变应性鼻炎课件

AllergicRhinitis变应性鼻炎Laihe赖荷E.N.TdepartmentThesecondaffiliatedhospitalGuangzhoumedicalcollegeGeneralinformationDefinition定义Allergicrhinitiscanbedefinedasadiseasegivingrisetotwoorthreeofthefollowingsymptoms:sneezingattacksseroushypersecretion（高分泌）andnasalblockageduetoaswollennasalmucosa.2.Morbidity（发病率）10%-40%Generalinformation3.Classification分类Perennialallergicrhinits常年性变应性鼻炎Seasonalallergicrhinitis季节性变应性鼻炎(pollinosis)4.Atopictype特应型个体Itisaindividualwhobringsthegeneswhichhaverelationwithallergicrhinitis(familialorhereditarynature)

带有与变应性鼻炎发病有关的基因的个体Pathophysiology病理生理1.Sensitization致敏contactAntigensRespiratorymucosa呼吸道粘膜activateCD4+TLymphocyteTh2cellsecreteDeliversignalIL-4,IL-5,IL-6,IL-10,IL-13(Mediators炎症介质)activateBcellHemaendotheliocyte血管内皮细胞

ICAM-1(intercellularadhesionmolecule-1细胞间粘附分子-1)produceattachEosinophil嗜酸细胞IgEMastcell肥大细胞gotonasalmucosareceptoronbasophil嗜碱细胞Tlymphocyte淋巴细胞

Pathophysiology病理生理2.Allergy

contactnasalAntigenbridgingofantigenmoleculeandIgEmucosaagainmastcellderganulation脱颗粒releaseHistamine组织胺andothermediators

contractionofhighexcitabilityincreasinginhypersensitivityresistantvesselparasympatheticvascularpermeabilityofsensorynerve&dilatationofnerve副交通透性感觉神经capacityvessel感神经阻力血管收缩和容量血管扩张increasingmucosalnasalitchingpale&purpleglanduloussecretionedemasneezingNasalMucosa粘膜水肿鼻痒、打喷嚏blockagewaterydischargeClinicalPresentation临床表现nasalitchingsometimesitchingofeyes

鼻痒conjunctival

injection结膜充血2.Sneezingattacks阵发性打喷嚏3.Nasaldischarge流涕watery4.Nasalblockage鼻塞5.Hyposmia

嗅觉减退

Examination检查1.Nasalexamination:lightblue,congestive

鼻腔检查orpalemucosa,mucosaledema水肿especiallyinferiorturbinate

下鼻甲2.Nasaldischargeexam:alotofeosinophil

鼻分泌物嗜酸细胞3.SerumtotalIgEdetermination

血清总IgE检查Examination检查2.Findingallergen寻找抗原a.SpecialIgEexamination特异性IgE检查

①Skintesting:pricktest点刺试验intracutaneoustest皮内试验②SerumspecialIgEdetermination血清特异性IgE检查b.Nasalallergenchallengetest鼻激发实验

DifferentialDiagnosis鉴别诊断1.Nonallergicrhinitiswitheosinophilia

嗜酸粒细胞增多性非变应性鼻炎2.Vasomotorrhinitis

血管运动性鼻炎Treatment治疗1.Pharmacotherapy

药物治疗a.Steroid

:topical—nasalspray

鼻喷雾剂类固醇general

全身用药b.Antihistamines:H1-receptorantagonistH1受体拮抗剂

抗组胺药First-generation第一代:toldrin朴尔敏second-generation:clarity(don’tcrosstheblood-第二代brainbarrier

不能通过血脑屏障)c.Mastcellstabilizingdrug:disodiumcromoglycate

肥大细胞膜稳定剂色甘酸钠Treatment治疗d.Decongestants血管减充剂typical:shortterme.Anticholinergicdrug:抗胆碱药f.Others:reducesensitivityofnasalmucosainferiorturbinate---lazar,crymotherapy冷冻microwave微波surgery:vidianneurectomy翼管神经切断术

手术anteriorethmoidneurectomy筛前神经切断术submucousresectionofnasalseptum

鼻中隔矫正术Treatment治疗2.Avoidtocontactallergen避免接触变应原3.Immunotherapy免疫治疗

Indication:

IgE-mediateddisease(Ⅰtypeallergy)causedby

适应症inhalantallergenMethod:increasingdosesofallergenareinjecteduntil

方法themaximumtolerabledoseisreachedmaintenancedose(maximumtolerabledose)

最大耐受剂量Course:2yearsormore

疗程

Immunotherapy免疫治疗

Mechanism作用机理

:unclearblockingantibody封闭抗体balancebetweenTh1andTh2

Rushimmunotherapy:pollinosis花粉症

快速免疫疗法

1-2weeksreachmaximumtolerabledose(maintenancedose)

referencesTian

yong-quanetal,otolaryngology5thedition,textbookofseriesofnewcentury,2001.Niels

mygindetal