结核菌素反应与伴有鼻炎及遗传性过敏的成人哮喘发生不相关
2008/06/06
为探索伴有鼻炎及遗传性过敏的成人哮喘的病情与结核菌素反应性试验间是否具有一定相关性。Jing Li等人对214个合并鼻炎的中重度哮喘病人以及220个正常志愿者进行了包括病史、胸部影像学、过敏原皮肤试验（SPT）、牛结核分支杆菌卡介菌菌株鉴别、纯化蛋白衍生物（PPD）结核菌素试验、血清总IgE 及特异性IgE 检测以及支气管激发试验（组胺激发剂量以能降低20% FEV1为准[PD20]）等一系列指标对比。结果发现满足皮肤试验结果至少有一项为阳性的，鼻炎－哮喘患者的发病比例 (168例，78.5%) 比健康人高得多(31例，14.1%) (p < 0.0001)。在任何一组中，卡介菌的表现和卡介苗接种史对遗传性过敏都没有显著影响。是否伴有遗传性过敏与PPD阳性率无明显差异。多因素logistic回归分析显示，结核菌素反应与屋尘螨(DP)和粉尘螨(DF)的血清总IgE或特异性IgE水平之间，以及皮肤对DP和DF的反应性与PD20之间都不存在相关性。
总之没有发现皮肤结核菌素反应与血清总IgE或logPD20之间有明显相关性。Jing Li的研究证明了有过敏性鼻炎及过敏的成人支气管哮喘与结核感染史、结核菌素反应之间没有相关性。并且提出儿童通过皮下接种卡介苗以预防特应性疾病的保护措施可能仅局限用于在大量细胞免疫调节还存在的儿童早期。
（于娜 中国医科大学附属第一医院呼吸内科 110001 摘择）
(Chest.2008 Jan;133(1):100-106)
Absence of relationships between tuberculin responses and development of adult asthma with rhinitis and atopy.
Li J, Zhou Z, An J, Zhang C, Sun B, Zhong N.
OBJECTIVE: To investigate the relationship between tuberculin skin responses and the development of adult asthma, rhinitis, and atopy.
METHODS: Two hundred fourteen patients with mild-to-moderate asthma accompanied with rhinitis and 220 normal volunteers underwent a medical history, chest radiography, allergen skin-prick testing (SPT), bovine Mycobacterium tuberculosis vaccine (BCG) scar identification, purified protein derivative (PPD) tuberculin skin testing, serum-total and serum-specific IgE measurements, and bronchial provocation (provocative dose of histamine causing a 20% fall in FEV(1) [PD(20)]).
RESULTS: Thirty-one normal volunteers (14.1%) and 168 asthma-rhinitis subjects (78.5%) had one or more positive skin test results (p < 0.0001). Neither the presence of a BCG scar nor a history of BCG vaccination had a significant effect on atopy in either group. The rate of PPD positivity had no statistical difference between atopy and nonatopy in both groups. In multivariate logistic regression analysis, the odds ratio for tuberculin reactivity was not related to the level of serum-total IgE nor to the level of serum-specific IgE to Dermatophagoides pteronyssinus (DP) and Dermatophagoides farinae (DF), skin response to DP and DF, and PD(20). Overall, no significant correlations were found between tuberculin skin reactivity and log serum-total IgE or PD(20).
CONCLUSION: There is no relationship between history of tuberculosis infection, tuberculin responses, and development of adult bronchial asthma, allergic rhinitis, and atopy. Our study suggests that the protection provided by intradermal BCG vaccination in infants to prevent atopic diseases may be limited in early childhood, when a substantial memory of cellular immune modulation still exists.
Key Words: adult • asthma • atopy • purified protein derivative skin test • rhinitis • tuberculosis infection
(Chest. 2008 Jan;133(1):100-6)
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血小板活化因子、血小板活化因子乙酰水解酶和严重过敏反应
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成人哮喘、鼻炎以及遗传性过敏症的病情严重程度与结核菌素反应性试验的相关性报告
