不同程度持续性变应性鼻炎对下气道的影响

目的 检测下气道炎症相关指标，探讨不同程度持续性变应性鼻炎(perennial allergic rhinitis，PAR)对下气道影响的程度及差异。方法 入选PAR患者266例，其中轻度组(165例)、中-重度组(101例)，另选健康正常组136例，均行诱导痰嗜酸性粒细胞(eosinophils，EOS)计数、呼出气一氧化氮(fraction of exhaled nitric oxide，FeNO)检测及支气管激发试验(bronchial provocation test，BPT)，比较三组受试者对下气道影响的程度和差异。结果 ①三组间FeNO及FeNO阳性率的差异均具有统计学意义(39.07±24.29 vs 25.81±18.68 vs 9.01±10.01，P＜0.01；66.19% vs 33.33% vs 8.82%，P＜0.01)；②两组鼻炎患者痰EOS比例及痰EOS阳性率的差异无统计学意义(5.51±9.11% vs 4.02±7.10%；40.59% vs 35.57%，P＞0.05)，与正常组的差异均有统计学意义(5.51±9.11% vs 0.48±1.28%， 4.02±7.10% vs 0.48±1.28%；40.59% vs 1.47%，35.57% vs 1.47%，P＜0.01)；③中-重度组BPT阳性率与轻度组、正常组差异均有统计学意义(14.85% vs 4.24%,14.85% vs 1.23%，P＜0.01 )，轻度组与正常组差异无统计学意义(4.24% vs 1.23%，P＞0.05)。结论 ①不同程度PAR患者下气道炎症存在差异；②研究证实，中-重度PAR患者呈现出更高水平的下气道异常，针对此类患者，可能暗示未来罹患哮喘(BA)的风险，耳鼻喉及呼吸科临床医师应给予高度重视。

Impact of persistent allergic rhinitis of different degrees on the lower airway

Objective To determine the characters and difference of the impact of persistent allergic rhinitis of different degrees on the lower airway. Methods All patients enrolled in this study were categorized into three groups, the mild group(165 subjects), the moderate/severe group(101 subjects), and the normal control group(136 healthy subjects). Induced sputum differential cytology tests, measurements of exhaled nitric oxide concentration and methacholine bronchial provocation tests were performed. The character and difference in the lower airway among the three groups were compared. Results ① The measurements of fractional exhaled nitric oxide concentration and the positive rate of fractional exhaled nitric oxide concentration of the moderate/severe group and the mild group both had significant statistical difference with the normal control group(39.07±24.29 vs 25.81±18.68 vs 9.01±10.01, P＜0.01; 66.19% vs 33.33% vs 8.82%, P＜0.01) ; ② Proportion and positive rate of eosinophils in induced sputum of the two rhinitis groups had no significantly statistical difference with each other(5.51±9.11% vs 4.02±7.10%; 40.59% vs 35.57%, P＞0.05), but they both had significantly statistical difference with the normal control group(5.51±9.11% vs 0.48±1.28%, 4.02±7.10% vs 0.48±1.28%; 40.59% vs 1.47%, 35.57% vs 1.47%, P＜0.01); ③ Positive rate of bronchial provocation test of the moderate/severe group had significantly statistical difference with the mild group and the normal control group(14.85% vs 4.24%,14.85% vs 1.23%, P＜0.01), but the mild group had no significantly statistical difference with the normal control group(4.24% vs 1.23%, P＞0.05). Conclusion ① The disparity of the lower airway inflammation consists in perennial allergic rhinitis of different degrees; ② Our research demonstrates that the moderate/severe perennial allergic rhinitis exhibits superior lower airway abnormality, indicating that such patients have high-risk of suffering from asthma, in view of this condition, they should be paid sufficient attention to by otorhinolaryngologists and respiratory physicians.