变应性鼻炎患者鼻与下气道炎症的相关性分析

The Correlation of Inflammation in Nose and Lower Airway of Patients with AR

摘要: 目的：评估变应性鼻炎(allergic rhinitis, AR)患者鼻与下气道炎症水平，探讨AR患者鼻与下气道炎症的相关性。方法：随机选取于2007年1月至2012年12月来南京军区南京总医院就诊的鼻炎患者，经变应原皮肤点刺试验(skin-prick test SPT)阳性诊断为AR 377例。采用统一的调查表采集患者一般资料；检测鼻分泌物涂片、鼻激发、鼻灌洗嗜酸细胞(EOS)计数，口呼出气一氧化氮(FeNO)、诱导痰EOS计数、支气管激发等炎症相关生物指标。结果：AR患者鼻激发阳性率61.73%，鼻灌洗EOS阳性率57.18%，鼻分泌物涂片EOS阳性79.01%；诱导痰EOS阳性率43.71%，支气管激发阳性率12.20%，FeNO值阳性率56.30%。鼻分泌物涂片和鼻灌洗EOS存相关性(r = 0.369, p < 0.000)，鼻分泌物涂片与诱导痰EOS (r = 0.185, p = 0.020)，鼻灌洗EOS与FeNO相关性(r = 0.273, p < 0.000)，鼻灌洗与诱导痰相关(r = 0.358, p < 0.000)，FeNO与支气管激发存在相关(r = 0.203, p = 0.001)，诱导痰EOS与FeNO值相关(r = 0.337, p < 0.000)。结论：无下气道症状的AR患者在鼻与下气道存在EOS炎症，且EOS炎症在鼻与下气道存在相关性，鼻灌洗EOS或鼻分泌物涂片EOS检查可以观测AR患者下气道炎症，也可以作为下气道炎症评估和疗效追踪的有效指标。

Abstract: Objective: Investigate inflammation in nose and lower airway of patients with AR and to explore the correlation of inflammation in nose and lower airway. Methods: From Jan. 2007 to Dec. 2012, 377 AR were collected according to results of SPT. General information of all patients was collected with uniform questionnaire. Eosinophil (EOS) counts of blood, nasal lavage fluid and induced sputum, nasal secretions smear, nasal or bronchial provocation were performed. Results: 61.73% AR nasal proocation was positive, 57.18% and 79.01% AR nasal lavage and nasal secretion smear EOS was increased. 43.71% AR Induced sputum EOS was increased, bronchial provocation and FeNO positive rate was 12.20% and 56.30%. There was correlation between nasal secretion smear EOS and nasal lavage EOS (r = 0.369, p < 0.000), between the nasal secretion smear and sputum induction EOS (r = 0.185, p = 0.020), between the nasal secretion smear EOS and FeNO (r = 0.273, p < 0.000), between the nasal lavage EOS and induced sputum EOS (r = 0.358, p < 0.000), between FeNO and bronchial excitation (r = 0.203, p = 0.001), between the induced sputum EOS and FeNO (r = 0.337, p < 0.000). Conclusion: Lower airway inflammation exists in AR. There was correlation between nose and lower airway. The nasal lavage EOS and nasal secretion smear examination may be indicators to observe lower airway inflammation and evaluate curative effect in AR.