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--> 00:16.396\n好，\n\n00:16.396 --> 00:16.934\n大家好。\n\n00:17.957 --> 00:22.857\n今天我们这个共同学习的这个内容呢，\n\n00:22.906 --> 00:24.457\n是变异性鼻炎。\n\n00:28.554 --> 00:33.054\n首先我们看变异性鼻炎的这个临床定义啊，\n\n00:33.054 --> 00:33.679\n然后呢，\n\n00:33.679 --> 00:38.104\n我们再学习这个变异性鼻炎的这个分类和分度。\n\n00:44.983 --> 00:47.033\n变异性鼻炎指的是什么呢？\n\n00:47.233 --> 00:48.382\n变异性鼻炎呢，\n\n00:48.682 --> 00:50.083\n就是过敏性鼻炎。\n\n00:51.178 --> 00:53.728\n它是机体接触病原后。\n\n00:54.622 --> 00:58.872\n主要由IGE介导的鼻粘膜的非感染性疾病。\n\n01:00.373 --> 01:02.222\n它主要包含三个方面的内容。\n\n01:05.088 --> 01:08.138\n一是过敏性鼻炎，\n\n01:08.388 --> 01:10.939\n是鼻粘膜非感染性疾病。\n\n01:12.407 --> 01:13.208\n抗炎呢，\n\n01:13.307 --> 01:15.708\n是本病治疗的主要措施。\n\n01:18.232 --> 01:19.281\n第二啊，\n\n01:19.281 --> 01:21.632\n致病因素是变应原。\n\n01:22.873 --> 01:23.273\n哎，\n\n01:23.273 --> 01:24.172\n提示呢，\n\n01:24.273 --> 01:27.873\n控制环境和免疫重疗的合理性。\n\n01:29.930 --> 01:32.055\n3本病的特征啊，\n\n01:32.055 --> 01:33.880\n是主要由RGE介导。\n\n01:34.793 --> 01:39.344\n考虑有非IG介导的T、H2反应存在的可能。\n\n01:43.064 --> 01:43.363\n然后呢，\n\n01:43.363 --> 01:46.613\n我们现在看变异性鼻炎的流行病学。\n\n01:49.733 --> 01:50.532\n变异性鼻炎呢，\n\n01:50.782 --> 01:53.432\n是全球性健康问题。\n\n01:55.177 --> 01:55.376\n嗯。\n\n01:56.100 --> 01:56.825\n国外报道呢，\n\n01:56.825 --> 02:00.600\n它的发病率在10%.20%。\n\n02:02.077 --> 02:03.376\n然后部分发达国家呢，\n\n02:03.476 --> 02:05.126\n甚至高达30%。\n\n02:06.991 --> 02:08.492\n但是国内呢，\n\n02:08.492 --> 02:12.141\n缺乏全国性流行病学的观察数据。\n\n02:13.973 --> 02:17.673\n有部分中心城市初步观察呢，\n\n02:17.673 --> 02:20.673\n这个发病率在5%.10%。\n\n02:22.296 --> 02:24.897\n所以估计全国患病人数啊，\n\n02:25.097 --> 02:26.996\n可以在5000万以上。\n\n02:29.365 --> 02:31.115\n说明的这个基数是非常庞大的。\n\n02:33.964 --> 02:36.589\n我们看变性鼻炎啊，\n\n02:36.589 --> 02:37.964\n对QL的影响。\n\n02:39.764 --> 02:40.264\n首先呢，\n\n02:40.464 --> 02:41.139\n它有一个，\n\n02:41.139 --> 02:42.014\nHigh prevalence,\n\n02:42.365 --> 02:44.315\n就是一个高的患病率。\n\n02:45.602 --> 02:46.352\n人群非常多。