重庆地区变态反应性疾病患者的变应原特征分析

Features of allergens in patients with allergic diseases in Chongqing，China

摘要:

目的：分析重庆地区变态反应性疾病患者吸入性变应原谱特点，进一步优选皮肤点刺试验（skin prick test，SPT）吸入性变应原的数目和种类。方法：对2014年9月至2016年8月于重庆市人民医院变态反应科就诊的2305例可疑变态反应性疾病患者行SPT，分析其结果。根据年龄、季节分层，描述吸入性变应原的分布特征，进一步优选SPT的变应原组合，使其可以检测≥95%的变应原阳性患者。结果：①2305例患者阳性数1672例，总阳性率为72.54%。SPT检测阳性率前6位的变应原依次为：粉尘螨（62.00%）、屋尘螨（58.61%）、蟑螂（28.81%）、猫毛（14.62%）、葎草（14.45%）、艾蒿（14.27%）。吸入性变应原阳性级别（+++）及以上的患者中，粉尘螨和户尘螨分别占两者的77.75%和76.24%，明显高于其他变应原。②不同季节变应原总阳性率（春季67.81%，夏季72.63%，秋季78.78%，冬季72.09%）差异有统计学意义（χ2=17.741，P=0.000）。尘螨阳性率与吸入性变应原总阳性率季节变化趋势相似。③不同年龄段变应原总阳性率（~17岁组为82.31%，18~39岁组为73.78%，40~59岁组为64.77%，60~岁组为54.97%）差异有统计学意义（χ2=65.456，P=0.000）。随着年龄增加吸入性变应原阳性率降低。④4个吸入性变应原（粉尘螨、蟑螂、屋尘螨、葎草）的SPT可以检测重庆地区可疑变态反应性疾病患者中≥95%的变应原阳性患者。结论：重庆地区变态反应性疾病最主要的吸入性变应原为粉尘螨和屋尘螨。吸入性变应原阳性率受季节、年龄的影响并存在一定的规律。4个吸入性变应原可以检测绝大多数吸入性变应原阳性患者，可以作为重庆地区变态反应性疾病吸入性变应原流行病学调查经济有效的变应原组。

Abstract:

Objective：To investigate the features of inhaled allergens in patients with allergic diseases in Chongqing，China，and to optimize the number and type of inhaled allergens used for skin prick test（SPT）. Methods：SPT was performed for 2305 patients sus－pected of having allergic diseases who visited Department of Allergy in Chongqing People’s Hospital from September 2014 to August 2016，and their results were analyzed. The distribution characteristics of inhaled allergens were described according to age and season，and then the combination of allergens for SPT was optimized to cover at least 95% of patients with positive allergens. Results：Of all 2 305 patients，1 672（72.54%） had at least one positive skin prick reaction. The six most common allergens identified by SPT were Dermatophagoides farina（62.00%），Dermatophagoides pteronyssinus（58.61%），cockroach（28.81%），cat hair（14.62%），Humulus （14.45%），and mugwort（14.27%）. Among the patients with grade（+++） positive inhaled allergens or above，Dermatophagoides farina had a positive rate of 77.75% and Dermatophagoides pteronyssinus had a positive rate of 76.24%，which were significantly higher than the positive rate of other allergens. The overall positive rate of allergens was 67.81% in spring，72.63% in summer，78.78% in autumn，and 72.09% in winter，and there was a significant difference between seasons（χ2=17.741，P=0.000）. The positive rate of dust mite showed a similar seasonal change trend as the overall pos－itive rate of allergens. The patients aged ≤17 years，18-39 years，40-59 years，and ≥60 years had overall positive rates of aller－gens of 82.31%，73.78%，64.77%，and 54.97%，respectively，and there was a significant difference between these age groups（χ2=65.456，P=0.000）；the positive rate of inhaled allergens decreased with the increase in age. SPT with four inhaled aller－gens（Dermatophagoides farina，cockroach，Dermatophagoides pteronyssinus，and Humulus） was sufficient to identify ≥95% patients with positive allergens among the patients with suspected allergic diseases in Chongqing. Conclusion：Dermatophagoides farina and Dermatophagoides pteronyssinus are the most common inhaled allergens in patients with allergic diseases in Chongqing. The positive rate of inhaled allergens is affected by age and season and shows a certain trend. SPT with four inhaled allergens can identify most patients with positive inhaled allergens and can be used as the economic and effective allergen combination for the epidemiological survey of inhaled allergens in patients with allergic diseases in Chongqing.