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Article(id=1211268933437485535, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1211268928383348982, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.2021.02.07, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1601827200000, receivedDateStr=2020-10-05, revisedDate=1610812800000, revisedDateStr=2021-01-17, acceptedDate=null, acceptedDateStr=null, onlineDate=1766718618019, onlineDateStr=2025-12-26, pubDate=1614441600000, pubDateStr=2021-02-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1766718618019, onlineIssueDateStr=2025-12-26, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1766718618019, creator=13701087609, updateTime=1766718618019, updator=13701087609, issue=Issue{id=1211268928383348982, tenantId=1146029695717560320, journalId=1189873630562394117, year='2021', volume='46', issue='2', pageStart='107', pageEnd='211', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1766718616815, creator=13701087609, updateTime=1766718805938, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1211269721685627740, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1211268928383348982, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1211269721685627741, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1211268928383348982, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=149, endPage=155, ext={EN=ArticleExt(id=1211268933810778623, articleId=1211268933437485535, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Investigation of the aeroallergens spectrum and related risk factors in 388 patients with allergic rhinitis in Zhangjiakou area, columnId=1190310109000602400, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Clinical Research, runingTitle=null, highlight=null, articleAbstract=

Objective To investigate the distribution of inhaled allergens and analyze the related risk factors among allergic rhinitis (AR) patients in Zhangjiakou area. Methods Serum specific IgE antibody of inhaled allergens was detected in 532 suspected AR patients in the Department of Otolaryngology, Head and Neck Surgery of the First Affiliated Hospital of Hebei North University form April 2019 to August 2020. A total of 245 family members of outpatient and inpatient patients (except family members of respiratory department, dermatology department and otolaryngology department) in the same period were selected as the control group. AR questionnaire survey was conducted in the AR patients and control group, and the survey results were statistically analyzed. Results Of the 532 patients with suspected allergic rhinitis, 388 (72.9%) were positive for at least one allergen. The top three positivity rates of inhalation allergens were mugwort (89.9%), common ragweed (44.1%) and cat epithelium(21.4%) among the AR patients. In the single allergen positive patients, the mudwort has a much higher positive detection rate(86.0%). The positive degree of allergens was mainly distributed in class 2, class 3 and class 6 of mugwort, in class 1 of house dust and house dust mite, and in class 2 of other allergens. There were statistically significant differences in the allergen positive rate of AR patients in different months, regions and ages (P<0.05). The allergen positivity rate from July to September was significantly higher than that in other months, in bar-upper region was significantly higher than that in bar-lower region, and the positive rate of allergen gradually declined with the increase of age. The differences of allergens in ragweed, cat epithelium, house dust, house dust mite and streptomyces alternaria between genders of AR patients were statistically significant (P<0.05). Multivariate logistic analysis showed that previous allergies, parents with allergic rhinitis, history of asthma, secondhand smoke exposure, staying up late, age 3-24 years old were AR high-risk factors (OR>1), regular physical exercise was an effective protective factor for AR (OR<1). Conclusions The most common inhalation allergens in Zhangjiakou area are mugwort and common ragweed. The distribution of allergens is correlated with the month, region, and gender and age of the patients. Previous allergies, history of asthma, parents having allergic rhinitis, age and so on are risk factors for AR.

, correspAuthors=Yu-Tuo Zhang, authorNote=null, correspAuthorsNote=
*E-mail:
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目的 探讨张家口地区变应性鼻炎(AR)患者吸入性变应原的分布情况及相关危险因素。方法 对2019年4月—2020年8月就诊于河北北方学院附属第一医院耳鼻咽喉头颈外科的532例疑似AR患者进行变应原血清特异性IgE检测，选取同期该院门诊及住院患者家属(呼吸科、皮肤科及耳鼻喉科家属除外)245名设为对照组，对AR患者和对照组进行AR问卷调查，统计分析调查结果。结果 532例疑似AR患者中，388例(72.9%)至少一种变应原呈阳性。AR患者阳性率排名前3位的吸入性变应原依次为艾蒿(89.9%)、普通豚草(44.1%)、猫上皮(21.4%)。在单一变应原阳性患者中，艾蒿阳性检出率(86.0%)明显高于其他变应原。在变应原的阳性程度分布中，艾蒿以2级、3级及6级为主，屋尘和屋尘螨以1级为主，其他变应原均以2级为主。不同月份、地区、年龄段的AR患者变应原阳性检出率差异有统计学意义(P<0.05)，7~9月份的变应原阳性检出率明显高于其他月份、坝上地区明显高于坝下地区，且变应原阳性率随年龄增长而逐渐降低。不同性别AR患者普通豚草、猫上皮、屋尘、屋尘螨及交链孢霉5种吸入性变应原的阳性检出率差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示，既往过敏史、父/母患AR、哮喘史、吸二手烟、熬夜以及年龄3~24岁为AR发病的高危因素(OR>1)；经常锻炼身体为AR的有效保护因素(OR<1)。结论 张家口地区的主要吸入性变应原为艾蒿、普通豚草。变应原的分布与月份、地区及患者的性别、年龄具有一定相关性。发生AR的危险因素主要有既往过敏史、哮喘史、父/母患AR、年龄等。

, correspAuthors=张玉妥, authorNote=null, correspAuthorsNote=
张玉妥，E-mail：
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陈蕊，硕士研究生，主要从事免疫学方面的研究。E-mail：

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陈蕊，硕士研究生，主要从事免疫学方面的研究。E-mail：

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陈蕊，硕士研究生，主要从事免疫学方面的研究。E-mail：

