背景:特应性皮炎(atopic dermatitis, AD)患者的一些吸入性过敏原特征会因年龄而异,并可合并呼吸道过敏性疾病等其他各种疾病,对诊断、治疗和预后产生重要影响。目的:探讨活动性AD患者中血清吸入性特异性lgE检测结果和年龄的相关性,及其与呼吸道过敏性疾病的关系,为与AD患者年龄阶段有关的临床管理及合并症的诊疗提供参考。方法:选取2015-09至2020-09在我院确诊为AD并处于活动期的患者409例,对其进行血清吸入性特异性IgE抗体检测,并根据是否合吸道过敏性疾病分为两组,计量资料采用独立样本t检验及方差分析,事后比较采用LSD法进行校正。计数资料采用卡方检验。等级资料采用秩和检验。结果:<6岁、6~12岁、≥12岁三个年龄段阳性率最高的前三种过敏原均依次为榆树、点青霉/烟曲霉/交链孢霉、梧桐,阳性率最低的两种过敏原均依次为豚草、艾蒿。18岁以下AD患者,点青霉/烟曲霉/交链孢霉和梧桐的阳性率随年龄呈上升趋势(P < 0.05),其余吸入性过敏原则未发现此趋势,且不同年龄组梧桐致敏的阳性等级存在差异(P < 0.05);三个年龄段中,6~12岁患者吸入性过敏原阳性种类数高于<6岁的患者(F = 4.270, P < 0.05)。此外,合并呼吸道过敏性疾病的患者吸入性过敏原阳性种类数高于未合并呼吸道过敏性疾病的患者(P < 0.01)。结论:患者各个年龄段吸入性过敏原结果有相同点,又有不同点:各年龄段致敏率最高的过敏原均为榆树、点青霉/烟曲霉/交链孢霉、梧桐;但18岁以下,点青霉/烟曲霉/交链孢霉和梧桐致敏率及致敏级别可能随年龄增大而变化;且不同年龄阶段的患者合并的过敏原种类数也有差异。此外可得出假设,AD患者合并的吸入物过敏原阳性种类数越高,越可能合并呼吸系统道过敏性疾病。 Background: The characteristics of some inhaled allergens in patients with AD may vary with age, and may be associated with respiratory allergic diseases and other diseases, which have an important impact on the diagnosis, treatment and prognosis. Objective: To investigate the correlation between serum inhalation-specific lgE test results and age in patients with active AD and its relationship with respiratory allergic disease to provide reference for clinical management and diagnosis and treatment of complications related to AD patients with different grades of age. Methods: A total of 409 active patients diagnosed with AD in our hospital from September 2015 to September 2020 were selected for the detection of serum inhalation-specific IgE antibody. They were divided into two groups according to whether or not they had closed suction tract allergic diseases. Independent sample T-test and analysis of variance were used for measurement data, and LSD method was used for correction of subsequent comparison. Chi-square test was used for counting data. Rank sum test was used for grade data. Results: The first three allergens with the highest positive rates at the ages of 6, 6~12, and ≥12 years all were elm, Penicillium punctatus/Aspergillus fumigatus/Alternaria alternata, and Wutong, respectively; the two allergens with the lowest positive rates all were ragweed and Artemisia argyi, respectively. In AD patients under 18 years of age, positive rates of Penicillium/Aspergillus fumigatus/Alternaria alternata and Sycamore showed an increasing trend with age (P < 0.05); no such trend was found in other inhalation allergy principles, and there were differences in positive levels of sycamore sensitization in different age groups (P < 0.05). Among the three age groups, the number of positive types of inhalant allergens in AD patients aged 6~12 years was higher than that in AD patients aged less than 6 years (F = 4.270, P < 0.05). In addition, the number of inhalant allergen positive types in patients with respiratory allergic diseases was higher than that in patients without respiratory allergic diseases (P < 0.01). Conclusion: The results of inhaled allergens in patients of different ages are similar and different: the allergens with the highest sensitivities in all ages grades were elm, Penicillium oryzae, Aspergillus fumigatus, and Sycamore. However, under the age of 18, the sensitization rate and the sensitization level of Penicillium/Aspergillus fumigatus/Alternaria alternaria and Sycamore may vary with age; there were also differences in the number of associated allergens in patients of different ages. In addition, it can be hypothesized that the higher the number of positive types of inhaled allergens in AD patients, the more likely they are to be associated with respiratory tract allergic diseases.
