改善過敏性鼻炎兒童黑眼圈之臨床研究

Study on nasal treatment on the levels of allergic shiners in children with allergic rhinitis

楊政宗(Cheng-Tsung Yang)

指導教授 ： 江伯倫

國立臺灣大學/醫學院/臨床醫學研究所/碩士(2022年)

https://doi.org/10.6342/NTU202202158

摘要

研究背景：黑眼圈的形成是由於血液或體液積累在眼睛下緣之上頜骨眶下溝。成因有許多，如鼻塞、鼻子發炎、眼睛發炎、臉部受傷或手術、和腫瘤形成等。在有過敏性鼻炎的兒童臉上，因為鼻塞造成靜脈回流不暢通，導致黑眼圈形成。過敏性黑眼圈（Allergic shiners）最早在1954年由Marks學者提出，在1963年，Marks更指出長期有過敏性鼻炎的兒童，會有更明顯的過敏性黑眼圈。此後，過敏性黑眼圈更廣泛地被視為在過敏性鼻炎兒童身上的一種重要的臨床表現。在2009年，台大醫院江伯倫教授和團隊率先創制以數位化影像和程式分析的方式去評估黑眼圈，並證實黑眼圈的顏色深淺和範圍大小與過敏疾病（如氣喘、過敏性鼻炎和異位性皮膚炎等）的嚴重度有相關。然而，有關過敏性鼻炎兒童在接受治療之後的黑眼圈變化的資料相當稀少。本研究首要目標是探討過敏性鼻炎的患童，在接受過敏性鼻炎的治療之後，其黑眼圈的顏色深淺和範圍大小是否也可以改善。次要目標是比較哪種過敏性鼻炎的治療能最有效地改善黑眼圈。
研究方法：招募6歲至12歲有中重度過敏性鼻炎的患童，並隨機分派至三組實驗組。第一組患童接受口服抗組織胺的治療，第二組接受合併類固醇鼻噴劑和口服抗組織胺的治療，第三組接受合併類固醇鼻噴劑和口服抗組織胺以及一週的血管收縮鼻噴劑的治療。在治療前和治療後的第七天、第十四天和第二十八天，受試兒童會接受標準化的數位影像拍攝，並回答兒童鼻結膜炎生活品質調查問卷（Pediatric Rhinoconjunctivitis Quality of Life Questionnaire， PRQLQ）。同時受試兒童的年齡、性別、有無合併其他過敏疾病、過敏性鼻炎的臨床症狀和嚴重度、相關的實驗室數據也會一併記錄。數位影像中的黑眼圈顏色深淺和範圍大小是交由無法獲知受試兒童資料的獨立研究人員分析。治療前後的資料在經過整理後，會進一步的分析和探討。
研究結果：從2020年1月至2022年4月，共有59位兒童參與研究。其中15位被分派至第一實驗組、11位至第二組、18位至第三組，並有15位患童被排除。針對首要研究目標，整體而言，過敏性鼻炎的治療不但能改善過敏性鼻炎，還能同時改善黑眼圈的大小。在治療後的28天，治療前後的黑眼圈的面積（the average area values of shiners，Aave）分別為1.32和1.13 cm2/m2（P = 0.016），有達到統計學上的差異。有關次要研究目標的結果，合併使用類固醇鼻噴劑和口服抗組織胺有或無再搭配一週的血管收縮鼻噴劑的治療可以有效縮小黑眼圈的面積大小。在第二實驗組，治療前為1.81 cm2/m2，治療後第28天為1.17 cm2/m2（P = 0.006）；在第三實驗組，治療前為1.25 cm2/m2，治療後第7天為0.95 cm2/m2（P = 0.021）。在群間比較的部分，在28天的治療之後，合併使用類固醇鼻噴劑和口服抗組織胺比單純只使用口服抗組織胺能更有效地使黑眼圈變小（Aave –0.35 cm2/m2, 95% CI, –0.67 to –0.03, P = 0.030）。另外，藥物醫囑遵從性好的受測兒童，其治療後黑眼圈大小改善的程度也比較好。在分派到合併使用類固醇鼻噴劑和口服抗組織胺治療的患童，若其藥物醫囑遵從性高，則其治療後的黑眼圈大小也會縮小比較多，彼此呈現中等程度的負相關（r = –0.402, P = 0.002）。此外，黑眼圈範圍大小的改善，也跟過敏性鼻炎鼻子症狀的改善呈現低度的正相關（r = 0.209, P = 0.028）。
結論：兒童過敏性鼻炎的治療，除了能改善過敏性鼻炎，也能改善黑眼圈大小。合併使用類固醇鼻噴劑和口服抗組織胺，能夠更有效地改善黑眼圈的大小。

