目的 研究深圳地区尘螨所致变应性鼻炎和哮喘儿童的屋尘螨组分分布特征,分析屋尘螨组分在儿童变应性鼻炎和哮喘诊治中的临床意义.方法 本研究为横断面研究,通过收集2021-2024年就诊于深圳市儿童医院过敏门诊由尘螨诱发的变应性鼻炎和哮喘儿童的临床资料,以及采用磁珠化学发光法对患儿血清屋尘螨、粉尘螨(Derp、Derf)和屋尘螨组分(Der p 1、Der p 2、Derp 10、Derp23)的sIgE水平进行检测,探讨屋尘螨组分与患儿临床资料的相关性.将患儿根据诊断分为变应性鼻炎(AR)组和AR合并哮喘(ARAS)组,根据年龄分为学龄前期(5岁≤ 年龄＜7岁)、学龄期(7岁≤年龄＜10岁)和青春期(10岁≤年龄≤15岁).比较屋尘螨组分在AR组和ARAS组以及不同年龄分组中的表达差异.结果 共314例尘螨所致变应性鼻炎和哮喘儿童纳入研究,其中男/女分别为222/92例,AR/ARAS分别为188/126例,年龄范围5～15岁、中位数年龄7.54岁、平均(8.02±2.24)岁,体重指数(BMI)范围 13.89～31.76 kg/m2、中位数 15.87 kg/m2、平均(16.55±3.05)kg/m2;AR组与 ARAS组患儿在性别、年龄、BMI、血嗜酸性粒细胞、血嗜碱性粒细胞、FeNO、FVC、FEV1上的差异无统计学意义(P＞0.05),在FEV1/FVC和小气道功能指标MMEF、MEF75％、MEF50％、MEF25％上的差异有统计学意义(P＜0.05).在314例患儿中,屋尘螨组分致敏率由高到低依次为Der p 1(97.1％)、Derp 2(89.8％)、Der p 23(55.1％)、Der p 10(8.6％),阳性率差异有统计学意义(x2=658.31,P＜0.001).屋尘螨组分 Derp 1、Der p 2、Der p 10在学龄前期、学龄期和青春期的阳性率差异无统计学意义(P＞0.05);Der p 23在学龄前期、学龄期和青春期的阳性率差异有统计学意义(x2=7.29,P=0.03).相关性分析发现Derp、Derf、Der p 1、Der p 2之间具有高度正相关性(P＜0.001);嗜酸性粒细胞与Der p、Der f、Der p 1、Der p 2、Der p 10、Der p 23具有正相关性(P＜0.001);FeNO与Der p、Der f、Derp 23具有正相关性(P＜0.05);小气道功能指标MMEF、MEF50％、MEF25％与 Der p、Der f、Der p 1 具有负相关性(P＜0.05).AR组患儿Der p、Der f、Der p 1、Derp2、Der p 10 的 sIgE 水平显著低于 ARAS 组患儿(P＜0.05).在 ARAS 组,有 120 例(95.24％)患儿出现≥2种屋尘螨组分阳性,有71例(56.35％)患儿出现≥3种屋尘螨组分阳性;在AR组,有171例(90.96％)患儿出现≥2种屋尘螨组分阳性,有94例(50.00％)患儿出现≥3种屋尘螨组分阳性.结论 Derp 1、Derp 2和Der p 23可能是深圳地区诱发AR和ARAS的主要屋尘螨过敏原组分.屋尘螨组分sIgE水平的升高会加重下气道嗜酸性炎症的严重程度和气道的阻塞情况.对于尘螨特异性免疫治疗疗效不佳的患儿需注意完善屋尘螨组分检测.
A clinical analysis on the distribution characteristics of dermatophagoides pteronyssinus allergen components among children with allergic rhinitis and asthma in a hospital of pediatric in Shenzhen City from 2021 to 2024
Objective To investigate the distribution characteristics and analyze the clinical significance of dermatophagoides pteronyssinus allergen components in children with allergic rhinitis and asthma in Shenzhen.Methods This study was a cross-sectional study.The clinical data of children with allergic rhinitis and asthma induced by dust mites admitted to the allergy clinic of Shenzhen Children's Hospital from 2021 to 2024 were collected and the serum sIgE levels of dermatophagoides pteronyssinus,dermatophagoides farinae(Der p,Der f)and dermatophagoides pteronyssinus components(Der p 1,Der p 2,Der p 10,Der p 23)were detected by magnetic bead chemiluminescence method.The correlation between dermatophagoides pteronyssinus allergen components and clinical data of children was analyzed.According to the diagnosis,the children were divided into allergic rhinitis(AR)group and AR with asthma(ARAS)group.According to the age,the children were divided into preschool age(5 years ≤age＜7 years),school age(7 years ≤age＜10 years)and adolescence(10 years ≤age≤15 years).The expression differences of dermatophagoides pteronyssinus components among AR group and ARAS group and different age groups were compared.Results A total of 314 children with allergic rhinitis and asthma caused by dust mites were included in the study,of whom 112 were male and 202 were female.There were 188 cases of AR and 126 cases of ARAS,aged 5-15 years,with a median age of 7.54 years and an average age of(8.02±2.24)years.BMI was 13.89-31.76 kg/m2,the median BMI was 15.87 kg/m2 and average BMI was(16.55±3.05)kg/m2.There was not statistically significant difference in gender,age,BMI,blood eosinophils,blood basophils,FeNO,FVC and FEV1 between the AR group and the ARAS group(P＞0.05).There was significant difference in FEV1/FVC and small airway function indexes MMEF,MEF75％,MEF50％and MEF25％between the AR group and the ARAS group(P＜0.05).In the 314 children,the dermatophagoides pteronyssinus allergen components sensitization rates were in the order of Der p 1(97.1％),Der p 2(89.8％),Der p 23(55.1％),Der p 10(8.6％),and the difference in the positive rate was statistically significant(x2=658.31,P＜0.001).There was not significant difference in Der p 1,Der p 2 and Der p 10 among children of different ages(P＞0.05).There was significant difference in Der p 23 among children of different ages(x2=7.29,P=0.03).A correlation analysis showed that Der p,Der f,Der p 1 and Der p 2 had a high positive correlation(P＜0.001).Eosinophils are positively correlated with Der p,Der f,Der p 1,Der p 2,Der p 10 and Der p 23(P＜0.001).FeNO is positively correlated with Der p,Der f,and Der p 23(P＜0.05).Small airway function indicators MMEF,MEF50％and MEF25％are negatively correlated with Der p,Der f and Der p 1(P＜0.05).The sIgE levels of Der p,Der f,Der p 1,Der p 2 and Der p 10 in the AR group were significantly lower than those in the ARAS group(P＜0.05).In the ARAS group,120 cases(95.24％)showed positive results for at least 2 dermatophagoides pteronyssinus components,while 71 cases(56.35％)showed positive results for at least 3 dermatophagoides pteronyssinus components.In the AR group,171 cases(90.96％)showed positive results for at least 2 dermatophagoides pteronyssinus components,while 94 cases(50.00％)showed positive results for at least 3 dermatophagoides pteronyssinus components.Conclusion Der p 1,Der p 2 and Der p 23 may be the main dermatophagoides pteronyssinus allergen components that induce allergic rhinitis and asthma in Shenzhen City.The elevation of sIgE levels in the dermatophagoides pteronyssinus components can aggravate the severity of lower airway eosinophilic inflammation and airway obstruction.Attention should be paid to the detection of dermatophagoides pteronyssinus components in children with poor response to dust mite-allergen specific immunotherapy.
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