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Analysis of allergen spectrum and related risk factors in 318 patients with allergic rhinitis in Guiyang area[D]. 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Allergic rhinitis and asthma: epidemiology and common pathophysiology[J]. Allergy Asthma Proc, 2014, 35(5): 357-361., articleTitle=Allergic rhinitis and asthma: epidemiology and common pathophysiology, refAbstract=null)], funds=[Fund(id=1211268946750206817, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268933437485535, awardId=YB2018015, language=EN, fundingSource=Key Project of Science and Technology Research of Hebei North University(YB2018015), fundOrder=null, country=null), Fund(id=1211268946825704293, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268933437485535, awardId=YB2018015, language=CN, fundingSource=河北北方学院科技研究重点项目(YB2018015), fundOrder=null, country=null), Fund(id=1211268946926367589, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268933437485535, awardId=CXZZSS2021129, language=EN, fundingSource=Postgraduate Innovation Support Project of Hebei Province(CXZZSS2021129), fundOrder=null, country=null), Fund(id=1211268947031225191, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268933437485535, awardId=CXZZSS2021129, language=CN, fundingSource=河北省研究生创新资助项目(CXZZSS2021129), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1211268935740158598, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268933437485535, xref=1, ext=[AuthorCompanyExt(id=1211268935752741511, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268933437485535, companyId=1211268935740158598, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1Institute of Pathogen Biology and Immunology, Hebei North University, Zhangjiakou, Hebei 075000, China), AuthorCompanyExt(id=1211268935761130120, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268933437485535, companyId=1211268935740158598, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1河北北方学院病原生物学与免疫研究所，河北 张家口 075000)]), AuthorCompany(id=1211268935840821901, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268933437485535, xref=2, ext=[AuthorCompanyExt(id=1211268935845016206, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268933437485535, companyId=1211268935840821901, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2Department of Otolaryngology, Head and Neck Surgery, the First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei 075000, China), AuthorCompanyExt(id=1211268935853404815, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268933437485535, companyId=1211268935840821901, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2河北北方学院附属第一医院耳鼻咽喉头颈外科，河北 张家口 075000)])], figs=[ArticleFig(id=1211268943310877480, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268933437485535, language=EN, label=Fig.1, caption=Age and gender distribution of AR patients in Zhangjiakou area, figureFileSmall=wpLVFDRnuSgsJyskwwK2fA==, figureFileBig=MJdPi582Z++5bMuXfu1UyQ==, tableContent=null), ArticleFig(id=1211268943394763563, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268933437485535, language=CN, label=图1, caption=张家口地区变应性鼻炎患者的年龄及性别分布, figureFileSmall=wpLVFDRnuSgsJyskwwK2fA==, figureFileBig=MJdPi582Z++5bMuXfu1UyQ==, tableContent=null), ArticleFig(id=1211268943612867378, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268933437485535, language=EN, label=Fig.2, caption=Distribution of AR patients outpatient visit month in Zhangjiakou area, figureFileSmall=Sl3FHh5cxqx6P34Iq3BrUQ==, figureFileBig=PnGJ/6/b75mnHctnOVoedA==, tableContent=null), ArticleFig(id=1211268943696753460, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268933437485535, language=CN, label=图2, caption=张家口地区变应性鼻炎患者门诊就诊月份分布, figureFileSmall=Sl3FHh5cxqx6P34Iq3BrUQ==, figureFileBig=PnGJ/6/b75mnHctnOVoedA==, tableContent=null), ArticleFig(id=1211268943789028149, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268933437485535, language=EN, label=Tab.1, caption=

Interpretation of allergen results

, figureFileSmall=null, figureFileBig=null, tableContent=
变应原级别参考范围(IU/ml)特异性IgE浓度
6级>100.0极高
5级50.0~100.0很高
4级17.5~50.0非常高
3级3.5~17.5高
2级0.7~3.5中等
1级0.35~0.7低
0级<0.35检测不到
), ArticleFig(id=1211268943889691447, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268933437485535, language=CN, label=表1, caption=

变应原结果判定

, figureFileSmall=null, figureFileBig=null, tableContent=
变应原级别参考范围(IU/ml)特异性IgE浓度
6级>100.0极高
5级50.0~100.0很高
4级17.5~50.0非常高
3级3.5~17.5高
2级0.7~3.5中等
1级0.35~0.7低
0级<0.35检测不到
), ArticleFig(id=1211268943977771833, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268933437485535, language=EN, label=Tab.2, caption=

Regional distribution of AR patients in Zhangjiakou area

, figureFileSmall=null, figureFileBig=null, tableContent=
地区就诊量[例(%)]男[例(%)]女[例(%)]年龄(岁)
坝上地区165(42.5)90(42.9)75(42.1)17(8~25)
坝下地区223(57.5)120(57.1)103(57.9)21(10~29)(1)
), ArticleFig(id=1211268944091018043, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268933437485535, language=CN, label=表2, caption=

张家口地区变应性鼻炎患者地区分布

, figureFileSmall=null, figureFileBig=null, tableContent=
地区就诊量[例(%)]男[例(%)]女[例(%)]年龄(岁)
坝上地区165(42.5)90(42.9)75(42.1)17(8~25)
坝下地区223(57.5)120(57.1)103(57.9)21(10~29)(1)
), ArticleFig(id=1211268944187487037, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268933437485535, language=EN, label=Tab.3, caption=

Distribution of allergens in AR patients in Zhangjiakou area [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变应原总数(n=388)单一变应原(n=136)双重变应原(n=122)三重变应原(n=65)
艾蒿349(89.9)117(86.0)115(94.3)53(81.5)
普通豚草171(44.1)2(1.5)82(67.2)36(55.4)
猫上皮83(21.4)3(2.2)9(7.4)23(35.4)
屋尘81(20.9)4(2.9)10(8.2)23(35.4)
柳树62(16.0)010(8.2)28(43.1)
狗上皮41(10.6)2(1.5)3(2.5)8(12.3)
屋尘螨33(8.5)4(2.9)7(5.7)8(12.3)
粉尘螨32(8.2)2(1.5)4(3.3)10(15.4)
交链孢霉26(6.7)2(1.5)4(3.3)6(9.2)
), ArticleFig(id=1211268944254595903, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268933437485535, language=CN, label=表3, caption=

9种变应原在张家口地区变应性鼻炎患者中的分布情况[例(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变应原总数(n=388)单一变应原(n=136)双重变应原(n=122)三重变应原(n=65)
艾蒿349(89.9)117(86.0)115(94.3)53(81.5)
普通豚草171(44.1)2(1.5)82(67.2)36(55.4)
猫上皮83(21.4)3(2.2)9(7.4)23(35.4)
屋尘81(20.9)4(2.9)10(8.2)23(35.4)
柳树62(16.0)010(8.2)28(43.1)
狗上皮41(10.6)2(1.5)3(2.5)8(12.3)
屋尘螨33(8.5)4(2.9)7(5.7)8(12.3)
粉尘螨32(8.2)2(1.5)4(3.3)10(15.4)
交链孢霉26(6.7)2(1.5)4(3.3)6(9.2)
), ArticleFig(id=1211268944342676290, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268933437485535, language=EN, label=Tab.4, caption=