\n\n02:48.453 --> 02:48.854\n然后呢，\n\n02:48.854 --> 02:50.804\n它可以impair the quality of life，\n\n02:51.203 --> 02:52.854\n可以损害生活质量，\n\n02:53.354 --> 02:55.154\n对生活质量有一个严重的影响。\n\n02:56.981 --> 02:57.481\n同时呢，\n\n02:57.531 --> 02:57.932\n哎，\n\n02:58.481 --> 03:01.082\n会导致work and school absence。\n\n03:01.481 --> 03:02.832\n然后进一步的啊，\n\n03:02.832 --> 03:04.307\n影响上班啊，\n\n03:04.307 --> 03:05.082\n影响上课。\n\n03:06.110 --> 03:08.110\nAired learning影响学习，\n\n03:08.561 --> 03:10.860\nImpaired sleeping影响睡眠。\n\n03:11.656 --> 03:14.705\n所以在生活、工作方方面面。\n\n03:15.475 --> 03:15.876\n好的。\n\n03:16.703 --> 03:19.453\n对人群、对患者产生了很大的影响。\n\n03:23.427 --> 03:23.927\n同时呢，\n\n03:24.128 --> 03:25.277\n变异性鼻炎呢，\n\n03:25.427 --> 03:27.227\n可以诱发多种疾病。\n\n03:29.936 --> 03:30.837\n首先，\n\n03:30.837 --> 03:32.587\n它可以导致过敏性结膜炎。\n\n03:34.186 --> 03:36.787\n出现眼睛干痒啊，\n\n03:36.787 --> 03:39.486\n流泪等等眼睛不舒服的表现。\n\n03:40.917 --> 03:41.242\n然后呢，\n\n03:41.242 --> 03:44.218\n它还可以导致鼻窦炎、鼻息肉。\n\n03:45.300 --> 03:47.074\n持续的过敏性鼻炎啊，\n\n03:47.074 --> 03:48.949\n可以引起鼻腔粘膜的肿胀。\n\n03:49.869 --> 03:52.893\n进一步导致鼻腔鼻窦啊，\n\n03:52.893 --> 03:55.994\n特别是窦口鼻道复合体这个位置粘膜肿胀啊，\n\n03:55.994 --> 03:56.819\n引起来的。\n\n03:57.654 --> 04:00.429\n这个鼻窦的交汇点。\n\n04:01.311 --> 04:02.936\n各个窦口引流不畅，\n\n04:03.636 --> 04:04.785\n导致粘膜肿胀，\n\n04:04.886 --> 04:07.035\n进一步出现息肉和鼻窦的炎症。\n\n04:08.860 --> 04:10.210\n同时呢，\n\n04:10.210 --> 04:12.035\n由于鼻窦炎啊，\n\n04:12.035 --> 04:14.809\n然后鼻咽粘膜的肿胀啊，\n\n04:15.160 --> 04:18.609\n进一步导致咽鼓管的通气引流不好啊。\n\n04:19.441 --> 04:20.842\n导致鼓室的负压，\n\n04:20.941 --> 04:22.691\n产生渗出性中耳炎。\n\n04:24.395 --> 04:25.071\n同时呢，\n\n04:25.071 --> 04:27.420\n它还可以进一步的诱发哮喘。\n\n04:30.162 --> 04:33.513\n我们看变异性鼻炎和哮喘的相关性。\n\n04:36.497 --> 04:38.197\n变异性鼻炎患者呢，\n\n04:38.197 --> 04:40.197\n有1/3合并哮喘。\n\n04:41.854 --> 04:44.704\n其他的2/3没有哮喘的患者中，\n\n04:44.903 --> 04:48.104\n又有2/3有支气管黏膜的高反应性。\n\n04:49.394 --> 04:49.845\n也就是说，\n\n04:49.945 --> 04:50.820\n剩下的，\n\n04:50.820 --> 04:51.119\n哎，\n\n04:51.119 --> 04:53.295\n2/3没有哮喘的患者啊，\n\n04:53.394 --> 04:54.345\n并不是。