儿童过敏性结膜炎与变应性鼻炎的相关性及鼻眼联合防治效果分析

目的：探讨儿童过敏性结膜炎与变应性鼻炎的相关性研究及鼻眼联合防治的临床效果。方法：回顾性分析300 例儿童过敏性 结膜炎与310 例儿童变应性鼻炎患者的临床资料,对儿童过敏性结膜炎与变应性鼻炎的相关性进行分析后将所有患儿随机均分 为对照组与观察组,对照组采用常规点眼的方法进行治疗,观察组则采用鼻朗喷鼻联合人工泪液点眼进行治疗。比较两组临床疗 效及不良反应情况。结果：（1）300 例过敏性结膜炎患儿中,50 例（16.67%）并发变应性鼻炎;310 例变应性鼻炎患儿中,59 例 （19.03%）并发过敏性结膜炎（P＞0.05）;（2）109 例同时并发两种疾病患儿中,均进行眼结膜与鼻粘膜的刮片检查嗜酸性粒细胞, 其中60 例（55.05%）结膜刮片与67 例（61.47%）鼻粘膜刮片检测到嗜酸性粒细胞（P＞0.05）;（3）两组治疗前后BUT 及角膜荧光素 染色评分、症状评分、临床总有效率比较差异明显（P＜0.05）。结论：儿童过敏性结膜炎与变应性鼻炎具有一定的相关性;鼻朗喷鼻 联合人工泪液点眼治疗儿童合并变应性鼻炎的临床疗效显著。     

季节因素对过敏性结膜炎就诊及用药的影响研究

目的:探讨过敏性结膜炎(AC)与抗过敏滴眼液用量间的关系,并分析季节因素对其产生的影响。方法:采用重力沉降法于2015年全年对北京城区主要气传花粉浓度进行监测,统计2015年我院变态反应科门诊AC就诊诊次及三种主要抗过敏滴眼液处方量,并采用Spearman相关性分析AC就诊诊次与抗过敏滴眼液用量间的关系。结果:2015年全年共监测花粉76164颗,花粉分布呈现春秋两季高峰,花粉分布最高的月份为4月(34.84%),其次为3月(29.72%),5月(10.87%),9月(10.52%),8月(9.94%);花粉分布最少的月份为1月和11月(0.11%)。春季花粉高峰期(3-5月份)月平均花粉数量为19150颗,秋季花粉高峰期(8-9月份)月平均花粉数量为7792颗,秋季花粉高峰期月平均花粉数量低于春季。2015年我院变态反应科AC月平均就诊诊次为(80.42±54.28)人次,8月份AC诊次最高,占全年的18.03%,其次为9月份(16.99%)、4月份(13.99%)、3月份(12.54%)、5月份(7.98%)。抗过敏滴眼液月平均用量为(148.67±148.63)瓶,8月份抗过敏滴眼液用量最高,占全年的28.25%,其次为3月份(17.21%)、9月份(14.18%)、4月份(13.11%)、5月份(8.30%),AC就诊次数及抗过敏滴眼液处方量均呈现春秋季节高峰。Spearman相关性分析显示,每月花粉量与AC就诊诊次、抗过敏滴眼液用量呈正相关(r=0.806,0.830,P=0.000,0.000),AC就诊诊次与抗过敏滴眼液用量呈正相关(r=0.923,P=0.000)。结论:花粉分布、AC诊次及抗过敏滴眼液用量均出现春秋季节高峰。秋季花粉致敏性高于春季花粉,用药及AC就诊最高峰均出现在秋季。     

厦门地区过敏性疾病儿童过敏原分析

目的:调查厦门地区儿童常见过敏性疾病的致病情况及过敏原,为临床防治提供依据。方法:利用免疫印迹法半定量检测患儿血清中的过敏原特异性Ig E抗体,对其分布情况进行分析。结果:厦门地区最常见过敏性疾病为哮喘,393例患儿总阳性率为89.3%,吸入性过敏原前三位是尘螨组合、蟑螂和狗上皮;食物性过敏原前三位是花生、牛奶和鸡蛋白。婴幼儿组食物过敏原阳性率高于吸入过敏原,且学龄前组与婴幼儿组相比,食物过敏原阳性率下降,吸入过敏原阳性率上升,吸入性+食物性过敏原在各个年龄段均占最大比重。大多数患儿同时具有多种混合过敏原阳性,7种及以上的占22.4%。结论:通过检测血清中的过敏原特异性Ig E抗体,可以帮助临床合理寻找相应过敏原,为儿童过敏性疾病的预防、诊断和治疗提供依据。     

