本文選題：變應(yīng)原 + 支氣管哮喘��； 參考：《廣州醫(yī)科大學(xué)》2017年碩士論文

【摘要】：第一部分呼吸道變應(yīng)性疾病臨床特征及吸入性變應(yīng)原分布呼吸道變應(yīng)性疾病主要包括變應(yīng)性鼻炎和支氣管哮喘,在世界范圍內(nèi)發(fā)病率逐年升高,是受到廣泛關(guān)注的健康問題。既往吸入性變應(yīng)原的研究多針對螨蟲、花粉等,相關(guān)研究結(jié)果顯示隨各地地理、氣候環(huán)境的不同,吸入性變應(yīng)原分布也存在差異,如在我國南方,屋塵螨及蟑螂陽性率較高,而在北方地區(qū),因氣候干冷不適合螨蟲等生長繁殖,其陽性率相對沒有南方的高。近年來空氣中真菌孢子也受到臨床醫(yī)師的關(guān)注,被認(rèn)為是重要的變應(yīng)原,可誘發(fā)加重呼吸道變應(yīng)性疾病,廣州屬亞熱帶海洋季風(fēng)氣候,夏季多雨潮濕,全年氣溫高,有利于真菌及其孢子的生長和繁殖,且真菌種類繁多,而真菌變應(yīng)原的種類及其在誘發(fā)呼吸道變應(yīng)性疾病中的作用尚不完全明確,深入研究真菌變應(yīng)原的分布,及與呼吸道變應(yīng)性疾病的臨床特征相關(guān)關(guān)系具有重要意義,可為呼吸道變應(yīng)性疾病的臨床診治提供依據(jù)。目的:研究采用血清吸入性變應(yīng)原Ig E檢測及皮膚變應(yīng)原點(diǎn)刺試驗(yàn)的方法對哮喘和/或變應(yīng)性鼻炎患者進(jìn)行過敏原檢測,以明確真菌變應(yīng)原分布,并對比分析其與患者臨床特征的相關(guān)關(guān)系。方法:1、收集廣州醫(yī)科大學(xué)附屬第二醫(yī)院就診的變應(yīng)性鼻炎和/或支氣管哮喘患者122例,根據(jù)診斷分成為鼻炎組、哮喘并鼻炎組和哮喘組3組。2、所有入組患者進(jìn)行血清吸入性變應(yīng)原Ig E檢測其中包括總Ig E、螨組合(屋塵螨、粉塵螨)、樹花粉組合(柏樹花粉、榆樹花粉、梧桐花粉、柳樹花粉、楊樹花粉)及霉菌組合(煙曲霉、分支孢霉、交鏈孢霉、點(diǎn)青霉、根霉、毛霉)及吸入性變應(yīng)原點(diǎn)皮膚刺試(包括花粉、刺莧菜、螨、蠶絲、美洲大蠊、屋塵、貓毛、狗毛、飛蛾、墊料、獸羽毛、蜜蜂、德國小蠊及霉菌組(煙曲霉、交鏈孢霉,支孢霉)。3、收集并比較三組患者的臨床特征及其吸入性變應(yīng)原分布情況。結(jié)果:1、哮喘并鼻炎組血清總Ig E水平(330.51±238.81)明顯高于鼻炎組(140.20±133.56)及哮喘組(170.08±197.63)(P值均0.01);2、哮喘并鼻炎組血清嗜酸粒細(xì)胞水平(0.36±0.25)明顯高于哮喘組(0.22±0.19)(P=0.012);3、哮喘組螨變應(yīng)原陽性比例(30.77%)明顯低于鼻炎組(85.11%)和哮喘并鼻炎組(91.3%)(P值均0.01);哮喘組樹花變應(yīng)原陽性比例(23.8%)明顯低于鼻炎組(48.94%)和哮喘并鼻炎組(69.57%)(P=0.011;P=0.001);4、鼻炎組與哮喘合并鼻炎組、鼻炎組與哮喘組、哮喘合并鼻炎組與單純哮喘組間霉菌變應(yīng)原陽性比例均無顯著差異(P=0.8,P=1,P=0.842)結(jié)論:1、螨、樹花及真菌是變應(yīng)性呼吸道疾病常見的變應(yīng)原。2、在合并變應(yīng)性鼻炎的哮喘患者中,真菌變應(yīng)原陽性率高。第二部分真菌致敏哮喘患者的臨床特征分析支氣管哮喘是常見的呼吸道慢性炎癥疾病,哮喘的病理基礎(chǔ)是由多種細(xì)胞參與的氣道慢性炎癥,變應(yīng)原的刺激可以誘發(fā)特異性體質(zhì)患者氣道的慢性炎癥和氣道高反應(yīng),出現(xiàn)反復(fù)發(fā)作咳嗽和/或喘息。我們前期的研究顯示真菌為常見的吸入性變應(yīng)原,在合并變應(yīng)性鼻炎的哮喘患者中真菌變應(yīng)原陽性率高,近期的研究認(rèn)為真菌變應(yīng)原與哮喘的嚴(yán)重程度密切相關(guān)。而環(huán)境中存在多種真菌及孢子,特應(yīng)性個(gè)體接觸后可誘發(fā)變態(tài)反應(yīng)性疾病,但真菌致敏的種類及誘發(fā)哮喘的臨床特征仍不完全清楚,深入研究真菌致敏性哮喘患者的臨床特征,明確本地區(qū)真菌相關(guān)性哮喘的致敏真菌種類,有助于真菌相關(guān)性哮喘的診療,減輕醫(yī)療、經(jīng)濟(jì)、家庭負(fù)擔(dān)。目的:研究采用血清吸入性變應(yīng)原Ig E檢測及皮膚變應(yīng)原點(diǎn)刺試驗(yàn)的方法篩選真菌致敏的支氣管哮喘患者,并采用ELISA酶聯(lián)免疫捕獲法檢測血清真菌特異性Ig E(s Ig E),并分析本地區(qū)哮喘患者真菌致敏的情況及其臨床特征。方法:1、收集112例哮喘患者,平均年齡48歲(3-82歲),其中兒童12例,男性49例,女性63例。2、通過血清霉菌Ig E檢測包括總Ig E、螨組合(屋塵螨、粉塵螨)、樹花粉組合(柏樹花粉、榆樹花粉、梧桐花粉、柳樹花粉、楊樹花粉)及霉菌組合(煙曲霉、分支孢霉、交鏈孢霉、點(diǎn)青霉、根霉、毛霉)及吸入性變應(yīng)原點(diǎn)皮膚刺試(包括花粉、刺莧菜、螨、蠶絲、美洲大蠊、屋塵、貓毛、狗毛、飛蛾、墊料、獸羽毛、蜜蜂、德國小蠊及霉菌組(煙曲霉、交鏈孢霉,支孢霉),篩選出伴真菌致敏的哮喘患者,根據(jù)真菌致敏情況分為真菌致敏組和不伴真菌致敏組。3、對篩選出的哮喘患者采用ELISA酶聯(lián)免疫捕獲法檢測血清真菌s Ig E(煙曲霉、鏈格孢霉、白色念珠菌、青霉及總毛霉)。4、收集患者臨床資料,比較分析真菌致敏組與不伴真菌致敏組哮喘患者的臨床特征。結(jié)果:1、真菌致敏組及不伴真菌致敏組患者性別、合并變應(yīng)性鼻炎和/或皮炎比例、血清總Ig E、外周血嗜酸粒細(xì)胞計(jì)數(shù)、FEV1%無明顯差異(P0.05)。2、入組的兒童哮喘患者12例中真菌致敏陽性的患兒6例,在兒童患者中伴真菌致敏性哮喘的比例明顯高于成人患者(P0.001),真菌致敏組平均年齡明顯低于不伴真菌致敏組(P=0.004)。3、真菌致敏組中的重癥哮喘患者比例高于后者(P=0.032);且同時(shí)存在多種變應(yīng)原致敏的比例明顯高于后者(P0.001);4、14例血清霉菌組合Ig E陽性患者血清SIg E檢測陽性11例(78.5%),其中煙曲霉SIg E陽性6例(42.9%)、白色念珠菌s Ig E陽性4例(28.6%)、青霉菌SIg E陽性2例(14.3%)、鏈格孢霉及總毛霉各1例(7.1%),2例兼有煙曲霉及青霉菌SIg E陽性,1例兼有白念珠菌、毛霉及青霉菌SIg E陽性結(jié)論:1、真菌致敏的哮喘患者平均年齡低、兒童多見、重癥哮喘比例高,且常存在對多種變應(yīng)原敏感的情況。2、煙曲霉、白色念珠菌是常見的哮喘致敏真菌變應(yīng)原。
[Abstract]:The first part is the clinical characteristics of respiratory allergic diseases and inhalation allergen distribution of respiratory allergic diseases mainly including allergic rhinitis and bronchial asthma. The incidence of allergic rhinitis and bronchial asthma is increasing year by year in the world. There are also differences in the distribution of inhalation allergens with different geographical and climatic conditions. In the south of China, the positive rate of house dust mites and cockroaches is higher. In northern China, the positive rate of the positive rate is relatively no higher in the north because of the dry and cold climate, and the positive rate is not high in the south. In recent years, the