\n\n04:55.661 --> 04:57.760\n这个什么问题都没有，\n\n04:57.960 --> 04:59.911\n他其中又有2/3的患者。\n\n05:00.621 --> 05:00.746\n哎，\n\n05:00.746 --> 05:04.145\n它的支气管粘膜是有高反应性的啊，\n\n05:04.145 --> 05:05.520\n很容易受到刺激。\n\n05:07.136 --> 05:07.337\n嗯。\n\n05:08.167 --> 05:08.917\n对于儿童来讲。\n\n05:09.805 --> 05:12.105\n这个哮喘的患者中，\n\n05:12.305 --> 05:14.656\n伴发着过敏性鼻炎的发病率更高，\n\n05:15.006 --> 05:16.605\n可以高达93%。\n\n05:17.841 --> 05:19.490\n也就是说十个人里头。\n\n05:20.440 --> 05:25.065\n十个哮喘的儿童里面有9个都可能会有过敏性鼻炎，\n\n05:25.765 --> 05:26.714\n对于成人来讲，\n\n05:26.714 --> 05:28.565\n这个比例也是很高的啊，\n\n05:28.565 --> 05:30.915\n两个人当中就有一个啊，\n\n05:30.915 --> 05:33.964\n他的伴随着过敏性鼻炎的发病率可以有58%。\n\n05:36.665 --> 05:39.615\n然后我们看变性鼻炎与哮喘的相关性。\n\n05:41.131 --> 05:42.131\n首先呢，\n\n05:42.131 --> 05:44.006\n他们的组织学啊，\n\n05:44.006 --> 05:44.981\n具有同源性，\n\n05:45.381 --> 05:45.907\n就是说，\n\n05:45.907 --> 05:50.332\n鼻腔粘膜与支气管粘膜的组织学具有一定同源性。\n\n05:51.752 --> 05:52.203\n首先呢，\n\n05:52.352 --> 05:54.703\n它们都是来源于内胚层。\n\n05:57.401 --> 05:57.901\n然后呢，\n\n05:58.200 --> 06:02.351\n都是背腹甲腹层纤毛柱状上皮。\n\n06:04.971 --> 06:06.272\n它们的结构细胞。\n\n06:07.102 --> 06:09.953\n炎症细胞、血管、粘液腺。\n\n06:11.075 --> 06:12.725\n和神经网络啊，\n\n06:12.774 --> 06:14.725\n都有明显的相似性。\n\n06:17.000 --> 06:17.299\n当然，\n\n06:17.450 --> 06:19.399\n它们也存在着一定的差异性。\n\n06:21.955 --> 06:25.455\n鼻粘膜的上皮下有丰富的血管啊，\n\n06:25.855 --> 06:27.506\n可以引起来鼻塞。\n\n06:30.209 --> 06:31.484\n气管的粘膜啊，\n\n06:31.484 --> 06:33.884\n并不是含有丰富的气管啊。\n\n06:33.884 --> 06:36.408\n它的粘膜下是平滑肌啊，\n\n06:36.408 --> 06:38.433\n所以说气管支气管啊，\n\n06:38.433 --> 06:39.158\n可以收缩。\n\n06:40.270 --> 06:42.096\n当受到刺激的时候啊，\n\n06:42.096 --> 06:43.020\n它可以收缩，\n\n06:43.020 --> 06:45.920\n引起来吸性的呼吸困难啊，\n\n06:45.920 --> 06:47.221\n这是哮喘的特点。\n\n06:49.747 --> 06:50.372\n同时呢，\n\n06:50.372 --> 06:55.898\n变异性鼻炎和哮喘在相关性上还表现为免疫病理学的相似性。\n\n06:58.079 --> 07:01.029\n它们都有大量的嗜酸性粒细胞的浸润。\n\n07:03.299 --> 07:03.399\n哎，\n\n07:03.399 --> 07:10.200\n相同点表现为嗜酸性粒细胞肥大细胞的浸润T、H二细胞因子。\n\n07:10.962 --> 07:13.837\n趋化因子粘附分子啊，\n\n07:13.837 --> 07:19.962\n前前炎症介质转录调节因子的表达调控等等，\n\n07:20.062 --> 07:22.462\n需要将相一定的相同点。