儿童过敏性紫癜30 例临床分析

目的：探讨儿童过敏性紫癜〈HSP）的临床特点。方法：对30例过敏性紫癜患儿的发病特点、临床表现、预后进行分析。结果：①诱因：感染进食特殊食物、接种疫苗。②有消化道症状者中以腹痛为最常见。其中4例被误诊为急性阑尾炎、肠套叠、上消化道出血、急性细菌性痢疾。⑤有肾脏受累者挖例。其中12例同时存在消化道症状③预后：28例治愈好转,占93．33％,1例于2年后再次发病。结论：①HSP患病率有逐年升高趋势。发病诱因以感染为第一位。患者中可表现较多的肾外症状,较易发生肾功能损害,及时诊断与治疗十分重要。     

儿童过敏性紫癜的临床特点及其肾损害的相关因素分析

摘要目的：总结儿童过敏性紫癜的临床特点,并分析其肾损害的相关因素。方法：选择2006年2月~2012年8月我院小儿科诊治的过敏性紫癜患儿86例,根据是否伴有肾脏损害分为观察组（34例）和对照组（52例）,分析两组患者的一般临床资料,总结儿童过敏性紫癜的临床特点,并探讨导致儿童过敏性紫癜并发肾损害的相关因素。结果：（1）儿童过敏性紫癜的诱因包括感染、过敏、疫苗接种、寄生虫病史及其它原因,其中感染比例最高,占66．28％;首发症状包括紫癜、腹痛及关节痛的一种或多种,其中紫癜比例最高,占59．30％。（2）观察组患儿中年龄≥8Y、皮疹反复≥4w及血FIB升高的比例分别为73．53％（25／34）、52．94％（18／34）和26．47％（9／34）,均显著高于对照组患儿（P〈0．05）,非条件Logistic多元回归分析结果示皮疹反复≥4W及血FⅢ升高为过敏性紫癜患儿发生肾脏损伤的危险因素。结论：儿童过敏性紫癜的主要诱因为感染,典型临床表现为紫癜,皮疹反复芝4w及血FIB升高为过敏性紫癜患儿发生肾脏损伤的危险因素。     

儿童过敏性紫癜发病的危险因素研究

为了探讨儿童过敏性紫癜发病的危险因素,本研究选取了2015年7月至2017年6月在本院治疗的过敏性紫癜患儿118例作为观察组研究对象,同时选取健康正常儿童120例作为对照组,调查分析两组微生物感染、食物过敏、药物过敏史等资料,同时观察治疗疗效。研究显示,观察组的幽门螺杆菌(Hp)、肺炎支原体、链球菌感染率和螨虫阳性率分别为61.02%、16.10%、10.17%和13.56%,明显高于对照组(p<0.05);观察组对牛奶、鸡蛋、虾过敏的比例分别为9.32%、11.02%和8.47%,明显高于对照组(p<0.05);观察组有药物过敏史、家中饲养猫、狗等动物、家中近3个月装修的比例为22.88%、45.76%和17.80%,明显高于对照组(p<0.05);Logistic回归分析显示,Hp感染是发生过敏性紫癜的危险因素(OR=1.613, p<0.05);Hp感染和无Hp感染患者治疗疗效差异比较无统计学意义(p>0.05)。本研究表明,Hp感染可能是儿童过敏性紫癜发生的影响因素,但Hp感染对治疗疗效无明显影响。     

