Eur Arch Otorhinolaryngol:常被误诊为过敏性鼻炎的无症状过敏原致敏伴鼻中隔偏曲的临床特征

2021-03-07 AlexYang MedSci原创

过敏性鼻炎(AR)通常是通过症状且伴有过敏原敏感性测试阳性结果来确定。然而,皮刺试验(SPT)阳性并不总是意味着发生临床症状。如果一个无症状的过敏原敏感患者有鼻中隔偏曲(DSN),且可能会引起鼻腔阻塞

过敏性鼻炎(AR)通常是通过症状且伴有过敏原敏感性测试阳性结果来确定。然而,皮刺试验(SPT)阳性并不总是意味着发生临床症状。如果一个无症状的过敏原敏感患者有鼻中隔偏曲(DSN),且可能会引起鼻腔阻塞,这种情况很容易与典型的症状性AR相混淆

最近,有研究人员调查了无症状过敏原敏感伴鼻中隔偏曲(ASSD)的临床和实验室特征

研究人员对8所大学医院进行的全国AR队列研究的患者进行了调查。当至少有1个鼻炎症状且SPT结果为阳性时,即诊断为AR。ASSD组包括有严重鼻阻塞,其他症状少,且SPT阳性,同时伴有鼻中隔偏曲。研究人员比较了ASSD组和真性AR组的临床和实验室特征。研究共包括了728名患者,平均年龄为32.2±12.7岁。结果发现,66%的患者有DSN。SPT表明,ASSD患者对屋尘螨的敏感度较低(Dp的P=0.019,Df的P=0.021)。ASSD组的男女比例高于AR组(3.59 vs. 1.77,p=0.012)。然而,在年龄、家族史和体重指数方面没有发现有统计学意义的差异。

最后,ASSD与AR类似在处理以鼻腔阻塞为主要症状的过敏原敏感患者时在确诊AR之前,也可考虑DSN

原始出处:

Seung-No Hong, Chae-Seo Rhee, Joon Kon Kim et al. Clinical characteristics of asymptomatic allergen sensitization with nasal septal deviation, often misdiagnosed as allergic rhinitis. Eur Arch Otorhinolaryngol. Mar 2021