\n\n07:23.484 --> 07:23.859\n当然，\n\n07:23.859 --> 07:25.285\n他们也有一定的不同点。\n\n07:26.454 --> 07:30.303\n支气管粘膜的上皮细胞容易脱落啊，\n\n07:30.303 --> 07:32.803\n所以支气管粘膜具有一定的重塑性。\n\n07:33.903 --> 07:35.203\n但是对鼻腔啊，\n\n07:35.203 --> 07:36.102\n并不是这样。\n\n07:36.970 --> 07:39.820\n鼻粘膜上皮细胞一般并不脱落，\n\n07:40.320 --> 07:43.170\n它的粘膜重塑性有争议啊，\n\n07:43.170 --> 07:44.695\n可能有一定的重塑性，\n\n07:44.695 --> 07:46.220\n也可能没有重塑性。\n\n07:49.924 --> 07:51.424\n然后治疗鼻炎的有效药物。\n\n07:52.906 --> 07:55.230\n是不是对哮喘有效呢？\n\n07:57.009 --> 07:58.158\n它包括哪些药呢？\n\n07:58.158 --> 08:00.834\n一个是抗组胺药物啊，\n\n08:00.834 --> 08:01.908\n一个是鼻内激素。\n\n08:03.680 --> 08:06.980\n它可能可以使哮喘的症状得到改善。\n\n08:08.950 --> 08:09.450\n然后呢，\n\n08:09.799 --> 08:12.075\n可以使支气管的收缩反应，\n\n08:12.075 --> 08:12.950\n得以减轻。\n\n08:14.226 --> 08:14.675\n所以说，\n\n08:14.825 --> 08:16.726\n治疗过敏性鼻炎的药物，\n\n08:17.026 --> 08:19.726\n其实对哮喘的症状啊，\n\n08:19.726 --> 08:20.976\n也有一定的改善。\n\n08:24.122 --> 08:24.196\n哎，\n\n08:24.196 --> 08:26.122\n上下气道的炎症啊，\n\n08:26.122 --> 08:29.372\n它们相互联系有哪些可能的机制呢？\n\n08:31.511 --> 08:34.711\n首先变性鼻炎它因为鼻塞呢，\n\n08:34.762 --> 08:36.111\n可以用口呼吸。\n\n08:36.903 --> 08:38.004\n这个时候啊，\n\n08:38.054 --> 08:42.604\n干冷不洁的空气就可以直接进入到下气道，\n\n08:42.804 --> 08:43.854\n加重哮喘。\n\n08:45.765 --> 08:48.166\n他这种鼻塞导致了口呼吸，\n\n08:48.466 --> 08:48.815\n哎，\n\n08:48.815 --> 08:52.666\n这种气流不经过鼻腔的过滤，\n\n08:52.866 --> 08:54.916\n加温加湿的这么一个作用，\n\n08:55.065 --> 08:55.390\n哎，\n\n08:55.390 --> 08:56.616\n直接刺激下气道，\n\n08:56.815 --> 08:57.866\n加重了哮喘。\n\n09:00.112 --> 09:00.413\n第二，\n\n09:00.663 --> 09:01.513\n鼻后流涕，\n\n09:01.562 --> 09:03.062\n或者我们叫鼻后滴漏。\n\n09:03.362 --> 09:03.737\n哎，\n\n09:03.737 --> 09:07.263\n这个气中其实含有炎性介质的啊，\n\n09:07.413 --> 09:09.413\n它是可以直接流入下气道。\n\n09:09.763 --> 09:11.362\n虽然说有一些啊，\n\n09:11.362 --> 09:13.112\n被我们咽下去了啊，\n\n09:13.112 --> 09:13.663\n但是呢，\n\n09:13.663 --> 09:15.362\n也有一部分流入了下气道。\n\n09:16.041 --> 09:18.291\n然后进一步诱发了支气管的炎症反应。