盐城地区未成年过敏性疾病患者吸入性过敏原IgE检测结果分析

摘要 目的：通过研究分析盐城地区未成年过敏性疾病患者吸入性过敏原特异性IgE检测结果分布变化特点,为过敏性疾病预防和临床诊疗提供科学依据。方法：自2020年1月至2021年3月期间,选择430例未成年(<18岁)过敏性疾病患者,血清检测方法采用欧蒙公司生产的过敏原特异性IgE检测试剂盒。结果：430例患者中,血清过敏原IgE阳性166例(38.60%),其中尘螨和屋尘是主要的吸入性过敏原。血清IgE阳性率男性39%,女性36% (P>0.05),中学组女性阳性率（61.11 %）高于男性（45.83 %）（P<0.05）。不同年龄组间IgE阳性率有统计学差异（P<0.05）,蟑螂、尘螨、霉菌、豚草、屋尘和年龄组间有统计学差异（P<0.05）。不同临床症状与IgE阳性率有统计学差异(P<0.05),其中呼吸道过敏症状组IgE阳性率最高（48.30 %）,不同症状组间主要过敏原都是尘螨。屋尘阳性患者均合并尘螨阳性,其中70.93 %的患者表现出了呼吸道过敏症状。结论：尘螨、屋尘是盐城地区未成年过敏性疾病患者最主要的吸入性过敏原,研究血清过敏原分布,对未成年人过敏性疾病的预防、诊疗具有重要意义。     

西替利嗪联合卡介菌多糖核酸对儿童过敏性紫癜的临床疗效分析

目的:观察分析西替利嗪联合卡介菌多糖核酸对儿童过敏性紫癜的临床疗效.方法:将我院从2010年1月至2011年10月我院收治的144例儿童过敏性紫癜患者随机平均分为对照组72例,应用以西替利嗪为主的常规治疗,实验组72例在对照组基础上加用卡介菌多糖核酸,治疗持续3周.检测对比治疗前后患者抗体水平,并统计计算治疗有效率;随访6个月,统计复发情况.结果:两组治疗前后血清T细胞和抗体、补体水平变化结果显示,治疗前组间差异无统计学意义(P＞0.05);治疗后,实验组CD3、CD4和CD16+56上升程度大于对照组,CD8、CD19、IgA和C3、C4下降程度大于对照组,组间差异有统计学意义(P＜0.05);对照组复发率为11.8％(8/68),治疗满意度为85.3％;实验组复发率为5.7％(4/70),治疗满意度为92.9％,组间差异有统计学意义(P＜0.05);对照组痊愈32例,显效25例,好转7例,无效4例,治疗有效率为83.8％;实验组痊愈39例,显效27例,好转3例,无效1例,治疗有效率94.3％,组间差异有统计学意义(P＜0.05).结论:西替利嗪联合卡介菌多糖核酸能有效治疗儿童过敏性紫癜,安全高效,值得推广应用.     

儿童过敏性紫癜外周血血小板参数及D-二聚体水平变化

目的:探讨外周血血小板参数及D-二聚体水平在儿童过敏性紫癜(Henoch-Schonlein purpura,HSP)的变化及临床意义.方法:选择2010年6月至2012年5月间青岛大学医学院附属医院儿科住院过敏性紫癜患儿137例为研究对象,儿童保健科健康查体儿童50例为对照组.血小板参数包括血小板计数(PLT)、平均血小板体积(MPV)、血小板压积(PCT)、血小板体积分布宽度(PDW),采用XE-2100全血细胞分析仪、电阻抗法检测;血浆D-二聚体采用胶乳比浊法检测.结果:与对照组比较,HSP患儿急性期外周血PLT、PCT显著升高(P＜0.05),而MPV显著降低(P＜0.05),PDW无显著差异(P＞0.05);有无胃肠道出血HSP组间和有无肾脏受损HSP组间血小板参数并无显著性差异(p＞0.05).84例(61.3％)HSP患儿急性期血浆D-二聚体水平增高,其绝对浓度(中位数)为435 ng/ml,显著高于正常水平(0-300 ng/ml);不同HSP临床表型组间血D-二聚体异常率和绝对浓度均无显著性差异(X2=2.75,P＞0.05;H=3.37,P＞0.05);合并胃肠道出血组与无消化道出血组比较HSP病儿血浆D-二聚体水平显著升高(Z=-2.691,P＜0.05);合并肾损害与无肾损害组比较HSP病儿血浆D-二聚体水平显著降低(Z=-4.063,P＜0.05).结论:HSP患儿急性期血液处于高凝及继发的纤溶状态,早期检测血小板参数及D-二聚体变化水平,指导临床诊断及临床用药.     