Distribution of allergen positive degree in AR patients in Zhangjiakou area [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变应原1级2级3级4级5级6级
艾蒿19(2.2)84(9.6)82(9.3)45(5.1)41(4.7)78(8.9)
普通豚草48(5.5)78(8.9)37(4.2)7(0.8)1(0.1)0
猫上皮9(1.0)43(4.9)10(1.1)15(1.7)2(0.2)4(0.5)
屋尘37(4.2)31(3.5)10(1.1)3(0.3)00
柳树24(2.7)34(3.9)4(0.5)000
狗上皮13(1.5)14(1.6)11(1.3)1(0.1)02(0.2)
屋尘螨16(1.8)12(1.4)5(0.6)000
粉尘螨12(1.4)13(1.5)7(0.8)000
交链孢霉4(0.5)7(0.8)6(0.7)7(0.8)2(0.2)0
), ArticleFig(id=1211268944426562372, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268933437485535, language=CN, label=表4, caption=

9种变应原阳性程度在张家口地区变应性鼻炎患者中的分布情况[例(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变应原1级2级3级4级5级6级
艾蒿19(2.2)84(9.6)82(9.3)45(5.1)41(4.7)78(8.9)
普通豚草48(5.5)78(8.9)37(4.2)7(0.8)1(0.1)0
猫上皮9(1.0)43(4.9)10(1.1)15(1.7)2(0.2)4(0.5)
屋尘37(4.2)31(3.5)10(1.1)3(0.3)00
柳树24(2.7)34(3.9)4(0.5)000
狗上皮13(1.5)14(1.6)11(1.3)1(0.1)02(0.2)
屋尘螨16(1.8)12(1.4)5(0.6)000
粉尘螨12(1.4)13(1.5)7(0.8)000
交链孢霉4(0.5)7(0.8)6(0.7)7(0.8)2(0.2)0
), ArticleFig(id=1211268944523031366, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268933437485535, language=EN, label=Tab.5, caption=

Distribution of allergens in different age groups of AR patients in Zhangjiakou area [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变应原3~14岁(n=184)14~24岁(n=86)24~34岁(n=69)34~44岁(n=27)>44岁(n=22)χ2P
艾蒿171(93.0)78(90.7)60(87.0)25(92.6)15(68.2)14.2890.006
普通豚草92(50.0)46(535)20(29.0)10(37.0)3(13.6)20.8980.000
柳树36(19.6)15(17.4)7(10.1)1(3.7)3(13.6)6.7690.149
猫上皮49(26.6)17(19.8)16(23.2)01(4.5)14.3310.006
狗上皮25(13.6)7(8.1)8(11.6)01(4.5)6.4230.170
屋尘49(26.6)11(12.8)18(26.1)03(13.6)16.0480.003
屋尘螨10(5.4)7(8.1)8(11.6)6(22.2)2(9.1)9.6280.047
粉尘螨15(8.2)6(7.0)5(7.2)4(14.8)2(9.1)1.8370.766
交链孢霉22(12.0)2(2.3)01(3.7)1(5.0)16.2700.003
), ArticleFig(id=1211268944615306055, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268933437485535, language=CN, label=表5, caption=

张家口地区不同年龄段变应性鼻炎患者的变应原分布情况[例(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变应原3~14岁(n=184)14~24岁(n=86)24~34岁(n=69)34~44岁(n=27)>44岁(n=22)χ2P
艾蒿171(93.0)78(90.7)60(87.0)25(92.6)15(68.2)14.2890.006
普通豚草92(50.0)46(535)20(29.0)10(37.0)3(13.6)20.8980.000
柳树36(19.6)15(17.4)7(10.1)1(3.7)3(13.6)6.7690.149
猫上皮49(26.6)17(19.8)16(23.2)01(4.5)14.3310.006
狗上皮25(13.6)7(8.1)8(11.6)01(4.5)6.4230.170
屋尘49(26.6)11(12.8)18(26.1)03(13.6)16.0480.003
屋尘螨10(5.4)7(8.1)8(11.6)6(22.2)2(9.1)9.6280.047
粉尘螨15(8.2)6(7.0)5(7.2)4(14.8)2(9.1)1.8370.766
交链孢霉22(12.0)2(2.3)01(3.7)1(5.0)16.2700.003
), ArticleFig(id=1211268944707580745, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268933437485535, language=EN, label=Tab.6, caption=

Comparison of allergen positive rate in AR patients of different genders in Zhangjiakou area [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变应原男性(n=210)女性(n=178)χ2P
艾蒿191(91.0)158(88.8)0.5100.475
普通豚草104(49.5)67(37.6)5.5190.019
柳树34(16.2)28(15.7)0.0150.902
猫上皮53(25.2)30(16.9)4.0270.045
狗上皮25(11.9)16(8.9)0.8670.352
屋尘52(24.8)29(16.3)4.1840.041
屋尘螨12(5.7)21(11.8)4.5820.032
粉尘螨15(7.1)17(9.6)7.7380.390
交链孢霉20(9.5)6(3.4)5.8340.016
), ArticleFig(id=1211268944812438346, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268933437485535, language=CN, label=表6, caption=

张家口地区不同性别变应性鼻炎患者变应原阳性检出率比较[例(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变应原男性(n=210)女性(n=178)χ2P
艾蒿191(91.0)158(88.8)0.5100.475
普通豚草104(49.5)67(37.6)5.5190.019
柳树34(16.2)28(15.7)0.0150.902
猫上皮53(25.2)30(16.9)4.0270.045
狗上皮25(11.9)16(8.9)0.8670.352
屋尘52(24.8)29(16.3)4.1840.041
屋尘螨12(5.7)21(11.8)4.5820.032
粉尘螨15(7.1)17(9.6)7.7380.390
交链孢霉20(9.5)6(3.4)5.8340.016
), ArticleFig(id=1211268944917295951, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268933437485535, language=EN, label=Tab.7, caption=