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  5. [GetPortalCommentsPageByObjectIdResponse(id=2047388, encodeId=62a5204e3883b, content=<a href='/topic/show?id=6f5294036b1' target=_blank style='color:#2F92EE;'>#过敏性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94036, encryptionId=6f5294036b1, topicName=过敏性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0a8e213, createdName=hongbochen, createdTime=Fri Dec 03 12:08:59 CST 2021, time=2021-12-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1992014, encodeId=03fc199201439, content=<a href='/topic/show?id=1426103402c0' target=_blank style='color:#2F92EE;'>#鼻中隔偏曲#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103402, encryptionId=1426103402c0, topicName=鼻中隔偏曲)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=43cb463, createdName=lfyang, createdTime=Thu Aug 05 05:08:59 CST 2021, time=2021-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1842967, encodeId=030d184296e04, content=<a href='/topic/show?id=112222886b8' target=_blank style='color:#2F92EE;'>#临床特征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22886, encryptionId=112222886b8, topicName=临床特征)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=yeye5224612, createdTime=Tue Aug 10 18:08:59 CST 2021, time=2021-08-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1442639, encodeId=e3b71442639e8, content=<a href='/topic/show?id=625194032a5' target=_blank style='color:#2F92EE;'>#过敏原#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94032, encryptionId=625194032a5, topicName=过敏原)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=81884942400, createdName=12498cb5m14暂无昵称, createdTime=Tue Mar 09 04:08:59 CST 2021, time=2021-03-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1485162, encodeId=2a571485162d8, content=<a href='/topic/show?id=4bbe5902ed2' target=_blank style='color:#2F92EE;'>#无症状#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59027, encryptionId=4bbe5902ed2, topicName=无症状)], attachment=null, authenticateStatus=null, createdAvatar=Bioon/avatar/20180429/70baad2aa5a046c5aa2914d262de7d37.jpg, createdBy=bd077990475, createdName=12498da4m34(暂无昵称), createdTime=Tue Mar 09 04:08:59 CST 2021, time=2021-03-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1604182, encodeId=6de61604182fb, content=<a href='/topic/show?id=edfe103399a6' target=_blank style='color:#2F92EE;'>#鼻中隔#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103399, encryptionId=edfe103399a6, topicName=鼻中隔)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=21015, createdName=heli0118, createdTime=Tue Mar 09 04:08:59 CST 2021, time=2021-03-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=946613, encodeId=e61f94661308, content=值得注意, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8f435296195, createdName=ms3000000449926787, createdTime=Mon Mar 08 23:24:09 CST 2021, time=2021-03-08, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=2047388, encodeId=62a5204e3883b, content=<a href='/topic/show?id=6f5294036b1' target=_blank style='color:#2F92EE;'>#过敏性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94036, encryptionId=6f5294036b1, topicName=过敏性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0a8e213, createdName=hongbochen, createdTime=Fri Dec 03 12:08:59 CST 2021, time=2021-12-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1992014, encodeId=03fc199201439, content=<a href='/topic/show?id=1426103402c0' target=_blank style='color:#2F92EE;'>#鼻中隔偏曲#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103402, encryptionId=1426103402c0, topicName=鼻中隔偏曲)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=43cb463, createdName=lfyang, createdTime=Thu Aug 05 05:08:59 CST 2021, time=2021-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1842967, encodeId=030d184296e04, content=<a href='/topic/show?id=112222886b8' target=_blank style='color:#2F92EE;'>#临床特征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22886, encryptionId=112222886b8, topicName=临床特征)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=yeye5224612, createdTime=Tue Aug 10 18:08:59 CST 2021, time=2021-08-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1442639, encodeId=e3b71442639e8, content=<a href='/topic/show?id=625194032a5' target=_blank style='color:#2F92EE;'>#过敏原#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94032, encryptionId=625194032a5, topicName=过敏原)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=81884942400, createdName=12498cb5m14暂无昵称, createdTime=Tue Mar 09 04:08:59 CST 2021, time=2021-03-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1485162, encodeId=2a571485162d8, content=<a href='/topic/show?id=4bbe5902ed2' target=_blank style='color:#2F92EE;'>#无症状#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59027, encryptionId=4bbe5902ed2, topicName=无症状)], attachment=null, authenticateStatus=null, createdAvatar=Bioon/avatar/20180429/70baad2aa5a046c5aa2914d262de7d37.jpg, createdBy=bd077990475, createdName=12498da4m34(暂无昵称), createdTime=Tue Mar 09 04:08:59 CST 2021, time=2021-03-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1604182, encodeId=6de61604182fb, content=<a href='/topic/show?id=edfe103399a6' target=_blank style='color:#2F92EE;'>#鼻中隔#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103399, encryptionId=edfe103399a6, topicName=鼻中隔)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=21015, createdName=heli0118, createdTime=Tue Mar 09 04:08:59 CST 2021, time=2021-03-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=946613, encodeId=e61f94661308, content=值得注意, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8f435296195, createdName=ms3000000449926787, createdTime=Mon Mar 08 23:24:09 CST 2021, time=2021-03-08, status=1, ipAttribution=)]
  7. [GetPortalCommentsPageByObjectIdResponse(id=2047388, encodeId=62a5204e3883b, content=<a href='/topic/show?id=6f5294036b1' target=_blank style='color:#2F92EE;'>#过敏性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94036, encryptionId=6f5294036b1, topicName=过敏性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0a8e213, createdName=hongbochen, createdTime=Fri Dec 03 12:08:59 CST 2021, time=2021-12-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1992014, encodeId=03fc199201439, content=<a href='/topic/show?id=1426103402c0' target=_blank style='color:#2F92EE;'>#鼻中隔偏曲#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103402, encryptionId=1426103402c0, topicName=鼻中隔偏曲)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=43cb463, createdName=lfyang, createdTime=Thu Aug 05 05:08:59 CST 2021, time=2021-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1842967, encodeId=030d184296e04, content=<a href='/topic/show?id=112222886b8' target=_blank style='color:#2F92EE;'>#临床特征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22886, encryptionId=112222886b8, topicName=临床特征)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=yeye5224612, createdTime=Tue Aug 10 18:08:59 CST 2021, time=2021-08-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1442639, encodeId=e3b71442639e8, content=<a href='/topic/show?id=625194032a5' target=_blank style='color:#2F92EE;'>#过敏原#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94032, encryptionId=625194032a5, topicName=过敏原)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=81884942400, createdName=12498cb5m14暂无昵称, createdTime=Tue Mar 09 04:08:59 CST 2021, time=2021-03-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1485162, encodeId=2a571485162d8, content=<a href='/topic/show?id=4bbe5902ed2' target=_blank style='color:#2F92EE;'>#无症状#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59027, encryptionId=4bbe5902ed2, topicName=无症状)], attachment=null, authenticateStatus=null, createdAvatar=Bioon/avatar/20180429/70baad2aa5a046c5aa2914d262de7d37.jpg, createdBy=bd077990475, createdName=12498da4m34(暂无昵称), createdTime=Tue Mar 09 04:08:59 CST 2021, time=2021-03-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1604182, encodeId=6de61604182fb, content=<a href='/topic/show?id=edfe103399a6' target=_blank style='color:#2F92EE;'>#鼻中隔#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103399, encryptionId=edfe103399a6, topicName=鼻中隔)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=21015, createdName=heli0118, createdTime=Tue Mar 09 04:08:59 CST 2021, time=2021-03-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=946613, encodeId=e61f94661308, content=值得注意, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8f435296195, createdName=ms3000000449926787, createdTime=Mon Mar 08 23:24:09 CST 2021, time=2021-03-08, status=1, ipAttribution=)]
    2021-03-08 ms3000000449926787

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患者男, 63 岁,左手大拇指发疹 1 年半,于半年 前来本院皮肤科就诊。患者 1 年半前,左手大拇指 无明显诱因出现花生大小皮疹,偶有轻度瘙痒,在外 院诊断为“钱币状湿疹”,用糖皮质激素软膏治疗未 见好转。近半年皮疹逐渐增大,表面有黄白色鳞屑 及厚痂,无破溃渗出。患者自发病以来,饮食、睡眠、 体重均无明显异常; 患者既往体健,否认高血压、糖 尿病、肿瘤等病史; 左手大拇指无外伤史及砷接触 史;

Stroke:头颈动脉夹层在急诊误诊的情况分析

30例夹层患者中约有1例患者在诊断前2周内被误诊。

误诊为脂溢性皮炎的老年头面部血管肉瘤1 例

患者男, 64 岁。右侧头部红斑渗液伴痒半个 月。患者半个月前右侧头部出现片状淡红斑,有少 许渗液、结痂,此后皮损逐渐增大,渗出较前明显。 皮肤科情况:右侧头部见大片状浸润性红斑,境界欠 清,其上可见结痂坏死,少许淡黄色渗液( 图1) 。门 诊以“脂溢性皮炎”予口服依巴斯汀片10 mg/d,外 用哈西奈德溶液 2 次/d,治疗后自觉病情无好转。 皮损组织病理示:表皮角化过度伴角化不全,棘层增生肥厚