广州医学院：《头颈外科学》课程PPT教学课件（讲稿）第七讲 变应性鼻炎

Allergic rhinitis变应性鼻炎 Lai he赖荷 E NT department The second affiliated hospital Guangzhou medical college 广医二院耳鼻咽喉教研室

Allergic Rhinitis变应性鼻炎 Lai he 赖荷 E.N.T department The second affiliated hospital Guangzhou medical college 广医二院耳鼻咽喉教研室

General information 1. Definition定义 Allergic rhinitis can be defined as a disease giving rise to two or three of the following symptoms: sneezing attacks serous hypersecretion(高分泌)and nasal blockage due to a swollen nasal mucosa 2 Morbidity(发病率)10%-40%

General information 1. Definition定义 Allergic rhinitis can be defined as a disease giving rise to two or three of the following symptoms: sneezing attacks serous hypersecretion（高分泌） and nasal blockage due to a swollen nasal mucosa. 2.Morbidity （发病率） 10%-40%

General information 3 Classification分类 Perennial allergic rhinits常年性变应性鼻炎 Seasonal allergic rhinitis季节性变应性鼻炎 pollinosis) 4 Atopic type特应型个体 It is a individual who brings the genes which have relation with allergic rhinitis(familial or hereditary nature 带有与变应性鼻炎发病有关的基因的个体

General information 3.Classification 分类 Perennial allergic rhinits 常年性变应性鼻炎 Seasonal allergic rhinitis 季节性变应性鼻炎 ( pollinosis) 4.Atopic type特应型个体 It is a individual who brings the genes which have relation with allergic rhinitis (familial or hereditary nature) 带有与变应性鼻炎发病有关的基因的个体

Pathophysiology病理生理 I type allergy一型变态反应 It is an inflammatory disorder characterized by an immunoglobulin E(gE)mediated hypersensitivity to allergens 由gE介导的机体对变应原超敏反应而引 起的炎症性损害

Pathophysiology病理生理 Ⅰtype allergy 一型变态反应 It is an inflammatory disorder characterized by an immunoglobulin E(IgE) mediated hypersensitivity to allergens 由IgE介导的机体对变应原超敏反应而引 起的炎症性损害

Pathophysiology病理生理 1. Sensitization致敏 contact Antigens 一 Respiratory mucosa呼吸道粘膜 activate CD4+ T Lymphocyte Th2 cell secrete Deliver signal IL4,L-5,IL-6,-10,-13( Mediators炎症介质) ↓ activate B cell Hemaendotheliocyte血管内皮细胞 ICAM-1( intercellular adhesion molecule1胞间粘附分子-1) produce attach Eosinophil嗜酸细胞 IgE Mast cell肥大细胞 go to nasal mucosa receptor on basophil嗜碱细胞 T lymphocyte淋巴细胞

Pathophysiology病理生理 1.Sensitization 致敏 contact Antigens Respiratory mucosa 呼吸道粘膜 activate CD4+ T Lymphocyte Th2 cell secrete Deliver signal IL-4,IL-5,IL-6,IL-10,IL-13 (Mediators炎症介质) activate B cell Hemaendotheliocyte 血管内皮细胞 ICAM-1(intercellular adhesion molecule-1细胞间粘附分子-1) produce attach Eosinophil嗜酸细胞 IgE Mast cell 肥大细胞 go to nasal mucosa receptor on basophil嗜碱细胞 T lymphocyte淋巴细胞

Pathophysiology病理生理 2. Allergy contact nasal Antigen bridging of antigen molecule and lgE mucosa again mast cell derganulation脱颗粒 release Histamine组织胺 and other mediators contraction of high excitability increasing in hypersensitivity resistant vessel parasympathetic vascular permeability of sensory nerve dilatation of nerve副交 通透性 感觉神经 capacity vessel 感神经 阻力血管收缩和 容量血管扩张 Increasing mucosal nasal itching pale &purple glandulous secretion edema sneezing Nasal mucosa 粘膜水肿 鼻痒、打喷嚏 blockage watery discharge

Pathophysiology病理生理 2. Allergy contact nasal Antigen bridging of antigen molecule and IgE mucosa again mast cell derganulation 脱颗粒 release Histamine 组织胺 and other mediators contraction of high excitability increasing in hypersensitivity resistant vessel parasympathetic vascular permeability of sensory nerve & dilatation of nerve 副交 通透性 感觉神经 capacity vessel 感神经 阻力血管收缩和 容量血管扩张 increasing mucosal nasal itching pale &purple glandulous secretion edema sneezing Nasal Mucosa 粘膜水肿 鼻痒、打喷嚏 blockage watery discharge

Clinical presentation临床表现 1. nasal itching sometimes itching of eyes 鼻痒 conjunctival injection结膜充血 2. Sneezing attacks阵发性打喷嚏 3. Nasal discharge流涕 watery 4. Nasal blockage鼻塞 5. Hyposmia嗅觉减退

Clinical Presentation 临床表现 1. nasal itching sometimes itching of eyes 鼻痒 conjunctival injection 结膜充血 2. Sneezing attacks 阵发性打喷嚏 3. Nasal discharge 流涕 watery 4. Nasal blockage 鼻塞 5. Hyposmia 嗅觉减退

Examination检查 1.Nasal examination: light blue, congestive 鼻腔检查 or pale mucosa. mucosal edema水肿 especially inferior turbinate 下鼻甲 2.Nasal discharge exam: a lot of eosinophil 鼻分泌物 嗜酸细胞 3. Serum total IgE determination 血清总IgE检查

Examination 检查 1.Nasal examination: light blue , congestive 鼻腔检查 or pale mucosa, mucosal edema 水肿 especially inferior turbinate 下鼻甲 2.Nasal discharge exam: a lot of eosinophil 鼻分泌物 嗜酸细胞 3.Serum total IgE determination 血清总IgE检查

Examination 2. Finding allergen寻找抗原 commom allergen: page 58 Perennial: house dust屋尘;mite螨虫 fungus真菌;poln花粉 chemical material Seasonal: pollen( sun flower, corn glass)

Examination 2. Finding allergen 寻找抗原 commom allergen: page 58 Perennial: house dust 屋尘；mite 螨虫 fungus真菌；pollen 花粉 chemical material Seasonal: pollen ( sun flower,corn ,glass)

Examination检查 2. Finding allergen寻找抗原 a. Special IgE examination特异性lgE检查 ① Skin testing: prick test点刺试验 Intracutaneous test皮内试验 ② Serum special IgE determination血清特异性IgE检查 b. Nasal allergen challenge test鼻激发实验

Examination检查 2. Finding allergen 寻找抗原 a. Special IgE examination 特异性IgE检查 ①Skin testing: prick test 点刺试验 intracutaneous test 皮内试验 ② Serum special IgE determination 血清特异性IgE检查 b. Nasal allergen challenge test 鼻激发实验