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目的了解广州城市青少年特应性的流行情况,探讨特应性与支气管哮喘(简称哮喘)的关系,明确主要的吸入性变应原。方法 2002年4至5月在广州市参加儿童哮喘和变应性疾病的国际性对比研究(简称 ISAAC)第三阶段调查的10所学校学生中,每所学校以班级为单位进行随机整群抽样调查。采用5组9种吸人性变应原(屋尘螨、粉尘螨、猫毛、美洲大镰、德国小镰、混合草花粉、混合树木花粉、链格孢属真菌、混合霉菌)对1187名学生进行皮肤点刺试验。哮喘定义为:既往或近12个月胸部有喘息声、胸闷或曾被医生诊断为哮喘,有哮喘、鼻炎、湿疹中的任1种疾病视为有变应性疾病史。变应原皮试反应的风团直径大于阴性对照3 mm 以上为阳性,有1个或以上变应原反应阳性视为特应性。特应性程度及变应原阳性反应强度分别以特应性指数(AI)及皮肤指数(SI)分级表示。结果随机抽取1543人参加调查,实际应答率为77.0%(1187/1543),其中男性为51.6%(613/1187),女性为48.4%(574/1187),年龄12～17岁(中位数14岁)。哮喘的患病率为9.4%(111/1187),其中合并鼻炎率为81.1%(90/111),合并湿疹率为24.3%(27/111)。686例有鼻炎史患者合并哮喘率为[13.1%(90/686)],高于无鼻炎史者[4.2%(21/501),OR 值为3.444,95%可信区间(CI)为2.110～5.622,P<0.01];200例有湿疹史患者合并哮喘率为[13.5%(27/200)],也高于无湿疹史者[8.5%(84/987),OR 值为1.676,95%CI 为1.055～2.663,P<0.05]。特应性阳性率为46.3%(549/1187),其中尘螨(屋尘螨、粉尘螨)皮试反应阳性率最高[分别为41.8%(496/1187)、42.7%(507/1187)]。哮喘患者特应性阳性率为[71.2%(79/111)],高于无变应性疾病者[26.4%(112/425),OR 值为6.812,95%CI 为4.276～10.853,P<0.01],且随着合并其他疾病种类的增加而升高。与特应性阴性者比较,特应性阳性是哮喘的危险因素(OR 值为3.183,95%CI 为2.075～4.883,P<0.01),且哮喘的患病风险随着特应性程度的增加而升高。单因素 Logistic 回归分析结果表明,哮喘的危险因素有屋尘螨(SI≥2)、粉尘螨(SI=3～4)、美洲大蠊、德国小蠊、猫毛、链格孢属、混合草花粉。多因素 Logistic 回归分析结果表明,屋尘螨(SI=3～4)、链格孢属阳性仍是哮喘独立的危险因素。结论广州城市青少年哮喘患者大多属尘螨变应性的,哮喘的患病风险随着特应性程度及屋尘螨皮试反应强度增加而升高。
Objective To understand the prevalence of atopy in urban adolescents in Guangzhou and to explore the relationship between atopy and bronchial asthma (asthma) and to identify the major inhaled allergens. Methods From April to May 2002 in Guangzhou, 10 schoolchildren who participated in the third phase of international comparative study on childhood asthma and allergic diseases (referred to as ISAAC), each school conducted a random cluster sampling survey. A total of 1187 students were enrolled in this study using 5 groups of 9 inhalable allergens (house dust mites, dust mites, cat hair, American Sickle, German sickle, mixed grass pollen, mixed tree pollen, Alternaria fungi, Skin prick test. Asthma is defined as: past or nearly 12 months have chest breathing, chest tightness or have been diagnosed as asthma by a doctor, asthma, rhinitis, eczema in any one of the diseases as a history of allergic diseases. Allergen skin test reaction wind group diameter larger than the negative control 3 mm above is positive, with 1 or more allergen positive reaction as atopic. The degree of atopy and allergen positive reaction intensity were respectively graded by atopy (AI) and skin index (SI). Results A total of 1543 people were randomly selected to participate in the survey. The actual response rate was 77.0% (1187/1543), of which 51.6% (613/1187) were male and 48.4% (574/1187) women, aged 12-17 years (median 14 years old). The prevalence of asthma was 9.4% (111/1187), with rhinitis combined with 81.1% (90/111) and eczema with 24.3% (27/111). The incidence of asthma in 686 patients with rhinitis was 13.1% (90/686), higher than those without rhinitis (4.2%, 21/501), OR was 3.444, 95% confidence interval (CI) was 2.110 ~ 5.622, P <0.01]. The incidence of asthma in 200 patients with history of eczema was 13.5% (27/200) and higher than those with no history of eczema (8.5%, 84.798, OR = 1.676, 95 % CI was 1.055 ~ 2.663, P <0.05]. The positive rate of atopy was 46.3% (549/1187), of which the highest positive rates of skin tests were dust mites (house dust mite and dust mite) [41.8% (496/1187) and 42.7% (507/1187], respectively] . The positive rate of atopic asthma was 71.2% (79/111), higher than that of those without allergic disease (26.4%, 112/425), OR was 6.812, and the 95% CI was 4.276-10.853 (P < 0.01], and increased with the increase of other disease types. Compared with atopic subjects, atopy positives were risk factors of asthma (OR = 3.183, 95% CI: 2.075-4.883, P <0.01), and the risk of asthma increased with the degree of atopy And rise. Logistic regression analysis showed that the risk factors of asthma were house dust mite (SI ≥2), dust mite (SI = 3-4), American cockroach, German cockroach, cat hair, Alternaria, mixed grass pollen. Multivariate logistic regression analysis showed that house dust mite (SI = 3-4) and Alternaria positive were still the independent risk factors of asthma. Conclusion Most urban asthma patients in Guangzhou are dust mite allergy. The risk of asthma is increased with the increase of the degree of atopy and the reaction intensity of house dust mite test.