高反应性鼻炎PPT课件.ppt

.,1,耳鼻咽喉头颈外科学,第二篇鼻科学及颅面疾病（3）,.,2,第十一章鼻黏膜高反应性鼻病,.,3,第一节变态反应性鼻炎,.,4,Respiratorymucosainnose,Thenasalmucosashowedbytransmi-ssionalelectromi-Croscope.,.,5,Thepictureofnormalmucosashowedbynasalendoscope,.,6,Nasalhyper-reactivity,Nasalcavity:FirstlineofairwaySensitivity:richnervedistributionMucosalcompound:respiratoryepithelialcellsGobletcellglands(serousormucous)richvessels,.,7,Immunecompound:Toll-likereceptorslymphocytes(T,B)serouscellsmastcellsepithelialcells,.,8,Responseofnoseinducedbysomefactors,Challengefactors:enviromentalWeather、temperature、humidityinhalants:Dust、allergen、chemicalspollutionmostofabove,.,9,Intrinsic:nervous、stressordisappoint、depressoranxious,.,10,NasalresponseProtective,CongestionreducepatencyoftheairwayandamountofharmfulgasandparticlestoenterairwayRhinorrheaTodischargeforeignparticlesandinflammatorymediatorsSneezerapidlyruleoutharmfulgasandparticles,.,11,hyper-reactivityofNasalmucosa,Thedifferenceofnasalmucosalreactionbetweenphysiologicandpathologiccondition,.,12,physiologicpathologicInducernervousstressimmunologic(allergy)temperaturechangesuddenlypsychologicodordustendocrineduration4days(consecutively)1hpathologicnervereflexinflammationbase（mainly)（mainly),.,13,高反应性鼻病,Definition：HyperreactiveRhinopathyissymptomicdisorderandthereactionofnasalmucosainducedbystimuliexceednormallimit,.,14,Mainincluding:AllergicRhinitisNon-allergicrhinitiscoldairinducingrhinitisendocrinerhinitisdruginducingrhinitisnonallergicallergicrhinitiswitheosinophiliavasomotorrhinitis(idiopathicrhinitis),.,15,Allergicrhinitis,.,16,AllergicrhinitisisasymptomaticdisorderofthenoseinducedafterallergenexposurebyanimmunoglobulinE(IgE)-mediatedinflammationofthemembranesliningthenose,DifinitionofAllergicrhinitis,.,17,Keypointofthedifinition,SusceptibleindividualInducedbyallergenexposureIgEmediatedmainlyNasalmucosainfalmmationMainsymptomsincludesneeze,rhinorrheaandobstruction,.,18,allergen,Pollen:tree,grass,cropplant,.,19,fugi,.,20,dustmite,.,21,petdander,.,22,Mechanismofallergicinflammation-Th2response,.,23,IL-4,变应原,IgE,IL-4,IL-5,释放炎症介质毒性蛋白细胞因子,释放炎症介质和细胞因子,Eo,变应性鼻炎免疫学机制以Th2反应为主的免疫性疾病,嗜酸性粒细胞,肥大细胞和嗜碱性粒细胞,速发反应（EarlyPhaseReaction）,迟发反应（LatePhaseReaction）,抗原提呈细胞,.,24,Symptoms,Nasalobstruction,Symptoms1hrdaylyLasting4dsweekly,.,25,sneeze,.,26,Noserunning,.,27,.,28,Pale-edemamucosa,.,29,Noseitch,.,30,Howarethesymptomscaused?,Irritationoffreenerveendings-ItchingandsneezingIncreasedmucusproduction-RhinorrhoeaVasodilation-MucosacongestionIncreasedvascularpermeability-Mucosaoedema,.,31,Relationshipbetweenupandlowairway,MorbidityofasthmainPatientswithallergicrhinitisis3timesmorethanonewhonoallergicrhinitis20%ofchildrenwithallergicrhinitiswilloccurasthmainlifelate,.,32,Relationshipbetweenupandlowairway,.,33,Mucosalinflammationispresentintheentireairwayofpatientswithallergicrhinitisand/orasthma.UpperairwayinflammationisassociatedwithbronchialhyperresponsivenessLowerairwayremodelingispresentinasthmatic,butalsoinallergicrhinitispatients.,Relationshipbetweenupandlowairway,.,34,Allergicrhinitisandasthmaarecharacterizedbyaninflammatoryprocessthatismarkedhistologicallybytissueeosinophils,mastcells,Tlymphocytes,macrophages,andepithelialcells.,.,35,inflammation,.,36,ImportantConcept,Oneairway,Onedisease,Growsman-1997,.,37,Worldwideprevalence,.,38,PrevalenceofAllergicrhinitisinCHINA（2007）,.,39,IncreasingprevalenceofAR,Thecausemaybeassociatedwithfactorsasfollows:Airpollution:exhaustparticle;ozone,NO2(nitrogendioxide),SO2(sulfurdioxide)Lifestyle:unsaturatedacidHyper-Hygiene,.,40,TheimpactofARonqualityofLive,Qualityoflive(QOL):Sleepingworkstudyentertainmentsocialcommunicationsystemicfelling,.,41,AllergicrhinitisandItsimpactonasthma（2008）theWHOGuideline:,Allergicrhinitisisaglobalhealthproblemthatcausesmajorillnessanddisabilityworldwide.Itaffectssociallife,sleep,schoolandwork.,.,42,Bothallergicrhinitisandasthmaaresystemicinflammatoryconditionsandareoftenco-morbidities.Theecon