儿童过敏性紫癜早期肾损伤中VCAM-1的临床意义

目的：探讨血管细胞粘附分子-1（VCAM-1）的检测在儿童过敏性紫癜（AP）早期肾损伤中的临床意义。方法：选择明确诊断为AP 患儿85 例,均为早期无肾损害的AP病儿。根据第七版诸福棠实用儿科学有关章节的诊断标准和随访结果,进一步将研究对象分为有肾损害AP 为APN 组,无肾损害AP为AP 组,于同时间、同群体中选择健康儿童35 名为对照组。应用ELISA 法分别检测三组患儿早期无肾损害时血VCAM-1 的含量,分析血VCAM-1在儿童过敏性紫癜早期肾损伤中的临床意义。结果：APN 组血VCAM-1 水平均高于AP组和正常对照组;AP 组亦高于正常对照组,差异均有统计学意义（P〈0.01）。结论：对早期无肾损害的AP病儿,检测血浆VCAM-1 对AP发生APN 的预后诊断有重要的临床意义。     

Treatment with FTY720 during the induction or effector phase suppresses the development of experimental allergic conjunctivitis in mice

Purpose

To investigate whether experimental allergic conjunctivitis (EC) can be suppressed by treatment with the immunomodulatory drug FTY720, which reduces the recruitment of effector T cells into inflammatory sites.

Methods

BALB/c mice were actively immunized with ragweed (RW) and then injected intraperitoneally with FTY720 on days 0, 2, 4, 6 and 8 (induction phase treatment) followed by challenge on day 10 with RW-containing eye drops. Alternatively, naïve mice that received RW-primed splenocytes were injected intraperitoneally with FTY720 on days 2 and 4 (effector phase treatment) followed by RW challenge on day 4. Twenty-four hours after RW challenge, conjunctivas and spleens were harvested for histology or immunohistochemistry, and flow cytometric analysis or cytokine assays, respectively.

Results

FTY720 treatment during the induction phase suppressed the conjunctival infiltration of T cells as well as eosinophils and macrophages. The splenocytes from induction phase-treated mice contained significantly less CD4⁺ and CD8⁺ T cells and showed significant suppression of Th2 but not Th1 cytokine production. Effector phase treatment with FTY720 suppressed conjunctival eosinophil infiltration.

Conclusions

These data demonstrate that FTY720 treatment during the induction phase decreases the absolute number of CD4⁺ and CD8⁺ T cells in the spleen and suppresses Th2 cytokine production by splenocytes. This leads to the suppression of EC. FTY720 treatment also suppresses EC when delivered during the effector phase. Thus, FTY720 treatment may be suitable for treating severe forms of vernal keratoconjunctivitis.     

益生菌对儿童变应性鼻炎的辅助治疗作用

探讨益生菌对儿童变应性鼻炎（AR）的辅助治疗作用,为该类患儿的治疗提供参考。

纳入我院耳鼻喉科2021年9月至2022年6月确诊为AR的62例患儿作为研究对象,随机选取37例作为AR组,另纳入40例健康儿童作为健康组,分别收集两组对象粪便进行高通量测序。将62例AR患儿进一步分为对照组和益生菌组,各31例。对照组患儿给予糠酸莫米松喷鼻治疗,益生菌组患儿在此基础上加用双歧杆菌四联活菌片。监测治疗期间两组患儿肠道主要菌群的变化并对治疗前后患儿临床症状进行评分。建立AR大鼠模型,验证益生菌对AR的治疗效果。