背景:特应性皮炎(atopic dermatitis, AD)患者的一些吸入性过敏原特征会因年龄而异,并可合并呼吸道过敏性疾病等其他各种疾病,对诊断、治疗和预后产生重要影响。目的:探讨活动性AD患者中血清吸入性特异性lgE检测结果和年龄的相关性,及其与呼吸道过敏性疾病的关系,为与AD患者年龄阶段有关的临床管理及合并症的诊疗提供参考。方法:选取2015-09至2020-09在我院确诊为AD并处于活动期的患者409例,对其进行血清吸入性特异性IgE抗体检测,并根据是否合吸道过敏性疾病分为两组,计量资料采用独立样本t检验及方差分析,事后比较采用LSD法进行校正。计数资料采用卡方检验。等级资料采用秩和检验。结果:<6岁、6~12岁、≥12岁三个年龄段阳性率最高的前三种过敏原均依次为榆树、点青霉/烟曲霉/交链孢霉、梧桐,阳性率最低的两种过敏原均依次为豚草、艾蒿。18岁以下AD患者,点青霉/烟曲霉/交链孢霉和梧桐的阳性率随年龄呈上升趋势(P < 0.05),其余吸入性过敏原则未发现此趋势,且不同年龄组梧桐致敏的阳性等级存在差异(P < 0.05);三个年龄段中,6~12岁患者吸入性过敏原阳性种类数高于<6岁的患者(F = 4.270, P < 0.05)。此外,合并呼吸道过敏性疾病的患者吸入性过敏原阳性种类数高于未合并呼吸道过敏性疾病的患者(P < 0.01)。结论:患者各个年龄段吸入性过敏原结果有相同点,又有不同点:各年龄段致敏率最高的过敏原均为榆树、点青霉/烟曲霉/交链孢霉、梧桐;但18岁以下,点青霉/烟曲霉/交链孢霉和梧桐致敏率及致敏级别可能随年龄增大而变化;且不同年龄阶段的患者合并的过敏原种类数也有差异。此外可得出假设,AD患者合并的吸入物过敏原阳性种类数越高,越可能合并呼吸系统道过敏性疾病。
特应性皮炎,吸入性特异性IgE,年龄,呼吸道过敏性疾病
Wenjun Cui*, Fuqian Huang, Yingying Wang, Xiufang Li
Affiliated Hospital of Qingdao University, Qingdao Shandong
Received: Nov. 2nd, 2020; accepted: Nov. 18th, 2020; published: Nov. 25th, 2020
Background: The characteristics of some inhaled allergens in patients with AD may vary with age, and may be associated with respiratory allergic diseases and other diseases, which have an important impact on the diagnosis, treatment and prognosis. Objective: To investigate the correlation between serum inhalation-specific lgE test results and age in patients with active AD and its relationship with respiratory allergic disease to provide reference for clinical management and diagnosis and treatment of complications related to AD patients with different grades of age. Methods: A total of 409 active patients diagnosed with AD in our hospital from September 2015 to September 2020 were selected for the detection of serum inhalation-specific IgE antibody. They were divided into two groups according to whether or not they had closed suction tract allergic diseases. Independent sample T-test and analysis of variance were used for measurement data, and LSD method was used for correction of subsequent comparison. Chi-square test was used for counting data. Rank sum test was used for grade data. Results: The first three allergens with the highest positive rates at the ages of 6, 6~12, and ≥12 years all were elm, Penicillium punctatus/Aspergillus fumigatus/Alternaria alternata, and Wutong, respectively; the two allergens with the lowest positive rates all were ragweed and Artemisia argyi, respectively. In AD patients under 18 years of age, positive rates of Penicillium/Aspergillus fumigatus/Alternaria alternata and Sycamore showed an increasing trend with age (P < 0.05); no such trend was found in other inhalation allergy principles, and there were differences in positive levels of sycamore sensitization in different age groups (P < 0.05). Among the three age groups, the number of positive types of inhalant allergens in AD patients aged 6~12 years was higher than that in AD patients aged less than 6 years (F = 4.270, P < 0.05). In addition, the number of inhalant allergen positive types in patients with respiratory allergic diseases was higher than that in patients without respiratory allergic diseases (P < 0.01). Conclusion: The results of inhaled allergens in patients of different ages are similar and different: the allergens with the highest sensitivities in all ages grades were elm, Penicillium oryzae, Aspergillus fumigatus, and Sycamore. However, under the age of 18, the sensitization rate and the sensitization level of Penicillium/Aspergillus fumigatus/Alternaria alternaria and Sycamore may vary with age; there were also differences in the number of associated allergens in patients of different ages. In addition, it can be hypothesized that the higher the number of positive types of inhaled allergens in AD patients, the more likely they are to be associated with respiratory tract allergic diseases.