Comparison of allergen positive rate in different regions in Zhangjiakou area [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变应原坝上地区(n=165)坝下地区(n=223)χ2P
艾蒿159(96.4)190(85.2)13.0680.000
普通豚草100(60.6)71(31.8)31.8400.000
柳树28(17.0)34(15.2)0.2100.676
猫上皮44(26.7)39(17.5)4.7500.029
狗上皮18(10.9)23(10.3)0.0360.869
屋尘38(23.0)43(19.3)0.8060.379
屋尘螨10(6.1)23(10.3)2.2050.146
粉尘螨10(6.1)22(9.9)1.8140.122
交链孢霉14(8.5)12(5.4)1.4610.304
), ArticleFig(id=1211268945013764943, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268933437485535, language=CN, label=表7, caption=

张家口坝上与坝下地区变应原阳性检出率比较[例(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变应原坝上地区(n=165)坝下地区(n=223)χ2P
艾蒿159(96.4)190(85.2)13.0680.000
普通豚草100(60.6)71(31.8)31.8400.000
柳树28(17.0)34(15.2)0.2100.676
猫上皮44(26.7)39(17.5)4.7500.029
狗上皮18(10.9)23(10.3)0.0360.869
屋尘38(23.0)43(19.3)0.8060.379
屋尘螨10(6.1)23(10.3)2.2050.146
粉尘螨10(6.1)22(9.9)1.8140.122
交链孢霉14(8.5)12(5.4)1.4610.304
), ArticleFig(id=1211268946230113105, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268933437485535, language=EN, label=Tab.8, caption=

Comparison of the Artemisia positive degree in different regions in Zhangjiakou area [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
艾蒿阳性程度坝上地区(n=165)坝下地区(n=223)合计χ2P
1级3(1.8)16(7.2)19(4.9)5.1790.029
2级26(15.8)58(26.0)84(21.6)4.7460.029
3级29(17.6)53(23.8)82(21.1)2.1810.167
4级25(15.2)20(9.0)45(11.6)3.5360.077
5级27(16.4)14(6.3)41(10.6)10.2070.002
6级49(29.7)29(13.0)78(20.1)16.4520.000
), ArticleFig(id=1211268946305610579, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268933437485535, language=CN, label=表8, caption=

张家口坝上与坝下地区的艾蒿阳性程度分布情况比较[例(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
艾蒿阳性程度坝上地区(n=165)坝下地区(n=223)合计χ2P
1级3(1.8)16(7.2)19(4.9)5.1790.029
2级26(15.8)58(26.0)84(21.6)4.7460.029
3级29(17.6)53(23.8)82(21.1)2.1810.167
4级25(15.2)20(9.0)45(11.6)3.5360.077
5级27(16.4)14(6.3)41(10.6)10.2070.002
6级49(29.7)29(13.0)78(20.1)16.4520.000
), ArticleFig(id=1211268946376913749, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268933437485535, language=EN, label=Tab.9, caption=

Univariate analysis of relevant influencing factors of AR patients in Zhangjiakou area [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
影响因素AR组(n=388)对照组(n=245)χ2P
既往过敏史105(27.1)13(5.3)46.8660.000
父/母患AR93(24.0)12(4.9)39.4760.000
哮喘史42(10.8)2(0.8)23.9680.000
吸烟史34(8.8)38(15.5)1.2080.272
吸二手烟295(76.0)158(64.5)9.8290.002
熬夜177(45.6)80(32.7)10.4680.000
家中居住人数>3人141(36.3)95(38.8)0.3810.537
饲养动物116(29.9)51(20.8)6.3760.012
室内种植开花植物34(8.8)38(15.5)1.2080.272
打扫房间76(19.6)109(44.5)45.0220.000
装修房间47(12.1)53(21.6)10.2300.001
房屋面积215(55.4)131(53.5)2.9830.084
经常开窗376(96.9)235(95.9)0.4380.508
空调使用情况4(1.0)3(1.2)0.0510.821
粉尘或化学性职业暴露17(4.4)10(4.1)0.0330.856
进行体育锻炼69(17.8)183(74.7)202.9830.000
年龄(岁)
 3~14184(47.4)79(32.2)14.2450.000
 14~2486(22.2)17(6.9)22.5550.000
 24~3469(17.8)56(22.9)2.4390.118
 34~4427(7.0)37(15.1)10.9570.001
 >4422(5.7)56(22.9)41.0600.000
), ArticleFig(id=1211268946456605527, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268933437485535, language=CN, label=表9, caption=

张家口地区变应性鼻炎患者相关影响因素单因素分析结果[例(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
影响因素AR组(n=388)对照组(n=245)χ2P
既往过敏史105(27.1)13(5.3)46.8660.000
父/母患AR93(24.0)12(4.9)39.4760.000
哮喘史42(10.8)2(0.8)23.9680.000
吸烟史34(8.8)38(15.5)1.2080.272
吸二手烟295(76.0)158(64.5)9.8290.002
熬夜177(45.6)80(32.7)10.4680.000
家中居住人数>3人141(36.3)95(38.8)0.3810.537
饲养动物116(29.9)51(20.8)6.3760.012
室内种植开花植物34(8.8)38(15.5)1.2080.272
打扫房间76(19.6)109(44.5)45.0220.000
装修房间47(12.1)53(21.6)10.2300.001
房屋面积215(55.4)131(53.5)2.9830.084
经常开窗376(96.9)235(95.9)0.4380.508
空调使用情况4(1.0)3(1.2)0.0510.821
粉尘或化学性职业暴露17(4.4)10(4.1)0.0330.856
进行体育锻炼69(17.8)183(74.7)202.9830.000
年龄(岁)
 3~14184(47.4)79(32.2)14.2450.000
 14~2486(22.2)17(6.9)22.5550.000
 24~3469(17.8)56(22.9)2.4390.118
 34~4427(7.0)37(15.1)10.9570.001
 >4422(5.7)56(22.9)41.0600.000
), ArticleFig(id=1211268946540491610, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268933437485535, language=EN, label=Tab.10, caption=

Multivariate logistic regression analysis on the influencing factors of AR patients in Zhangjiakou area

, figureFileSmall=null, figureFileBig=null, tableContent=
危险因素βSEWaldPOR95%CI
既往过敏史1.4180.38213.7490.0004.1271.951~8.731
父/母患AR0.8690.4354.0020.0452.3851.018~5.590
哮喘史1.8150.8544.5150.0346.1401.151~32.748
吸二手烟0.5770.2425.6730.0171.7811.108~2.865
熬夜0.6280.2476.4610.0111.8751.155~3.043
经常锻炼身体–2.8110.245131.2300.0000.0600.037~0.098
年龄(岁)
 3~141.9170.43919.1050.0006.8022.879~16.071
 14~241.6400.51010.3280.0015.1561.896~14.017
), ArticleFig(id=1211268946645349213, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1211268933437485535, language=CN, label=表10, caption=