\n\n09:21.114 --> 09:21.614\n同时呢，\n\n09:21.763 --> 09:23.314\n鼻部的炎症介质呢，\n\n09:23.364 --> 09:24.763\n还可以吸收入血，\n\n09:24.963 --> 09:26.213\n直接到达肺部。\n\n09:27.059 --> 09:28.559\n诱发了支气管炎症反应。\n\n09:31.374 --> 09:31.773\n再一个，\n\n09:31.973 --> 09:34.374\n黑气通过鼻肺反射，\n\n09:34.723 --> 09:35.124\n哎，\n\n09:35.374 --> 09:36.924\n就是鼻粘膜刺激，\n\n09:37.073 --> 09:37.448\n哎，\n\n09:37.448 --> 09:38.973\n可以引起来支气管的收缩。\n\n09:40.122 --> 09:40.822\n进一步。\n\n09:41.580 --> 09:42.431\n加重哮喘。\n\n09:44.445 --> 09:44.945\n同时呢。\n\n09:45.674 --> 09:51.374\n骨髓反应、血液循环也是联系上下气道的一种途径。\n\n09:54.396 --> 09:56.947\n然后我们看有哪一些边影源呢？\n\n09:56.947 --> 09:59.146\n就是说哪一些过敏源呢？\n\n09:59.197 --> 10:00.247\n其实有很多。\n\n10:01.260 --> 10:01.409\n哎，\n\n10:01.409 --> 10:03.309\n可以分为吸入性的，\n\n10:03.460 --> 10:03.809\n哎，\n\n10:03.809 --> 10:06.510\n食入性的以及接触性的。\n\n10:07.343 --> 10:09.193\n我们看吸入性的边缘有哪些？\n\n10:10.882 --> 10:12.057\n虚的边缘呢，\n\n10:12.057 --> 10:13.283\n有室内的。\n\n10:13.960 --> 10:15.359\n室外的啊，\n\n10:15.460 --> 10:17.059\n包括尘埃，\n\n10:17.460 --> 10:18.159\n尘螨。\n\n10:18.961 --> 10:25.512\n真菌、动物皮毛、羽毛、棉絮、植物花粉颗粒等等。\n\n10:28.419 --> 10:29.619\n食物性的包括哪些呢？\n\n10:30.020 --> 10:37.619\n有鱼、虾、鸡蛋、牛奶、面粉、花生、大豆、药品等。\n\n10:39.276 --> 10:40.325\n接触物有哪些呢？\n\n10:40.676 --> 10:45.325\n化妆品、油漆、汽油、酒精等等。\n\n10:46.797 --> 10:46.872\n哎，\n\n10:46.872 --> 10:50.773\n这些都是容易让人产生过敏的啊，\n\n10:50.773 --> 10:51.447\n变应原。\n\n10:52.531 --> 10:52.731\n然后，\n\n10:52.731 --> 10:54.130\n我们进一步看图片，\n\n10:54.830 --> 10:56.580\n常见的呼吸道的变应原，\n\n10:56.630 --> 10:58.681\n也就是吸入性变原有哪些呢？\n\n10:59.080 --> 10:59.481\n哎，\n\n10:59.481 --> 11:00.431\n这就是螨虫，\n\n11:01.231 --> 11:01.580\n哎，\n\n11:01.580 --> 11:02.380\n就是猫毛，\n\n11:02.531 --> 11:04.580\n就代表着动物皮毛。\n\n11:06.671 --> 11:06.870\n哎，\n\n11:07.020 --> 11:09.270\n这个是微生物类啊，\n\n11:09.770 --> 11:13.570\n然后可以看到可能是真菌一类的这种病原体。\n\n11:16.034 --> 11:16.385\n题。\n\n11:17.642 --> 11:17.892\n嗯。\n\n11:18.668 --> 11:20.218\n还有往下，\n\n11:20.218 --> 11:22.567\n这个大概是真菌的孢子，\n\n11:22.918 --> 11:23.317\n哎，\n\n11:23.668 --> 11:24.168\n你看，\n\n11:24.317 --> 11:27.567\n这些可能都是孢子一类的病原病，\n\n11:27.617 --> 11:29.418\n那个致致敏原。