Keywords:Atopic Dermatitis, Inhalation Specific IgE, Age, Respiratory Allergic Disease
Copyright © 2020 by author(s) and Hans Publishers Inc.
This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).
http://creativecommons.org/licenses/by/4.0/
AD是最常见的炎症性皮肤病之一,影响15%至30%的儿童和2%至10%的成人。基于人群的研究表明,患有AD与其他特应性疾病的后续发展有关,因此预防该病及其相关的共患疾病十分重要 [
选取2015-09至2020-09在青岛大学附属医院诊断的活动期AD患者。入选标准是医生诊断的湿疹伴明显的瘙痒皮疹,至少需要局部外用皮质类固醇。所有受试者的排除标准包括在过去30天内口服皮质类固醇治疗;在过去6个月内接受全身免疫抑制治疗(包括硫唑嘌呤或环孢霉素A);除哮喘或湿疹外,对任何慢性炎症性疾病进行全身性皮质类固醇治疗;以及恶性肿瘤或涉及主要器官系统的任何严重疾病的存在或发展。
利用医渡云数据平台搜集研究对象的一般信息,包括年龄,性别等。根据病史资料记录的在采集静脉血样本12个月内发生的呼吸道过敏疾病史(主要包括哮喘,过敏性鼻炎),患者被分类为有无呼吸道过敏性疾病史两组。
对研究对象行血清吸入性特异性lgE抗体检测,酶联免疫法检测以下10种过敏原(尘螨、蟑螂、点青霉/烟曲霉/交链孢霉、梧桐、榆树、葎草、艾蒿、豚草、猫毛、狗上皮)。临床阳性判断参考WHO标准 [
采用IBMSPSS26.0软件进行统计学分析。计量资料:两组间均数比较采用独立样本t检验;多组间比较采用方差分析,事后比较采用LSD法进行校正。计数资料用频数表示,采用卡方检验比较组间差异。等级资料用频数(百分比)表示,采用秩和检验比较组间差异。
研究对象共409人,男性183人,女性226人,年龄 < 6岁的48人,6 ≤ 年龄 < 12岁的181人,≥12岁的180人,血清吸入性特异性lgE抗体检测阳性(包含弱阳性)的共375例,占总人数的百分比是93.05%,合并呼吸道过敏性疾病的有30例,占总人数的7.45%。合并1种过敏原阳性的133例(33.00%),合并2种阳性的0例,合并3种阳性的160例(39.70%),合并大于等于4种阳性的88例(21.84%)。
对<6岁、6~12岁、≥12岁3个年龄组的AD患者中每种过敏原阳性率进行描述分析:上述各年龄段阳性率最高的前三种过敏原均依次为榆树、点青霉/烟曲霉/交链孢霉、梧桐,阳性率最低的两组过敏原均依次为豚草、艾蒿。
卡方检验的结果表明不同年龄组间点青霉/烟曲霉/交链孢霉、梧桐的阳性率差异具有统计学意义(P = 0.045),且针对点青霉/烟曲霉/交链孢霉、梧桐,可认为6~12岁患者的阳性率高于≥12岁和<6岁的患者。进一步线性卡方检验结果的P值均大于0.05,尚不能认为随着年龄的增大,各过敏源的阳性率升高。见表1根据卡方检验的结果调整年龄划分及范围为≤6岁、7~12岁、13~18岁三组,再次进行线性卡方检验,结果18岁以下AD患者,点青霉/烟曲霉/交链孢霉和梧桐的阳性率随年龄呈上升趋势(P < 0.05),其余吸入性过敏原则未发现此趋势。见表2。
