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[广州地区2535例呼吸道过敏性疾病和呼吸道感染性疾病患者屋尘螨和烟曲霉特异性sIgE检测分析]

[Analysis of specific sIgE detection of house dust mites and aspergillus fumigatus in 2 535 patients with respiratory allergic diseases and respiratory infectious diseases in the Guangzhou area].

作者信息

Lin Y L, Wu L T, Huang H M, Liang X Q, Sun B Q, Luo W T

机构信息

Jinyu College of Laboratory Science, Guangzhou Medical University, Guangzhou 511436, China.

Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease,the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.

出版信息

Zhonghua Yu Fang Yi Xue Za Zhi. 2022 Jun 6;56(6):755-762. doi: 10.3760/cma.j.cn112150-20211209-01141.

Abstract

To compare the specific IgE positive rates of the patients between allergic respiratory diseases and respiratory infectious diseases in Guangzhou, the relationship between the co-sensitization of house dust mite (HDM) allergen and Aspergillus fumigatus (AF) allergen and asthma, allergic rhinitis with asthma, pneumonia, upper respiratory infections, bronchitis, serum total immunoglobulin E (total Immunoglobulin E, tIgE) and age were analyzed, to provide the basis for the prevention and treatment of respiratory allergic diseases and respiratory infectious diseases in this area. A total of 2 535 patients with confirmed respiratory allergic diseases and respiratory infectious diseases were selected retrospectively from the outpatient or inpatient department of the First Affiliated Hospital of Guangzhou Medical University from April 2017 to June 2021 and detected HDM and AF specific IgE (sIgE) by the ImmunoCAP system. The age range was 1 to 89 years. The median age was 5 years. The average age was 9. ≤3 years old group =894, 4-6 years old group =721, 7-18 years old group =615, 19-49 years old group =207, >49 years old group =98. There were 1 596 males (62.96%) and 939 females (37.04%). There were 1 279 cases of allergic diseases and 1 256 cases of respiratory infectious diseases. The different disease groups were divided into asthma group (411 cases), allergic rhinitis group (458 cases), allergic rhinitis combined with asthma group (410 cases), pneumonia group (463 cases), upper respiratory tract infection group (299 cases) and bronchitis group (494 cases). The difference of specific IgE (sIgE) and tIgE between HDM and AF was analyzed. For statistical analysis, continuous variables were tested by Mann-Whitney . Classification data by chi-square test or Fisher's exact test. 1 313 (51.79%) patients were sIgE positive for HDM allergen, 65 (2.56%) were sIgE positive for AF allergen, and 50 (1.97%) were both positive. In the respiratory allergic disease group, 877 cases (68.57%,877/1 279) were positive for HDM allergen sIgE, 57 cases (4.46%,57/1 279) were positive for AF allergen sIgE, and 44 cases (3.44%,44/1 279) were both positive; 436 cases (34.71%,436/1 256) of respiratory infectious diseases were positive for HDM allergen sIgE, 8 cases (0.64%,8/1 256) were positive for AF allergen sIgE, and 6 cases (0.48%,6/1 256) were both positive. In monosensitization, the HDM allergen sIgE sensitization rate was the highest in the allergic rhinitis & asthma group, at 80.24% (329/410). The positive rate of HDM allergen sIgE in male patients was 53.76%(858/1 596), and the positive rate in female patients was 46.22%(434/939), and the difference between the two was statistically significant (χ=13.449, <0.001). In polysensitization, asthma patients (5.35%,22/411) had the highest positive rate of HDM sensitization with AF, followed by allergic rhinitis patients (3.06%,14/458), allergic rhinitis with asthma (1.95%,8/410). The positive rate of respiratory infectious diseases such as pneumonia (0.43%,2/463), upper respiratory infections (0.33%,1/299), and bronchitis (0.61%,3/494) with AF was extremely low. The positive rate of HDM combined with AF in infants(≤3 years old group,0.34%, 3/894; 4-6 years old group, 0.97%, 7/721)was significantly lower than that in teenagers and adults(7-18 years old group,3.58%, 22/615; 19-49 years old group,6.28%, 13/207;>49 years old group,5.10%, 5/98).In the patients with HDM and AF combined sensitization, HDM sIgE levels were distributed in all grades, and AF sIgE levels were mainly in grades 1, 2, and 3. The positive rate of HDM combined with AF was higher in patients with respiratory allergic diseases such as asthma, allergic rhinitis, and allergic rhinitis combined with asthma, suggesting that clinical attention should be paid to the combination of HDM and AF in patients with asthma and allergic rhinitis, especially adults, more likely to be combined with AF.