\n\n11:32.458 --> 11:32.596\n看，\n\n11:32.596 --> 11:34.208\n这是花粉啊，\n\n11:34.208 --> 11:37.359\n柳絮或一些特殊的一些植物性的啊，\n\n11:37.359 --> 11:38.359\n吸入性过敏原。\n\n11:41.299 --> 11:41.424\n哎，\n\n11:41.424 --> 11:42.875\n这种特殊的植物啊，\n\n11:42.875 --> 11:44.200\n也很容易引起来过敏。\n\n11:47.401 --> 11:48.752\n这是一些微生物啊，\n\n11:48.752 --> 11:50.377\n引起来过敏啊，\n\n11:50.377 --> 11:51.752\n这是吸入性的过敏原。\n\n11:54.802 --> 11:56.151\n然后我们看食物性的过敏源，\n\n11:56.351 --> 11:56.726\n哎，\n\n11:56.726 --> 11:57.302\n牛奶。\n\n11:58.122 --> 12:00.447\n很多小朋友其实对牛奶也过敏的，\n\n12:00.797 --> 12:01.797\n鸡蛋啊，\n\n12:01.797 --> 12:03.572\n这都是动物蛋白啊，\n\n12:03.572 --> 12:04.348\n包括大豆。\n\n12:05.547 --> 12:07.797\n这都是容易过敏的东西啊，\n\n12:07.797 --> 12:11.098\n包括鱼类、虾类和花生啊。\n\n12:11.098 --> 12:13.547\n这些看似普通的食物，\n\n12:13.648 --> 12:16.348\n其实有很多人其实对它们是过敏的啊，\n\n12:16.348 --> 12:17.797\n就不能接触这些东西。\n\n12:21.002 --> 12:22.353\n我们看它的发病机制。\n\n12:23.783 --> 12:25.133\n发病机制啊，\n\n12:25.133 --> 12:30.133\n其实是首先变应原到达鼻腔之后啊。\n\n12:31.429 --> 12:33.630\n刺激我们这个APC细胞。\n\n12:34.732 --> 12:36.033\n然后这个APC细胞呢。\n\n12:36.747 --> 12:38.447\n然后分泌白介素10，\n\n12:39.098 --> 12:40.398\n然后到达T细胞。\n\n12:41.226 --> 12:42.026\n肌细胞呢，\n\n12:42.125 --> 12:44.226\n又进一步分泌白介素4，\n\n12:44.226 --> 12:45.625\n然后刺激B细胞。\n\n12:46.465 --> 12:48.039\n然后又进一步的啊，\n\n12:48.039 --> 12:50.114\n刺激其他炎症细胞啊，\n\n12:50.664 --> 12:52.565\n然后产生了白介素五。\n\n12:53.015 --> 12:56.515\n然后白介素五可以刺激嗜酸性粒细胞，\n\n12:56.815 --> 12:57.539\n同时呢，\n\n12:57.539 --> 12:58.440\nT细胞呢，\n\n12:58.440 --> 13:00.465\n它也可以通过白介素三，\n\n13:00.914 --> 13:02.114\n然后白介素五。\n\n13:02.934 --> 13:08.833\n和GMCSF这个细胞因子直接刺激这个嗜酸性粒细胞。\n\n13:10.213 --> 13:11.687\n同时呢，\n\n13:11.687 --> 13:12.963\nVCM这个细胞呢，\n\n13:13.013 --> 13:15.562\n它也可以刺激嗜酸性粒细胞。\n\n13:15.963 --> 13:19.187\n所有的这些嗜酸性粒细胞受到刺激之后，\n\n13:19.187 --> 13:21.612\n就产生了主要的碱性蛋白，\n\n13:22.163 --> 13:23.513\n嗜酸性啊，\n\n13:23.513 --> 13:27.413\n离子蛋白、白三烯以及血小板的活化因子。