fungal spores in the air are also concerned by the clinicians. It is considered to be an important allergens which can induce aggravated respiratory allergic diseases. Guangzhou is a subtropical marine monsoon climate. It is rainy and humid in summer and has high temperature throughout the year. It is beneficial to the growth and reproduction of fungi and spores, and there are many kinds of fungi. The species of fungal allergen and its role in inducing respiratory allergic diseases are not yet finished. A thorough study of the distribution of fungal allergen and the correlation with the clinical characteristics of respiratory allergic diseases is of great significance and can provide a basis for the clinical diagnosis and treatment of respiratory allergic diseases. Objective: To study the use of serum inhaled allergens Ig E and skin allergen pricking test for asthma and / or allergy Patients with rhinitis were detected by anaphylaxis to identify the distribution of fungal allergen and to compare the correlation with the clinical features of the patients. Methods: 1, 122 cases of allergic rhinitis and / or bronchial asthma in the Second Affiliated Hospital of Guangzhou Medical University were collected. According to the diagnosis, the patients were divided into rhinitis, asthma, rhinitis and asthma group, 3 groups of.2, All the patients were tested for serum inhaled allergens Ig E, including total Ig E, mites (house dust mites, dust mites), tree pollen assemblage (cypress pollen, elm pollen, parasol pollen, willow pollen, poplar pollen) and mould combinations (Aspergillus fumigatus, spores branchomyces, Alternaria, Penicillium, Rhizopus, Mucor) and inhaled allergic skin prickle Test (including pollen, prickly amaranth, mites, silk, Periplaneta americana, house dust, cat hair, dog hair, moth, moth, animal feather, bee, Blattella germanica, and mould group (Aspergillus fumigatus, Alternaria, aspergillus).3, collected and compared the clinical features and the distribution of inhaled allergens in three groups of patients. Results: 1, the serum total Ig E level of asthma and rhinitis group (330.51 + 2) 38.81) obviously higher than the rhinitis group (140.20 + 133.56) and asthma group (170.08 + 197.63) (P value 0.01), 2, the serum eosinophil level of asthma and rhinitis group (0.36 + 0.25) was significantly higher than that of the asthma group (0.22 + 0.19) (0.22 + 0.19) (0.22 P=0.012); 3, the positive ratio of mites allergens in asthma group was significantly lower than that of the rhinitis group (85.11%) and the asthma and rhinitis group (P value) The positive proportion of tree flower allergen (23.8%) in asthma group was significantly lower than that of rhinitis group (48.94%) and asthma and rhinitis group (69.57%) (P=0.011; P=0.001); 4, rhinitis group and asthma combined with rhinitis group, rhinitis and asthma group, asthma combined with rhinitis and simple asthma group had no significant difference (P=0.8, P=1, P=0.842): 1, mites, Tree flowers and fungi are the common allergen.2 of allergic respiratory diseases. In the patients with allergic rhinitis, the positive rate of fungal allergen is high. The clinical characteristics of asthma patients with second parts of fungi are the common chronic inflammatory diseases of the respiratory tract. The pathological basis of asthma is the gas of various cells. Chronic inflammation of the tract, allergen stimulation can induce chronic airway inflammation and airway hyperresponsiveness in patients with specific constitution, recurrent coughs and / or wheezing. Our previous study showed that fungi were common inhaled allergens and have high positive rates of fungal allergen in patients with allergic rhinitis. Fungal allergen is closely related to the severity