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以下鼻甲外觀變化鑑別診斷過敏性鼻炎及血管運動性鼻炎

The Changes of Interior Inferior Turbinate Appearance in Differential Diagnosis of Allergic Rhinitis and Vasomotor Rhinitis

摘要


背景:過敏性鼻炎與血管運動性鼻炎患者分別具有不同的下鼻甲黏膜變化。本研究希望瞭解以此種變化來鑑別診斷過敏性鼻炎與血管運動性鼻炎的可信度有多高?是否具有臨床價值? 方法:自民國83年1月至12月對澎湖地區7599名國小學童,其中3941名男性、3658性女性,年齡由7歲至14歲,進行本項研究。經疑似病例分組及對照組選定後,以前鼻鏡檢視下鼻甲黏膜變化,並以此為變項來探討不同鼻黏膜變化(紅色無腫脹、蒼白無腫脹、蒼白且腫脹、蒼白腫脹且有水性分泌物及藍色鼻黏膜)對過每性鼻炎及血管運動性鼻炎的診斷程度及血清全IgE濃度。 結果:不同鼻黏膜變化對診斷過每性鼻炎及血管運動性鼻炎的敏感度階低,但專一度及陽性預測值則非常高。陽性預測值較具有臨床價值,由本研究可知:當吾人以前鼻鏡檢發現為蒼白無腫脹的下鼻甲黏膜時,有78.6%的可能性推論此為罹患過每性鼻炎的學童;發現為蒼白且腫脹的下鼻甲黏膜時,則有91.6%的可能性可推論此為罹患過敏性鼻炎的學童;發現為蒼白腫脹且合併水性分泌物的下鼻甲黏膜時,則有98.4%的可能性可推論此為罹患過敏性鼻炎的學童;而當發現為藍色的下鼻甲黏膜時,則有72.1%的可能性可推論此為罹患血管運動性鼻炎的學童。此外,當下鼻甲黏膜變化愈明顯時,其血清全IgE農度也愈高。 結論:低敏感度懷不宜以下鼻甲黏膜變化作為過敏性鼻炎及血管運動性鼻炎的篩選工具,但高陽性預測值則使得下鼻甲黏膜變化的確可作為過敏性鼻炎及血管運動性鼻炎的鑑別診斷之用。

並列摘要


Background: The inferior turbinate appearance of allergic rhinitis patients is different from that of vasomotor rhinitis ones. The aim of our study was to determine whether such mucosal changes could be a valuable criteria for differentiating allergic from vasomotor rhinitis. Methods: From Jan. 1994 to Dec. 1994, 7599 school children, including 3941 boys and 3658 girls, ranging in age from 7 to 14 years old were included in our study. After classifying suspicious cases and selecting control cases based on Mullarkey’s criteria, we examined and recorded inferior turbinate mucosal changes using anterior rhinoscopy. The results were used as variables for diagnostic differentiation of allergic rhinitis and vasomotor rhinitis patients and the average of total serum IgE concentrations (in 95% C.I.) represented under different inferior turbinate mucosal changes. Results: The sensitivities of these tests were low, but specificities and positive predictive values were high. According to the positive predictive values from the results, a 78.6% possibility for allergic rhinitis was shown in patients with pale inferior turbinate mucosa, a 91.6% possibility in patients with pale and swollen mucosa, a 98.4% possibility in patients with pale, swollen turbinate and watery rhinorrhea, and a 72.1% possibility for vasomotor rhinitis in patients with lightly bluish mucosa. In addition, the most obvious change occurred in inferior turbinate mucosa which also showed the highest total serum IgE concentration. Conclusion: Low sensitivity indicates that these tests are not available for screening. However, a high positive predictive valus proved that the changes of inferior turbinate appearance can be used on differentiating criteria in clinical diagnoses of allergic rhinitis and vasomotor rhinitis. As more obvious changes occurred, the possibility to conclude the presence of allergic rhinitis increased.

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