张家口地区变应性鼻炎患者影响因素多因素logistic回归分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
危险因素βSEWaldPOR95%CI
既往过敏史1.4180.38213.7490.0004.1271.951~8.731
父/母患AR0.8690.4354.0020.0452.3851.018~5.590
哮喘史1.8150.8544.5150.0346.1401.151~32.748
吸二手烟0.5770.2425.6730.0171.7811.108~2.865
熬夜0.6280.2476.4610.0111.8751.155~3.043
经常锻炼身体–2.8110.245131.2300.0000.0600.037~0.098
年龄(岁)
 3~141.9170.43919.1050.0006.8022.879~16.071
 14~241.6400.51010.3280.0015.1561.896~14.017
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张家口地区388例变应性鼻炎患者吸入性变应原谱及危险因素分析
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陈蕊 1 , 赵颖 1 , 安晶 1 , 曾琳 1 , 薛刚 2 , 宋鸿儒 1 , 张玉妥 1, *
解放军医学杂志 | 临床研究 2021,46(2): 149-155
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解放军医学杂志 | 临床研究 2021, 46(2): 149-155
张家口地区388例变应性鼻炎患者吸入性变应原谱及危险因素分析
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陈蕊1 , 赵颖1, 安晶1, 曾琳1, 薛刚2, 宋鸿儒1, 张玉妥1, *
作者信息
  • 1河北北方学院病原生物学与免疫研究所，河北 张家口 075000
  • 2河北北方学院附属第一医院耳鼻咽喉头颈外科，河北 张家口 075000

    • 陈蕊，硕士研究生，主要从事免疫学方面的研究。E-mail：

通讯作者:

张玉妥，E-mail：
Investigation of the aeroallergens spectrum and related risk factors in 388 patients with allergic rhinitis in Zhangjiakou area
Rui Chen1 , Ying Zhao1, Jing An1, Lin Zeng1, Gang Xue2, Hong-Ru Song1, Yu-Tuo Zhang1, *
Affiliations
  • 1Institute of Pathogen Biology and Immunology, Hebei North University, Zhangjiakou, Hebei 075000, China
  • 2Department of Otolaryngology, Head and Neck Surgery, the First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei 075000, China
出版时间: 2021-02-28 doi: 10.11855/j.issn.0577-7402.2021.02.07
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摘要
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目的 探讨张家口地区变应性鼻炎(AR)患者吸入性变应原的分布情况及相关危险因素。方法 对2019年4月—2020年8月就诊于河北北方学院附属第一医院耳鼻咽喉头颈外科的532例疑似AR患者进行变应原血清特异性IgE检测，选取同期该院门诊及住院患者家属(呼吸科、皮肤科及耳鼻喉科家属除外)245名设为对照组，对AR患者和对照组进行AR问卷调查，统计分析调查结果。结果 532例疑似AR患者中，388例(72.9%)至少一种变应原呈阳性。AR患者阳性率排名前3位的吸入性变应原依次为艾蒿(89.9%)、普通豚草(44.1%)、猫上皮(21.4%)。在单一变应原阳性患者中，艾蒿阳性检出率(86.0%)明显高于其他变应原。在变应原的阳性程度分布中，艾蒿以2级、3级及6级为主，屋尘和屋尘螨以1级为主，其他变应原均以2级为主。不同月份、地区、年龄段的AR患者变应原阳性检出率差异有统计学意义(P<0.05)，7~9月份的变应原阳性检出率明显高于其他月份、坝上地区明显高于坝下地区，且变应原阳性率随年龄增长而逐渐降低。不同性别AR患者普通豚草、猫上皮、屋尘、屋尘螨及交链孢霉5种吸入性变应原的阳性检出率差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示，既往过敏史、父/母患AR、哮喘史、吸二手烟、熬夜以及年龄3~24岁为AR发病的高危因素(OR>1)；经常锻炼身体为AR的有效保护因素(OR<1)。结论 张家口地区的主要吸入性变应原为艾蒿、普通豚草。变应原的分布与月份、地区及患者的性别、年龄具有一定相关性。发生AR的危险因素主要有既往过敏史、哮喘史、父/母患AR、年龄等。

张家口地区  /  变应性鼻炎  /  吸入性变应原  /  危险因素

Objective To investigate the distribution of inhaled allergens and analyze the related risk factors among allergic rhinitis (AR) patients in Zhangjiakou area. Methods Serum specific IgE antibody of inhaled allergens was detected in 532 suspected AR patients in the Department of Otolaryngology, Head and Neck Surgery of the First Affiliated Hospital of Hebei North University form April 2019 to August 2020. A total of 245 family members of outpatient and inpatient patients (except family members of respiratory department, dermatology department and otolaryngology department) in the same period were selected as the control group. AR questionnaire survey was conducted in the AR patients and control group, and the survey results were statistically analyzed. Results Of the 532 patients with suspected allergic rhinitis, 388 (72.9%) were positive for at least one allergen. The top three positivity rates of inhalation allergens were mugwort (89.9%), common ragweed (44.1%) and cat epithelium(21.4%) among the AR patients. In the single allergen positive patients, the mudwort has a much higher positive detection rate(86.0%). The positive degree of allergens was mainly distributed in class 2, class 3 and class 6 of mugwort, in class 1 of house dust and house dust mite, and in class 2 of other allergens. There were statistically significant differences in the allergen positive rate of AR patients in different months, regions and ages (P<0.05). The allergen positivity rate from July to September was significantly higher than that in other months, in bar-upper region was significantly higher than that in bar-lower region, and the positive rate of allergen gradually declined with the increase of age. The differences of allergens in ragweed, cat epithelium, house dust, house dust mite and streptomyces alternaria between genders of AR patients were statistically significant (P<0.05). Multivariate logistic analysis showed that previous allergies, parents with allergic rhinitis, history of asthma, secondhand smoke exposure, staying up late, age 3-24 years old were AR high-risk factors (OR>1), regular physical exercise was an effective protective factor for AR (OR<1). Conclusions The most common inhalation allergens in Zhangjiakou area are mugwort and common ragweed. The distribution of allergens is correlated with the month, region, and gender and age of the patients. Previous allergies, history of asthma, parents having allergic rhinitis, age and so on are risk factors for AR.