of asthma. There are a variety of fungi and spores in the environment, and allergic diseases can be induced by individual allergic contact. However, the types of fungal sensitization and the clinical characteristics of inducing asthma are still not completely clear. The clinical features of fungal sensitized asthmatics are studied in depth and the local fungi are clearly defined. The types of sensitized fungi associated with asthma contribute to the diagnosis and treatment of fungal related asthma, reduce medical, economic, and family burdens. Objective: To study the screening of bronchial asthma patients with fungal sensitization by using serum inhaled allergen Ig E and skin strain test, and to detect the serum fungi by ELISA enzyme linked immunosorbent assay (ELISA) Specific Ig E (s Ig E) and analysis of the fungal sensitization of the local asthmatic patients and its clinical characteristics. Methods: 1, 112 cases of asthma were collected, the average age of 48 years (3-82 years old), including 12 children, 49 males and 63 females, including total Ig E, mites (dust mites, dust mites), and pollen combination of cypress tree (cypress pollen,) Elm pollen, parasol pollen, willow pollen, poplar pollen) and fungal combinations (Aspergillus fumigatus, spore spporomyces, cyclosporin, Penicillium, Rhizopus, Mucor) and inhaled allergen test skin test (including pollen, amaranth, mites, silkworm, cockroach, house dust, cat hair, dog hair, moth, pads, animal feathers, bee, Blattella germanica and mold group (Aspergillus fumigatus) Aspergillus oryzae, Aspergillus oryzae, screening the asthmatic patients with fungal sensitization, divided into fungal sensitization and non fungal sensitization group.3 according to fungal sensitization, and detected the serum fungal s Ig E (Aspergillus fumigatus, sporomyces, Candida albicans, Penicillium and mucorus total Mucor) by ELISA enzyme linked immunosorbent assay in the patients with asthma. Data, compare and analyze the clinical characteristics of the asthmatic patients in the fungal sensitization group and the non fungal sensitization group. Results: 1, the sex of the fungal sensitizing group and the non fungal sensitization group, the proportion of allergic rhinitis and / or dermatitis, the serum total Ig E, the peripheral eosinophil count, the FEV1% no significant difference (P0.05).2, and the 12 cases of children with asthma in the group In 6 children with fungal sensitization, the proportion of fungal sensitized asthma in children was significantly higher than that in adult patients (P0.001). The average age of the fungal sensitization group was significantly lower than that in the non fungal sensitization group (P=0.004).3, and the proportion of severe asthma in the fungal sensitization group was higher than that of the latter (P=0.032), and the ratio of various allergen sensitization was also found at the same time. The cases were significantly higher than that of the latter (P0.001); 11 cases (78.5%) were positive for SIg E detection in sera Ig E positive patients, including 6 cases (42.9%) of Aspergillus fumigatus SIg E positive, 4 cases of s Ig E positive of Candida albicans (28.6%), 2 cases (14.3%) of Penicillium SIg, 1 (7.1%) and 2 cases of Aspergillus fumigatus and Penicillium, 1, 1, 1 (7.1%), 2 cases of Aspergillus fumigatus and Penicillium, 1, 1, 1, 1, and 1. In addition, the positive conclusion of Candida albicans, Mucor and Penicillium SIg E: 1, the average age of the asthmatic asthmatic patients with fungal sensitization is low, the children are more common, the proportion of severe asthma is high, and there are often.2 sensitive to various allergen, Aspergillus fumigatus and Candida albicans are common allergen allergen sensitized by asthma.