關鍵字

過敏性鼻炎 ； 數位分析技術 ； 類固醇鼻噴劑 ； 黑眼圈

並列摘要

Background: Allergic shiners are caused when blood and other fluids accumulate in the infraorbital groove. The correlation between the darkness and area values of allergic shiners and the severity of allergic rhinitis was documented. But no data revealed the reduction of allergic shiners after the relief of allergic rhinitis. The study aims to investigate whether the levels of allergic shiners could be alleviated by the treatments for children with allergic rhinitis.
Methods: Children aged from 6 to 12 years old with moderate-severe allergic rhinitis were randomly assigned into three groups, including an oral antihistamine (OAH) alone group (group I), the combined a nasal corticosteroids (NCS) with an OAH group (group II), and the combined an NCS with an OAH plus a one-week nasal decongestant (ND) group (group III). A standardized digital photograph and the Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ) were recorded at the beginning of the treatment, and on the 7th day, 14th day, and 28th day after treatment. The baseline levels of allergic shiners were compared with the data after treatment.
Results: Fifty-nine children were recruited between Jan. 2020 to Apr. 2022, and fifteen were excluded or withdrawn. The remaining fifteen, eleven, and eighteen were assigned into group I, group II, and group III, respectively. Overall, nasal therapies improved the symptoms of allergic rhinitis as well as the area values of allergic shiners (Aave 1.32 vs 1.13 cm2/m2, P = 0.016) 28 days after treatment. In addition, the combined an NCS and an OAH with or without a one-week ND shrank allergic shiners remarkably (Aave 1.81 vs 1.17 cm2/m2, P = 0.006, in group II, on the 28th day after treatment; Aave 1.25 vs 0.95 cm2/m2, P = 0.021 in group III, on the 7th day after treatment, respectively). When compared with an OAH alone, the combined an NCS with an OAH was more efficacious in lessening allergic shiners (Aave –0.35 cm2/m2, 95% CI, –0.67 to –0.03, P = 0.030) 28 days after treatment. The reduction of the area values of allergic shiners disclosed a moderate correlation with the good adherence to the combined an NCS with an OAH (r = –0.402, P = 0.002), and a weak relationship between the improvement of nasal symptoms of allergic rhinitis (r = 0.209, P = 0.028).
Conclusion: Nasal therapies alleviated not only the symptoms of allergic rhinitis but also the levels of allergic shiners in children. The application of a combination therapy is reasonable to provide a satisfying outcome in the clinic.

並列關鍵字

allergic rhinitis ； digital-analyzed tool ； nasal corticosteroids ； allergic shiners ； infraorbital dark circles

參考文獻

1. Chen CH, Lin YT, Wen CY, et al. Quantitative assessment of allergic shiners in children with allergic rhinitis. J Allergy Clin Immunol, 2009. 123(3): p. 665-71, 671.e1-6.

2. Marks MB. Allergic shiners. Dark circles under the eyes in children. Clin Pediatr (Phila), 1966. 5(11): p. 655-8.

3. Friedmann DP, Goldman MP. Dark circles: etiology and management options. Clin Plast Surg, 2015. 42(1): p. 33-50.

4. Shah-Desai S, Joganathan V. Novel technique of non-surgical rejuvenation of infraorbital dark circles. J Cosmet Dermatol, 2021. 20(4): p. 1214-20.

5. Barone CR, Boza JC, Machado PG, et al. Association between clinical characteristics, quality of life, and sleep quality in patients with periorbital hyperchromia. J Cosmet Dermatol, 2019. 18(1): p. 230-5.