摘要

为比较广州地区过敏性呼吸道疾病与呼吸道感染性疾病患者的特异性IgE阳性率,分析尘螨(HDM)变应原与烟曲霉(AF)变应原共同致敏与哮喘、过敏性鼻炎伴哮喘、肺炎、上呼吸道感染、支气管炎、血清总免疫球蛋白E(总免疫球蛋白E,tIgE)及年龄的关系,为该地区呼吸道过敏性疾病和呼吸道感染性疾病的防治提供依据。回顾性选取2017年4月至2021年6月广州医科大学附属第一医院门诊或住院确诊的2535例呼吸道过敏性疾病和呼吸道感染性疾病患者,采用免疫捕获系统检测HDM和AF特异性IgE(sIgE)。年龄范围为1至89岁。中位年龄为5岁。平均年龄为9岁。≤3岁组=894例,4 - 6岁组=721例,7 - 18岁组=615例,19 - 49岁组=207例,>49岁组=98例。男性1596例(62.96%),女性939例(37.04%)。过敏性疾病1279例,呼吸道感染性疾病1256例。将不同疾病组分为哮喘组(411例)、过敏性鼻炎组(458例)、过敏性鼻炎合并哮喘组(410例)、肺炎组(463例)、上呼吸道感染组(299例)和支气管炎组(494例)。分析HDM和AF之间特异性IgE(sIgE)和tIgE差异。统计分析时,连续变量采用Mann - Whitney检验。分类资料采用卡方检验或Fisher确切概率法检验。1313例(51.79%)患者HDM变应原sIgE阳性,65例(2.56%)患者AF变应原sIgE阳性,50例(1.97%)患者两者均阳性。在呼吸道过敏性疾病组中,877例(68.57%,877/1279)患者HDM变应原sIgE阳性,57例(4.46%,57/1279)患者AF变应原sIgE阳性,44例(3.44%,44/1279)患者两者均阳性;呼吸道感染性疾病患者436例(34.71%,436/1256)HDM变应原sIgE阳性, 8例(0.64%,8/1256)AF变应原sIgE阳性,6例(0.48%,6/1256)患者两者均阳性。在单致敏中,过敏性鼻炎合并哮喘组HDM变应原sIgE致敏率最高,为80.24%(329/410)。男性患者HDM变应原sIgE阳性率为53.76%(858/1596),女性患者为46.22%(434/939),两者差异有统计学意义(χ=13.449,P<0.001)。在多致敏中,哮喘患者(5.35%,22/411)HDM与AF共同致敏阳性率最高,其次为过敏性鼻炎患者(3.06%,14/458)、过敏性鼻炎合并哮喘患者(1.95%,8/410)。肺炎(0.43%,2/463)、上呼吸道感染(0.33%,1/299)、支气管炎(0.61%,3/494)等呼吸道感染性疾病患者AF阳性率极低。婴儿(≤3岁组,0.34%,3/894;4 - 6岁组,0.97%,7/721)HDM与AF共同阳性率显著低于青少年及成人(7 - 18岁组,3.58%,22/615;19 - 49岁组,6.28%,13/207;>49岁组,5.10%,5/98)。在HDM与AF共同致敏患者中,HDM sIgE水平各等级均有分布,AF sIgE水平主要在1、2、3级。哮喘、过敏性鼻炎、过敏性鼻炎合并哮喘等呼吸道过敏性疾病患者HDM与AF共同阳性率较高,提示临床应关注哮喘及过敏性鼻炎患者HDM与AF合并情况,尤其是成人,更易合并AF。

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