无哮喘青少年过敏性鼻炎病程与小气道功能障碍：一项横断面脉冲振荡研究

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中文摘要

目的： 过敏性鼻炎（AR）是一种黏膜炎症性疾病，日益被视为统一气道框架的一部分，但在无哮喘的青少年中，随着AR持续存在，下气道功能是否恶化仍不清楚。我们使用脉冲振荡（IOS）来检验AR病程与小气道功能之间的关系，并检测血清内皮素（endocan，内皮细胞特异性分子-1），其与AR中气道功能的关系尚不明确，作为候选全身生物标志物。
方法： 40名未接受过治疗、对气传过敏原致敏的AR青少年（12-17岁）和37名年龄和性别相当的非特应性对照者接受了IOS、血清endocan测定（ELISA）、特异性IgE检测和皮肤点刺试验。症状采用视觉模拟量表评分，核心IOS指标以年龄和性别校正的z评分表示。
结果： 患者与对照之间没有任何IOS参数存在差异。然而，较长的AR病程与较高的总气道阻力（zR5：r = 0.323，p = 0.042）和较低的电抗（zX5：r = -0.502，p < 0.001）相关；特异性IgE也随年龄、病程和严重程度而增加。患者与对照的血清endocan水平相似（中位数200.8 vs 218.8 ng/mL；p = 0.517），并且在AR组内，endocan与严重程度、持续性或IOS参数均不相关。
结论： 更严重的振荡法小气道功能障碍与更长的AR病程相关，支持使用IOS评估长期AR青少年的下气道功能。血清endocan不能区分患者与对照；由于未进行配对气道采样，AR中是否存在任何endocan信号仅限于气道黏膜仍属推测。

英文摘要

OBJECTIVE: Allergic rhinitis (AR) is a mucosal inflammatory disease increasingly viewed within a united-airway framework, yet whether lower-airway function deteriorates as AR persists in adolescents without asthma remains unclear. We used impulse oscillometry (IOS) to examine the relationship between AR duration and small-airway function, and examined serum endocan (endothelial cell-specific molecule-1), whose relationship to airway function in AR is unknown, as a candidate systemic biomarker.
METHODS: Forty treatment-naïve, aeroallergen-sensitized adolescents (12-17 years) with AR and 37 non-atopic controls of comparable age and sex underwent IOS, serum endocan measurement (ELISA), specific IgE testing, and skin prick testing. Symptoms were scored on a visual analog scale, and core IOS indices were expressed as age- and sex-adjusted z-scores.
RESULTS: No IOS parameter differed between patients and controls. However, longer AR duration was associated with higher total-airway resistance (zR5: r = 0.323, p = 0.042) and lower reactance (zX5: r= -0.502, p < 0.001); specific IgE also increased with age, duration, and severity. Serum endocan levels were similar in patients and controls (median 200.8 vs 218.8 ng/mL; p = 0.517) and, within the AR group, did not correlate with severity, persistence, or IOS parameters.
CONCLUSIONS: Greater oscillometric small-airway dysfunction was associated with longer AR duration, supporting the use of IOS to assess lower-airway function in adolescents with long-standing AR. Serum endocan did not distinguish patients from controls; because paired airway sampling was not performed, whether any endocan signal in AR is confined to the airway mucosa remains speculative.