AR组患儿肠道菌群Faith’s PD指数、Shannon指数、Simpson指数、Pielou_e指数均显著低于健康组（U = 538.000、459.000、445.000、446.000,均P＜0.05）。AR患儿与健康儿童相比,肠道拟杆菌属、粪杆菌属均显著增多（U = 275.000、412.000,均P＜0.05）,而双歧杆菌显著减少（U = 304.000,P＜0.001）。与对照组相比,益生菌组患儿治疗后肠道双歧杆菌属、肠球菌属均显著增加（U = −241.500、−212.000,均P＜0.05）,拟杆菌属显著减少（U = −327.000,P＜0.05）且症状改善更加显著（t = 11.63,P＜0.05）。补充益生菌可以显著缓解大鼠鼻腔黏膜的炎症。

AR患儿与健康儿童相比肠道菌群发生显著变化。补充的双歧杆菌、肠球菌能有效地在AR患儿的肠道中定植,且对肠道中的拟杆菌可能有抑制作用。益生菌对儿童AR有较好的辅助治疗作用。

     

Antibodies to T-cell Ig and mucin domain-containing proteins (Tim)-1 and -3 suppress the induction and progression of murine allergic conjunctivitis

The T cell Ig and mucin domain-containing proteins (Tim) regulate Th1- and Th2-mediated immune responses. We investigated the ability of Abs blocking Tim-1 or Tim-3 ligand-binding activity to prevent and treat murine experimental allergic conjunctivitis (EC), a Th2-mediated disease. Treatment with either Ab during the induction phase of EC in actively immunized wild-type mice suppressed EC and upregulated Th1 and Th2 immune responses. In contrast, both Abs exacerbated EC in actively immunized IFN-gamma-knockout mice. Thus, both anti-Tim Abs suppress the pathogenic immune responses generated in the induction phase by upregulating systemic IFN-gamma production. Treatment of actively immunized mice and passively immunized mice with either anti-Tim Ab just prior to RW challenge also suppressed EC. Thus, treatment with anti-Tim-1 or anti-Tim-3 Ab can suppress both the induction and progression of EC, which could indicate potential preventive and/or therapeutic approaches for allergic diseases such as allergic conjunctivitis.     

Interaction between nitric oxide and prostaglandin synthesis in the acute phase of allergic conjunctivitis

Both nitric oxide and prostaglandins induce vasodilatation which is an important feature of local inflammation. The purpose of the study described here was to investigate a possible interaction between these two types of mediators in an experimental model of allergic conjunctivitis. A conjunctival allergic reaction was induced with antigen in sensitized guinea pigs. Conjunctival vascular permeability changes were evaluated with the prophylactic use of an inhibitor of nitric oxide synthase (L-NAME) and a cycloxygenase inhibitor (indomethacin). To study a possible interaction between nitric oxide and prostaglandin synthesis in the acute phase of allergic conjunctivitis, the levels of nitrite and PGE₂ were determined in lavage fluid. The prophylactic use of L-NAME on the formation of conjunctival edema in response to topical PGD₂ administration was studied by measurement of albumin levels in lavage fluid. Both nitric oxide and PGE₂ are synthesized in response to antigen provocation and after histamine administration. Nitric oxide and PGE₂ are produced simultaneously in the conjunctiva and they showed identical synthesis profiles in response to antigen provocation. Pretreatment with L-NAME inhibited the synthesis of PGE₂ whereas exogenous administration of nitric oxide increased the level of PGE₂ in lavage fluid. Prophylactic treatment with L-NAME significantly inhibited the PGD₂ induced albumin extravasation. Nitric oxide seems to play an important role in the acute phase of allergic conjunctivitis it may stimulate PGE₂ production and acts as a secondary mediator in PGD₂ and histamine induced conjunctival edema.     

The interaction between ICOS and B7RP-1 is not required for the development of experimental murine allergic conjunctivitis

It is still unclear whether the interaction between inducible costimulator (ICOS) and its ligand, B7 related protein (B7RP)-1, is important for the development of allergic diseases. We investigated whether blocking the ICOS/B7RP-1 interaction affects the development of murine experimental allergic conjunctivitis (EC). EC was induced in Balb/c mice either by active immunization of ragweed (RW) or by transferring RW-primed splenocytes, followed by challenge with RW-containing eye drops. The mice were treated with anti-B7RP-1 antibody (Ab) or normal rat immunoglobulin G (IgG) during either the induction or effector phase. Regardless of the induction method or when the animals were treated, eosinophil infiltration into the conjunctiva was not affected by the anti-B7RP-1 Ab treatment. Splenocyte responses were not largely affected by this treatment. However, serum Ig levels were significantly reduced. These data suggest that blocking the ICOS/B7RP-1 in allergic diseases may not always be therapeutic.     