【學(xué)位授予單位】：廣州醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R562.25

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 石晶金;袁東;趙卓慧;;中國人群哮喘和環(huán)境真菌關(guān)系的研究進(jìn)展[J];衛(wèi)生研究;2015年06期

2 許柳柳;;支氣管哮喘合并變應(yīng)性鼻炎與單純支氣管哮喘之差異分析[J];中國社區(qū)醫(yī)師;2015年21期

3 朱華明;張維天;時(shí)海波;蘇開明;;上海地區(qū)2種不同變應(yīng)原皮膚點(diǎn)刺試劑陽性率的比較[J];臨床耳鼻咽喉頭頸外科雜志;2014年05期

4 劉長智;鄭曉濱;劉茂;鄔偉明;黃瑾;;奧馬珠單抗治療難治性哮喘療效與安全性的Meta分析[J];中華臨床醫(yī)師雜志(電子版);2013年14期

5 鄒暉;蘇磊;方秋紅;馬迎民;;真菌致敏的支氣管哮喘的臨床研究[J];中華臨床醫(yī)師雜志(電子版);2012年23期

6 楊海;楊小蘭;陳遠(yuǎn)東;黃超群;吳峰;;檢測誘導(dǎo)痰嗜酸性粒細(xì)胞在哮喘病情評估中的應(yīng)用[J];實(shí)用醫(yī)學(xué)雜志;2012年06期

7 黃芳;趙艷;何荊培;鄧萍萍;周平;周凈潔;趙喜桂;楊自力;;荊門地區(qū)變應(yīng)性鼻炎患者吸入變應(yīng)原譜分析[J];臨床耳鼻咽喉頭頸外科雜志;2010年08期

8 唐世雄;歐陽天斌;康厚墉;姚壽國;羅守軍;郭玉紅;;真菌相關(guān)性變應(yīng)性鼻炎283例分析[J];現(xiàn)代實(shí)用醫(yī)學(xué);2009年08期

9 孫英華;;氣傳致敏真菌與支氣管哮喘相關(guān)性研究[J];濱州醫(yī)學(xué)院學(xué)報(bào);2009年02期

10 方治國;歐陽志云;;城市室內(nèi)外空氣真菌群落及影響因素研究進(jìn)展[J];生態(tài)環(huán)境學(xué)報(bào);2009年01期

相關(guān)碩士學(xué)位論文 前1條

1 韓亞娟;哈爾濱地區(qū)住宅環(huán)境對兒童呼吸過敏性疾病的影響研究[D];哈爾濱工業(yè)大學(xué);2013年

，

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