Zhangjiakou area  /  allergic rhinitis  /  allergens  /  risk factors
陈蕊, 赵颖, 安晶, 曾琳, 薛刚, 宋鸿儒, 张玉妥. 张家口地区388例变应性鼻炎患者吸入性变应原谱及危险因素分析. 解放军医学杂志, 2021 , 46 (2) : 149 -155 . DOI: 10.11855/j.issn.0577-7402.2021.02.07
Rui Chen, Ying Zhao, Jing An, Lin Zeng, Gang Xue, Hong-Ru Song, Yu-Tuo Zhang. Investigation of the aeroallergens spectrum and related risk factors in 388 patients with allergic rhinitis in Zhangjiakou area[J]. Medical Journal of Chinese People’s Liberation Army, 2021 , 46 (2) : 149 -155 . DOI: 10.11855/j.issn.0577-7402.2021.02.07
正文
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变应性鼻炎(allergic rhinitis，AR)是一种常见的过敏性疾病[1]，是指易感人群暴露于吸入性过敏原(如花粉、霉菌和尘螨)时，由IgE介导的以Th2为主导的细胞因子反应以及肥大细胞、嗜酸性粒细胞和其他相关细胞参与完成的，以打喷嚏、流鼻涕、鼻塞和鼻痒为主要特征的鼻黏膜免疫炎性疾病[2]。Pawankar[3]研究指出，全球约4亿人患有AR，占总人数的10%~30%，严重影响患者的生活质量，甚至危及患者的生命，造成巨大的经济负担[4]。我国幅员辽阔，不同地区诱发变应性鼻炎的主要变应原种类不尽相同，因此明确当地变应原种类及其AR患者在不同月份、地区、年龄段的分布特征，对不同地区AR的防治具有重大意义。本研究初步探讨张家口地区变应原的分布特征并分析相关影响因素，旨在为张家口地区临床防治AR提供参考。
1 资料与方法
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1.1 研究对象
收集2019年4月—2020年8月就诊于河北北方学院附属第一医院耳鼻咽喉头颈外科的疑似AR患者532例。纳入标准：(1)符合中华医学会耳鼻喉分会制定的AR诊断标准[5]；(2)来自张家口地区，外来人口居住时间超过4年，年龄≥3岁；(3)抽血前3周未使用过抗组胺类药物且未接受过糖皮质激素治疗。排除标准：(1)患有其他全身性疾病；(2)妊娠期；(3)调查问卷不全及不配合者。选取同期本院门诊及住院患者家属(呼吸科、皮肤科及耳鼻喉科患者家属除外)245名设为对照组。对照组志愿者明确否认患有AR以及出现过AR典型症状，并经临床医师行前鼻镜检查无明显鼻炎特征及哮喘病史等，所有调查对象均在知情同意下参与问卷调查，本研究通过河北北方学院附属第一医院伦理委员会审批(W2020132)。
1.2 调查方法
统一采用自制的《张家口地区过敏性鼻炎相关因素问卷调查表》收集资料，调查表内容包括患者的一般资料、临床表现及AR发病相关的危险因素。由作者对门诊就诊患者进行面对面调查，同时对本院门诊及住院患者家属(呼吸科、皮肤科及耳鼻喉科患者家属除外)进行问卷调查，未能独自完成问卷的儿童及老人均在其家属的帮助下完成。每份问卷均由两名作者进行核查，确保问卷质量。
1.3 标本收集
采用黄色促凝管抽取受试者静脉血5 ml，离心分离血清。采用血清特异性IgE试剂盒(苏州浩欧博生物医药有限公司)进行变应原检测，共检测9种常见的吸入性变应原：交链孢霉、艾蒿、普通豚草、柳树、狗上皮、猫上皮、粉尘螨、屋尘螨及屋尘。检测方法按照试剂盒说明书操作，结果判定如表1所示。
1.4 问卷调查项目及标准
本研究调查了16项AR可能相关的危险因素，分别为既往过敏史、父/母患AR、哮喘史、吸烟史、吸二手烟、熬夜、家中居住人数>3人、饲养带毛动物、室内种植开花植物、经常打扫房屋、2年内室内装修、房屋面积、经常开窗、空调使用情况、粉尘或化学性职业暴露、经常进行体育锻炼等，其中熬夜是指每天超过23:00睡觉；经常打扫房屋定义为每周打扫≥4次；房屋面积是指面积≥90 m2；经常开窗界定为每日开窗面积≥2 m2且>1 h；经常进行体育锻炼是指每周体育锻炼≥2次且每次锻炼时间>0.5 h[6]。
1.5 统计学处理
采用SPSS 25.0软件进行统计分析。计数资料以例(%)表示，组间比较采用χ2检验或Fisher确切概率法；多因素分析采用logistic多元回归分析。P<0.05为差异有统计学意义。
2 结果
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2.1 不同年龄段、性别AR患者的分布情况
2.1.1 AR患者的性别分布
532例疑似AR患者确诊为AR(血清特异性IgE阳性)388例(72.9%)，其中男性血清特异性IgE阳性率为80.2%(210/262)，女性为65.9%(178/270)。男性患者的血清特异性IgE阳性率高于女性患者(χ2=13.633，P=0.000)。
2.1.2 各年龄段AR患者在疑似患者中所占比例
如图1所示，近70%(270/388)的患者集中在3~24岁年龄段。将疑似AR患者按照年龄分为3~14岁组(205例)、14~24岁组(114例)、24~34岁组(98例)、34~44岁组(47例)与>44岁组(68例)，各年龄段血清特异性IgE阳性率分别为89.8%(184/205)、75.4%(86/114)、70.4%(69/98)、57.4%(27/47)、32.4%(22/68)，其中3~14岁组IgE阳性率最高，且IgE阳性率随着年龄的增长而降低，组间差异有统计学意义(χ2=92.502，P=0.000)。
2.2 AR患者门诊就诊月份分布情况
张家口地区90%(355/388)的AR患者就诊高峰集中在7~9月份，其中以8月份的就诊量最多，共268例(69.1%)；1~3月份为低谷期，就诊量为2例(0.5%)；其他月份数量相对稳定(图2)。
2.3 AR患者地区分布情况
