潜在类别分析识别的分子致敏模式与伴或不伴哮喘的过敏性鼻炎患者临床表型的关联

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中文摘要

引言： 对不同过敏原组分的致敏与包括疾病表型和严重程度在内的不同临床特征相关。更好地理解个体致敏模式对于过敏患者的诊断和个性化管理非常重要。这是首批在阿尔巴尼亚患者中调查室内和室外过敏原的分子致敏模式的综合研究之一。
方法： 在地拉那开展了一项针对伴或不伴哮喘的过敏性鼻炎（AR）患者的横断面研究。患者接受了关于临床过敏史的详细访谈、皮肤点刺试验和Allergy Explorer Test 2（ALEX 2）多重阵列检测。采用潜在类别分析来识别不同的致敏特征。
结果： 分析了140例患者的数据。在我们的研究人群中得出了四个不同的致敏类别：第1类，以草花粉分子过敏原致敏为主（n=56，40%）；第2类，以屋尘螨（HDM）分子过敏原致敏为主（n=38，27.1%）；第3类，以发病机制相关第10类（PR-10）分子过敏原致敏为主（n=25，17.9%）；第4类，对多种吸入性和食物组分广泛致敏（n=21，15%）。与单纯AR相比，CL2患者患AR伴哮喘的比值比更高（OR=2.430，95% CI [1.016-5.811]，p=0.046），而CL3患者（OR=10.286，95% CI [3.334-31.731]，p<0.001）与花粉-食物过敏综合征的比值比更高相关。
结论： 在一个国家层面的患者队列中，致敏模式具有异质性，并与不同的临床表型相关。在总体研究人群中，对HDM的致敏以及持续性、重度AR与AR伴发哮喘相关。

英文摘要

INTRODUCTION: Sensitization to different allergen components is associated with distinct clinical characteristics including disease phenotypes and severity. A better understanding of the individual patterns of sensitization is important for the diagnosis and personalized management of the allergic patient. This is one of the first comprehensive studies of the molecular sensitization patterns investigating both indoor and outdoor allergens in Albanian patients.
METHODS: A cross-sectional study among patients with allergic rhinitis (AR) with and without asthma was conducted in Tirana. Patients underwent a detailed interview on clinical allergy history, skin prick testing and the Allergy Explorer Test 2 (ALEX 2) multiplex array. Latent class analysis was carried out to identify distinct sensitization profiles.
RESULTS: Data from 140 cases were analyzed. Four distinct sensitization classes were derived in our study population: Class 1, predominant sensitization to grass pollen molecular allergens (n=56,40%); Class 2, predominant sensitization to house dust mites (HDM) molecular allergens (n=38, 27.1%); Class 3, predominant sensitization to pathogenesis-related class 10 (PR-10) molecular allergens (n=25,17.9%) and Class 4, broad sensitization to multiple inhalant and food components (n=21, 15%). Patients in CL2 had higher odds of having AR with asthma compared to AR only (OR= 2.430, 95% CI [1.016-5.811], p=0.046), whereas patients in CL3 (OR=10.286, 95% CI [3.334-31.731], p<0.001) were associated with higher odds of Pollen-food allergy syndrome.
CONCLUSION: Sensitization patterns are heterogeneous within a country-level cohort of patients and are associated with distinct clinical phenotypes. In the overall study population, sensitization to HDM and persistent, severe AR were associated with AR with concomitant asthma.