布拉酵母菌联合孟鲁斯特钠治疗变应性鼻炎的疗效观察

目的探讨布拉酵母菌联合孟鲁斯特钠治疗变应性鼻炎的临床疗效。方法将患儿随机分为治疗组与对照组,每组35例,两组患儿均用糠酸莫米松鼻喷剂早晨喷鼻1次,1喷/次。对照组用孟鲁司特钠咀嚼片2~5岁4 mg,6~12岁5 mg,12岁10 mg每晚睡前口服。治疗组在对照组基础上联合布拉酵母菌散剂1.0 g/次,2次/d,口服,4周1个疗程。结果两组患儿治疗后VAS评分均比治疗前降低,治疗组评分前后差异有统计学意义(P0.01),治疗后组间比较差异有统计学意义(P0.01),两组患儿随访6个月后与治疗结束时比较差异无统计学意义(P0.05)。治疗组与对照组患儿在总有效率和复发率的比较上差异均有统计学意义(P0.05)。结论布拉酵母菌联合孟鲁斯特钠治疗变应性鼻炎的临床疗效明显。     

CD8+ T cells play disparate roles in the induction and the effector phases of murine experimental allergic conjunctivitis

Although CD4+ Th2 cells clearly play an essential role in the development of experimental allergic diseases, the functions CD8+ T cells may have in these diseases have been investigated less extensively and remain controversial. Here, we investigated the roles of CD8+ T cells in the development of experimental allergic conjunctivitis (EC). EC was induced in CD8alpha-deficient (CD8KO) mice and wild-type (WT) mice by active immunization with short ragweed pollen (RW) followed by challenge with RW-containing eye drops. Alternatively, EC was induced by transferring RW-primed splenocytes followed by RW challenge. With regard to actively immunized mice, CD8KO mice showed significantly less severe eosinophil infiltration of the conjunctiva and lower total IgE levels, although the levels of the other Igs were equivalent between the two strains. Cytokine production by cultured splenocytes also did not differ, but the WT conjunctivas showed upregulated IL-5 and IL-6 expression and greater upregulation of IL-4 expression than the conjunctivas of CD8KO mice. Thus, CD8+ T cells may play a significant role during the induction phase by aiding IgE production and the generation of Th2 cytokines in the conjunctiva, thus promoting the development of EC. In contrast, splenocytes from CD8KO mice induced significantly more severe EC in WT mice than cells from WT mice. In addition, transfer of RW-primed splenocytes induced significantly more severe eosinophil infiltration in CD8KO recipient mice. Thus, CD8+ T cells promote the development of EC during the induction phase, but suppress it during the effector phase.     

微生态制剂辅助普米克令舒提高过敏性哮喘患儿免疫功能

目的 探讨微生态制剂辅助普米克令舒是否能提高过敏性哮喘患儿免疫功能。 方法 选择2018年1月至2019年12月在我院确诊并进行治疗的过敏性哮喘患儿150例,根据数字表法随机分为观察组与对照组,每组各75例。对照组患儿给予普米克令舒雾化吸入及常规综合治疗,观察组在对照组基础上辅助微生态制剂双歧四联活菌片进行治疗。对两组患儿治疗效果、治疗前后肠道菌群变化、免疫功能和用药期间不良反应发生率等指标进行比较分析。 结果 两组患儿治疗后观察组有效率为92.0%,显著高于对照组的77.3%(P0.05)。与治疗前比较,观察组患儿治疗后乳酸菌、双歧杆菌数量明显增多,肠球菌、肠杆菌数量明显减少(P+、CD4+水平、CD4+/CD8+比值均升高,CD8+水平下降(P结论 在过敏性哮喘患儿的治疗中,普米克令舒辅助微生态制剂可有效提高治疗效果,提高免疫功能,疗效确切且安全。