张家口地区根据地理位置分为坝上地区(张北县、康保县、尚义县及沽源县)和坝下地区。如表2所示，坝上地区、坝下地区AR患者就诊量分别为165例(42.5%)、223例(57.5%)，且两个地区就诊的AR患者性别差异无统计学意义(P=0.886)；年龄分布以坝上地区较小，差异有统计学意义(P=0.021)。
2.4 张家口地区吸入性变应原特征分析
2.4.1 变应原检出情况
张家口地区AR患者最常见的变应原为艾蒿(89.9%，349/388)，其次为普通豚草(44.1%，171/388)、猫上皮(21.4%，83/388，表3)。
AR患者的变应原分布由单一变应原到多重变应原，其中占比前3位的依次为单一变应原(35.1%，136/388)、双重变应原(31.4%，122/388)、三重变应原(16.8%，65/388)。单一变应原中最常见的依次为艾蒿(86.0%，117/136)、屋尘螨(2.9%，4/136)，艾蒿的阳性检出率明显高于其他变应原。双重变应原中最常见的依次为艾蒿(94.3%，115/122)、普通豚草(67.2%，82/122)、屋尘(8.2%，10/122)、柳树(8.2%，10/122)，最为常见的阳性组合依次为艾蒿+普通豚草(65.6%，80/122)、艾蒿+柳树(7.4%，9/122)、艾蒿+屋尘(5.7%，7/122)、艾蒿+猫上皮(4.1%，5/122)。三重变应原中最常见的依次为艾蒿(81.5%，53/65)、普通豚草(55.4%，36/65)、柳树(43.1%，28/65)、屋尘(35.4%，23/65)、猫上皮(35.4%，23/65)，最为常见的阳性组合依次为艾蒿+普通豚草+柳树(36.9%，24/65)、艾蒿+猫上皮+屋尘(13.8%，9/65)、狗上皮+猫上皮+屋尘(10.8%，7/65)、艾蒿+屋尘螨+粉尘螨(6.2%，4/65，表3)。
2.4.2 变应原阳性程度分布情况
在AR患者吸入性变应原中，艾蒿以2级、3级和6级为主，屋尘和屋尘螨以1级为主，其他变应原均以2级为主(表4)。
2.4.3 不同年龄段AR患者的变应原分布情况
388例AR患者中，年龄在3~14岁、14~24岁、24~34岁、34~44岁、>44岁者分别为184例(47.4%)、86例(22.2%)、69例(17.8%)、27例(7.0%)、22例(5.7%)。艾蒿、普通豚草、猫上皮、屋尘、屋尘螨及交链孢霉6种变应原的阳性检出率在不同年龄段的分布差异有统计学意义(P<0.05，表5)。
2.4.4 不同性别AR患者的变应原分布情况
男性患者中检出的前3位变应原依次为艾蒿(91.0%，191/210)、普通豚草(49.5%，104/210)、猫上皮(25.2%，53/210)，女性患者中依次为艾蒿(88.8%，158/178)、普通豚草(37.6%，67/178)、屋尘(16.3%，29/178)。不同性别AR患者普通豚草、猫上皮、屋尘、屋尘螨及交链孢霉的阳性检出率差异有统计学意义(P<0.05)，其余变应原的阳性检出率差异无统计学意义(P>0.05)，其中男性患者普通豚草、猫上皮、屋尘及交链孢霉的阳性检出率高于女性患者，屋尘螨的阳性检出率低于女性患者(P<0.05，表6)。
2.4.5 不同地区的变应原分布情况
388例AR患者中，坝上地区165例，占42.5%，坝下地区223例，占57.5%。如表7所示，坝上地区艾蒿、普通豚草及猫上皮3种变应原的阳性检出率高于坝下地区，差异有统计学意义(P<0.05)。
2.4.6 不同地区艾蒿阳性程度的分布情况
两个地区1级、2级、5级、6级艾蒿阳性程度差异有统计学意义，其中坝下地区艾蒿阳性程度以1级、2级为主(P<0.05)，而坝上地区5级、6级构成比明显大于坝下地区(P<0.01，表8)。
2.5 张家口地区AR发病的相关因素分析
2.5.1 AR患者相关影响因素单因素分析
单因素分析结果显示，与对照组比较，AR组与对照组既往过敏史、父/母患AR、哮喘史、吸二手烟、熬夜、饲养动物、打扫房间、装修房间、进行体育锻炼、年龄等因素差异有统计学意义(P<0.05，表9)。
2.5.2 AR患者相关影响因素多因素分析
多因素logistic回归分析结果显示，过敏史、父/母患有AR、哮喘史、吸二手烟、熬夜，以及年龄3~24岁为AR发病的高危因素(P<0.05)，而经常锻炼身体为AR的有效保护因素(P<0.05，表10)。
3 讨论
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AR作为耳鼻咽喉科的常见病及多发病，在世界范围内发病率逐年增高，严重影响患者的睡眠质量及正常生活[7]。我国由于幅员辽阔，人口基数大，不同地区环境、气候及经济发展不同等原因，使得不同地区、不同性别及不同年龄段人群的吸入性变应原有一定差异。本研究对河北省张家口地区AR患者进行调查，了解该地区AR患者吸入性变应原的分布情况及发病相关危险因素，对于因地制宜地制定AR防控措施、合理管理临床资源、提高诊疗效率具有重要意义。
3.1 AR变应原分布
过敏性疾病症状的产生和变应原阳性率均与变应原暴露情况有关[8]。本研究结果显示，在388例AR患者中，艾蒿为最主要、最常见的吸入性变应原，占89.9%(349/388)，其次为普通豚草(44.1%，171/388)、猫上皮(21.4%，83/388)。有调查显示，内蒙古通辽地区的致敏原主要为蒿属花粉(21.96%)、藜科花粉(21.49%)、葎草花粉(20.06%)[9]，新疆地区阜康市的变应原主要为藜属花粉(61.58%)和艾蒿(44.09%)[10]，乌鲁木齐市的过敏原主要为蒿属花粉(20.7%)、葎草花粉(16.0%)、蒿属合并葎草花粉(8.4%)[11]，本研究结果与之一致，但不同于广州与上海地区[致敏原主要为屋尘螨(40.51%)、粉尘螨(49.00%)][12-13]。分析原因为：(1)张家口地区属于温带大陆性季风气候，具有独特的气候特点：四季分明，春季干燥、夏季炎热而短促、秋季冷暖适中、冬季长而冷，干燥的环境致使该地区螨虫、霉菌的检出率明显低于全国大部分地区及沿海城市；(2)张家口坝上地区种植了大量的蒿草及其他草本植物，显著增加了人们接触蒿类植物的机会。