采用Kruskal-Wallis秩和检验对患者每种吸入性过敏原阳性等级和年龄的相关性分别进行分析,结果显示梧桐阳性等级在不同年龄段(<6岁、6~12岁、≥12)的差异具有统计学意义(P < 0.05)。其余过敏原无相关统计学差异(P > 0.05)。见表3。
采用方差分析研究表明<6岁、6~12岁、≥12三个年龄段的患者吸入性过敏原阳性种类数存在差异,进一步行LSD检验多重比较的结果表明6~12岁吸入性过敏原阳性种类数高于<6岁的患者(F = 4.270, P < 0.05)。见表4。
采用t检验分析有无合并呼吸道过敏性疾病的两组AD患者吸入性过敏原阳性种类数的相关性,t检验的结果表明有无合并呼吸道过敏性疾病与AD患者吸入性过敏原阳性种类数显著相关(p < 0.01),且合并呼吸道过敏性疾病患者的吸入性过敏源种类数高于未合并呼吸道过敏性疾病患者。见表5。
变量 | <6岁 (N = 48) | 6~12岁 (N = 181) | ≥12岁 (N = 180) | Pearson c2 | P值 | 线性c2 | P值 |
---|---|---|---|---|---|---|---|
尘螨 | 12 (25.00) | 53 (29.28) | 49 (27.22) | 0.414 | 0.813 | 0.001 | 0.973 |
蟑螂 | 12 (25.00) | 51 (28.18) | 45 (25.00) | 0.524 | 0.770 | 0.095 | 0.757 |
点青霉/烟曲霉/交链孢霉 | 12 (25.00) | 81 (44.75) | 71 (39.44) | 6.219 | 0.045* | 0.826 | 0.364 |
梧桐 | 12 (25.00) | 81 (44.75) | 71 (39.44) | 6.219 | 0.045* | 0.826 | 0.364 |
榆树 | 30 (62.50) | 117 (64.64) | 125 (69.44) | 1.326 | 0.515 | 1.257 | 0.262 |
葎草 | 5 (10.42) | 29 (16.02) | 19 (10.56) | 2.703 | 0.259 | 0.460 | 0.498 |
艾蒿 | 1 (2.08) | 16 (8.84) | 12 (6.67) | 2.717 | 0.257 | 0.220 | 0.639 |
豚草 | 5 (10.42) | 31 (17.13) | 23 (12.78) | 2.091 | 0.352 | 0.047 | 0.828 |
猫毛 | 6 (12.50) | 45 (24.86) | 31 (17.22) | 5.219 | 0.074 | 0.072 | 0.788 |
狗上皮 | 7 (14.58) | 49 (27.07) | 35 (19.44) | 4.883 | 0.087 | 0.058 | 0.809 |
表1. 不同年龄段AD患者各个吸入性过敏源lgE检测阳性率
*P < 0.05.
