不同类型鼻炎对下气道炎症的影响

摘要

Objective To describe the effects of allergic and nonallergic rhinitis on patients with bronchial inflammation by comparing the bronchial inflammation characteristics . Methods All patients enrolled in the study were categorized into two groups according to rhinitis diagnostic criteria , 377 cases in the allergic rhinitis ( AR) group, 262 cases in non-allergic rhinitis ( NAR) group and another 264 patients without rhinitis as control group .Induced sputum differential cytology tests , exhaled nitric oxide concentration measurements and methacholine bronchial provocation tests were performed .The characteristics and differences in lower airway inflam-mation among the three groups were compared . Results The exhaled nitric oxide level and the positive rate of the exhaled nitric ox-ide were different significantly in AR group and NAR group than the control group (P<0.05);Bronchial provocation positive rate was 12.20%in AR group, and 6.10%in the NAR group, the difference was significant (P<0.05), and the levels in the two groups were significantly higher than the control group (P<0.05).AR group and NAR group has a significant different (P<0.05) propor-tions of eosinophil in induced sputum , while the positive rate of eosinophil in induced sputum was not different significantly ( P >0.05). Conclusion Bronchial inflammation may be aggravated by AR and NAR , so all patients with AR and NAR need treatment , and the degree of inflammation was higher in AR patients than the NAR patients .%目的：慢性鼻炎临床上分为可明确过敏原的变应性鼻炎和过敏原不明确的非变应性鼻炎。文中探求不同类型鼻炎对下气道炎症影响的差异，以利于更好地认识并干预不同类型鼻炎对于下气道炎症的影响。方法收集2010年1月至12月初次在南京军区南京总医院耳鼻咽喉-头颈外科就诊的鼻炎患者共639例。依据鼻炎诊断标准将受试者分为变应性鼻炎（allergic rhinitis， AR）组377例、非变应性鼻炎（nonallergic rhinitis， NAR）组262例，以及264例无鼻炎症状患者作为健康对照组。分别进行乙酰甲胆碱支气管激发试验、呼出气一氧化氮及诱导痰炎症细胞分类检测，明确不同类型鼻炎患者下气道炎症的特征和差异。结果 AR组和NAR组患者FeNO阳性率的差异有统计学意义（37．93％vs 20．99％， P＜0．05）；支气管激发试验阳性率的差异有统计学意义（12．20％vs 6．10％， P＜0．05）；诱导痰EOS计数差异有统计学意义[2．00（0．25，7．10） vs 0．50（0．00，1．71）， P＜0．05]，但诱导痰阳性率差异无统计学意义（P＞0．05）。结论 AR和NAR均可能加重患者的下气道嗜酸细胞炎症和气道高反应性，需要进行治疗和干预，而AR对下气道炎症的影响比NAR作用更强。