季节为影响AR的因素之一，AR患者就诊高峰一般出现在春秋两季[14]。本研究结果显示，就诊的AR患者90%集中在7~9月份，其中以8月份(69.1%，268/388)为主，与秋季花粉高峰期相吻合。从中国环境监测总站获取的张家口市2019年度空气质量报告发现，PM2.5、PM10、CO、NO2、SO2、O3等6项常规检测中仅O3在不同月份之间有明显差异；袁芳[15]发现，O3与AR发病呈负相关或不相关，提示AR症状主要是由空气中的花粉引发的。但本研究在4月份并未出现AR患者的另一个就诊高峰，即春季高峰期，可能与本地区春季短且花期短、空气中花粉浓度相对较低、致使患者出现症状较轻可以用药自行缓解有关。
不同年龄段人群的主要吸入性变应原并不完全一致。本研究对9种变应原在不同年龄段AR患者中的阳性检出率进行分析发现，艾蒿、普通豚草、猫上皮、屋尘、屋尘螨及交链孢霉6种变应原的阳性检出率在不同年龄段的分布有明显差异，其中猫上皮、交链孢霉呈现明显的年轻化，主要集中在3~14岁年龄段。陈建军等[16]报道，3~9岁儿童真菌Ⅰ的阳性率明显高于其他年龄组。秦雅楠等[17]报道，猫毛、狗毛、链格孢霉菌、烟曲菌阳性患者主要集中在<18岁年龄段。既往研究报道，变应原的阳性率随年龄增长呈下降趋势[18]，与本研究结果相一致。提示随着年龄的增长、接触变应原种类的增多以及免疫系统的不断完善，机体对变应原的免疫应答不断增强。本研究发现，3~14岁年龄段疑似AR患者占38.5%(205/532)，表明一方面家长对AR疾病越来越重视，另一方面AR患者呈现年轻化。因此，需要高度重视年轻AR患者尤其是儿童AR患者的临床防治。
地理位置及覆盖植被不同致使各地区空气中致敏花粉的种类和含量存在差异。新疆地区的气传花粉以藜属花粉为主[10]，内蒙古地区以蒿属花粉为主[19]。张家口地区地理位置特殊，可分为坝上地区(张北县、沽源县、尚义县及康保县)和坝下地区，坝上地区相对坝下地区气温偏低，且因为环境治理种植了大量的蒿草及其他植被。本研究发现，9种常见的变应原中，艾蒿、普通豚草、猫上皮的阳性检出率在两个地区间存在差异，且艾蒿、普通豚草占居变应原阳性检出率前2位，为坝上地区的主要致敏原。进一步研究艾蒿阳性程度在两个地区的分布发现，坝下地区主要以1级、2级为主，坝上地区则以5级、6级为主。有研究发现，艾蒿、普通豚草花粉过敏与鼻炎症状严重程度明显相关[20]，因此，坝上地区AR患者的鼻炎严重程度高于坝下地区，提示应更加重视坝上地区AR患者的诊治工作。
本研究对性别与AR的关系进行分析发现，男性患者普通豚草、猫上皮、屋尘及交链孢霉的阳性检出率高于女性患者，屋尘螨的阳性检出率低于女性患者，其余变应原在不同性别组间无明显差异，与国内多项研究存在一定的差异[21]，考虑主要原因为地区之间的差异及受试者样本量不同。
3.2 AR发病的危险因素
AR发病是遗传因素和环境因素共同作用的结果。本研究结果显示，既往过敏史、父/母患AR、哮喘史、吸二手烟、熬夜及年龄3~24岁为AR发病的主要危险因素。宋庆均[22]指出，家族遗传史及既往过敏史是AR发病的危险因素，与本研究结果一致(OR分别为2.385、4.127)。哮喘和AR同属过敏性疾病，二者关系密切，AR通常被认为是哮喘的危险因素[23]。本研究结果显示，哮喘患者的AR发病率是非哮喘患者的6.14倍。经常熬夜会使机体抵抗力下降，经常接触二手烟会使受试者的口腔黏膜受损，这些因素都会使吸入性变应原更容易入侵呼吸道，增加AR的发病风险。经常进行锻炼可以增强自身抵抗力，为AR的有效保护因素。
综上所述，张家口地区AR患者的主要吸入性变应原为艾蒿，其次为普通豚草、猫上皮。随着年龄的增长，变应原阳性率逐渐降低。张家口地区应提高对儿童与坝上地区AR患者的重视程度。既往过敏史、父/母患AR、哮喘史、吸二手烟、熬夜及年龄3~24岁为AR发病的主要危险因素。本研究结果在一定程度上反映了张家口地区AR人群的变应原分布特征，为该地区AR的防治提供了参考依据。但本研究存在以下不足：样本量有限，不可避免地存在选择性偏倚。未来需进一步扩大样本量以探讨不同年份AR患者变应原的种类分布是否存在差异，从而更加全面地了解张家口地区AR变应原的分布情况。
基金
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  • 河北北方学院科技研究重点项目(YB2018015)
  • 河北省研究生创新资助项目(CXZZSS2021129)
文献
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参考文献 引证文献
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2021年第46卷第2期
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doi: 10.11855/j.issn.0577-7402.2021.02.07
  • 接收时间：2020-10-05
  • 首发时间：2025-12-26
  • 出版时间：2021-02-28
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  • 收稿日期：2020-10-05
  • 修回日期：2021-01-17
基金
Key Project of Science and Technology Research of Hebei North University(YB2018015)
河北北方学院科技研究重点项目(YB2018015)
Postgraduate Innovation Support Project of Hebei Province(CXZZSS2021129)
河北省研究生创新资助项目(CXZZSS2021129)
作者信息
    1河北北方学院病原生物学与免疫研究所，河北 张家口 075000
    2河北北方学院附属第一医院耳鼻咽喉头颈外科，河北 张家口 075000

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张玉妥，E-mail：
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https://castjournals.cast.org.cn/joweb/jfjyxzz/CN/10.11855/j.issn.0577-7402.2021.02.07
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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