞剂对变应性鼻炎疗效分析

为评价 Ｈ１ 及 Ｈ２ 受体阻滞剂合用治疗变应性鼻炎的疗效,回顾分析了５１ 例变应性鼻炎治疗的临床资料。２７ 例用 Ｈ１ 受体阻滞剂阿司咪唑及 Ｈ２ 受体阻滞剂西咪替丁联合治疗,有效率为 ８８８９％ （２４／２７）;２４ 例单用阿司咪唑,有效率为 ５８３３％ （１４／２４）,两组差异有显著性（ Ｐ＜ ００５）。加用西咪替丁组改善鼻气道阻力有效率为 ６２９６（１７／２７）,单用阿司咪唑组鼻气道阻力改善有效率为 ２０８３（５／２４）,差异有高度显著性（ Ｐ＜ ００１）。提示 Ｈ１ 及 Ｈ２ 受体阻滞剂联合治疗变应性鼻炎疗效好。     

蝶腭,筛前神经及鼻甲联合手术治疗常年性变应性鼻炎

在鼻内窥镜下为４０例行蝶腭、筛前神经及鼻甲联合手术治疗常年性变应性鼻炎。结果：术后１月全部患者症状消失,显效１００％;术后１年显效３３例,占８２．５％;有效６例,占１５％,有效率为９７．５％。提示该方法可广泛阻滞鼻腔副交感神经来源,降低鼻粘膜感觉灵敏部位敏感性以及感觉—副交感神经反射,破坏喷嚏反射弧的传入通路,使鼻粘膜对外界刺激敏感性下降,血管扩张减轻,腺体分泌减少,对常年性变应性鼻炎有明显疗效。     

变应性鼻炎患者外周血白细胞及鼻黏膜诱导型一氧化氮合酶mRNA 表达的意义

目的　探讨变应性鼻炎 (allergicrhinitis,AR)患者外周血白细胞及鼻黏膜诱导型一氧化氮合酶 (induciblenitricoxidesynthase,iNOS)mRNA表达的关系。方法　选择 3 5例AR患者及 3 0例健康人的外周血白细胞。其中 8例变应性鼻炎患者鼻黏膜 ,6例正常鼻黏膜。iNOS mRNA表达采用原位杂交方法。血浆一氧化氮 (nitricoxide,NO)水平采用硝酸还原酶比色法测定。结果　健康人外周血白细胞未见iNOS mRNA表达 ,而AR患者外周血白细胞iNOS mRNA表达高度增强 ,其阳性率达 40 82 %。正常人鼻黏膜上皮、腺体及巨噬细胞可见iNOS mRNA的低度表达 ,而AR患者中上皮、腺体及巨噬细胞增生 ,并iNOS mRNA表达高度增强 (t=2 3 17,P <0 0 0 1)。AR组血浆NO水平显著高于对照组 (t=2 7 89,P <0 0 1)。结论　AR患者血浆NO水平与外周血白细胞及组织内iNOS mRNA表达高度增强有关。提示iNOS NO通路在AR的发病过程中可能起重要作用。本研究为检测体内某些信号提供了简便易行的原位杂交试验方法