变量 | <6岁(N = 80) | 7~12岁(N = 172) | 13~18岁(N = 70) | 线性c2 | P值 |
---|---|---|---|---|---|
尘螨 | 20 (25.00) | 46 (26.74) | 21 (30.00) | 0.463 | 0.496 |
蟑螂 | 20 (25.00) | 44 (25.58) | 20 (28.57) | 0.235 | 0.628 |
点青霉/烟曲霉/交链孢霉 | 27 (33.75) | 72 (41.86) | 35 (50.00) | 4.054 | 0.044* |
梧桐 | 27 (33.75) | 72 (41.86) | 35 (50.00) | 4.054 | 0.044* |
---|---|---|---|---|---|
榆树 | 53 (66.25) | 111 (64.53) | 54 (77.14) | 1.839 | 0.175 |
葎草 | 11 (13.75) | 24 (13.95) | 8 (11.43) | 0.159 | 0.690 |
艾蒿 | 5 (6.25) | 16 (9.30) | 3 (4.29) | 0.152 | 0.697 |
豚草 | 11 (13.75) | 26 (15.12) | 9 (12.86) | 0.018 | 0.894 |
猫毛 | 16 (20.00) | 40 (23.26) | 11 (15.71) | 0.344 | 0.557 |
狗上皮 | 14 (17.50) | 52 (30.23) | 10 (14.29) | 0.099 | 0.753 |
表2. 不同年龄段AD患者吸入性过敏源lgE检测阳性率
*P < 0.015。
变量 | 分级 | <6岁 (N = 48) | 6~12岁 (N = 181) | ≥12岁 (N = 180) | Z值 | P值 |
---|---|---|---|---|---|---|
梧桐分级 | 阴性 | 36 (75.00) | 100 (55.25) | 109 (60.56) | 6.204 | 0.045* |
低 | 12 (25.00) | 81 (44.75) | 71 (39.44) | |||
中 | 0 (0.00) | 0 (0.00) | 0 (0.00) | |||
高 | 0 (0.00) | 0 (0.00) | 0 (0.00) | |||
很高 | 0 (0.00) | 0 (0.00) | 0 (0.00) | |||
极高 | 0 (0.00) | 0 (0.00) | 0 (0.00) |
表3. 不同年龄段AD患者的梧桐阳性等级
<6岁 (N = 48) | 6~12岁 (N = 181) | ≥12岁 (N = 180) | F值 | P值 | |
---|---|---|---|---|---|
过敏源种类数 | 2.13 ± 2.17 | 3.06 ± 2.13a | 2.67 ± 1.96 | 4.270 | 0.015 |
表4. 不同年龄段AD患者合并的吸入性过敏源种类数
未合并呼吸系统过敏性疾病 (N = 379) | 合并呼吸系统过敏性疾病 (N = 30) | t值 | P值 | |
---|---|---|---|---|
过敏源种类数 | 2.62 ± 1.93 | 4.73 ± 2.83 | −5.539 | 0.000** |
表5. 合并呼吸系统过敏性疾病和吸入性过敏原种类数的相关性分析
本研究中特应性皮炎患者合并吸入性过敏原阳性的比例为93.05%,在国内既往研究 [
本研究中特应性皮炎患者合并呼吸道过敏的比例为7.45%。本研究发现合并呼吸系统过敏性疾病的患者吸入性过敏原阳性种类数高于未合并呼吸系统过敏性疾病患者。我们可以推测AD患者合并吸入物过敏原阳性种类数越高,越可能合并呼吸系统道过敏性疾病。需要进一步的大样本及纵向研究。国外研究 [
综上所述,临床工作中对AD患者过敏原的管理要遵循一定的共性,同时也要分年龄段,动态监测及管理。本研究示榆树、点青霉/烟曲霉/交链孢霉、梧桐是与各个年龄段的活动期AD患者相关的重要过敏原;但18岁以下AD患者,点青霉/烟曲霉/交链孢霉、梧桐的阳性率随年龄呈上升趋势,二者的阳性等级在不同年龄阶段也存在差异,不同年龄阶段的患者合并的过敏原种类数也有差异;此外AD患者合并吸入物过敏原阳性种类数多少可考虑作为合并呼吸道过敏性疾病的预测因子之一。本研究样本量较小,且研究对象多位于胶东地区,期待未来大样本及更大范围人群的研究为临床提供更准确的参考。
该研究已取得相应的伦理许可。
崔文君,黄福倩,王莹莹,李秀芳. 特应性皮炎患者吸入性特异性lgE与年龄、呼吸道过敏性疾病的相关性Correlation of Inhalation-Specific lgE with Age Grades and Respiratory Irritability in Patients with Atopic Dermatitis[J]. 临床医学进展, 2020, 10(11): 2660-2666. https://doi.org/10.12677/ACM.2020.1011405