\n\n13:27.562 --> 13:27.913\n哎，\n\n13:27.913 --> 13:31.062\n这些炎症因子又产生了相应的症状，\n\n13:31.213 --> 13:36.112\n会导致持续性的鼻塞以及清水样的鼻涕啊，\n\n13:36.112 --> 13:38.763\n连续性的喷嚏以及鼻痒等等表现。\n\n13:40.737 --> 13:41.187\n同时呢，\n\n13:41.187 --> 13:44.987\n这个T细胞它还可以分泌神经营养素，\n\n13:45.138 --> 13:46.788\n然后刺激这个细胞，\n\n13:46.888 --> 13:50.588\n然后产生了神经肽和P物质以及神经激肽，\n\n13:50.888 --> 13:53.963\n然后进一步导致了这个鼻塞的症状。\n\n13:53.963 --> 13:55.838\n这个主要是鼻塞的这个原因。\n\n13:57.554 --> 13:58.578\n同时呢，\n\n13:58.578 --> 14:05.804\n这个细胞还可以产生组胺、白三烯、血小板活化因子以及类胰蛋白酶。\n\n14:06.054 --> 14:10.953\n然后导致了清水样的鼻涕、连续的打喷嚏以及鼻塞这些症状。\n\n14:11.632 --> 14:11.783\n哎，\n\n14:11.783 --> 14:13.458\n同时这个细胞呢，\n\n14:13.458 --> 14:16.232\n它还可以分泌其他的一些炎性介质，\n\n14:16.283 --> 14:21.507\n然后促进这些细胞释放白三烯以及组胺和细胞因子。\n\n14:21.507 --> 14:23.132\n既导致了持续性的鼻塞，\n\n14:23.182 --> 14:25.182\n又引起来了清水样鼻涕，\n\n14:25.232 --> 14:27.732\n连续打喷嚏以及鼻痒这些症状。\n\n14:30.635 --> 14:31.385\n同时呢，\n\n14:31.486 --> 14:33.085\n大量的抗原啊，\n\n14:33.085 --> 14:39.185\n以及细菌中的CPG重复序列可以刺激a a PC细胞分泌什么呢？\n\n14:39.185 --> 14:39.585\n哎，\n\n14:39.786 --> 14:40.810\n白介素12，\n\n14:40.810 --> 14:43.760\n然后进一步刺激TH二细胞。\n\n14:43.760 --> 14:45.085\nTH 1 TH 2细胞，\n\n14:45.236 --> 14:49.736\n然后产生了1氧化氮前列素一二及少量的抗原，\n\n14:49.736 --> 14:50.635\n相互促进。\n\n14:50.736 --> 14:51.310\n同时呢，\n\n14:51.310 --> 14:53.036\n它还可以分泌白介素18，\n\n14:53.135 --> 14:57.685\n刺激NK细胞分泌FN这个这个细胞因子，\n\n14:57.685 --> 14:59.986\n然后进一步刺激T细胞。\n\n15:00.552 --> 15:00.627\n哎，\n\n15:00.627 --> 15:02.151\n他们进一步的相互影响。\n\n15:05.492 --> 15:07.841\n我们看到这个过敏反应呢，\n\n15:07.841 --> 15:10.291\n可以包括速发项和迟发项。\n\n15:11.096 --> 15:12.620\n它们有什么区别呢？\n\n15:12.620 --> 15:14.495\n首先从时间上的一个区别，\n\n15:14.745 --> 15:18.895\n然后是一个进行程度的一个区别和发生率的区别。\n\n15:18.995 --> 15:20.370\n速发项呢，\n\n15:20.370 --> 15:23.945\n它的开始时间是再次接触病源的15分钟以内，\n\n15:23.945 --> 15:25.096\n发作时间非常快。\n\n15:25.395 --> 15:25.846\n同时，\n\n15:25.846 --> 15:26.620\n它的高峰呢，\n\n15:26.620 --> 15:29.695\n一般是在12.5分钟加减0.5分钟左右，\n\n15:29.695 --> 15:30.846\n也就十二三分钟。\n\n15:31.046 --> 15:31.995\n它持续呢，\n\n15:31.995 --> 15:34.995\n可持续一个半小时左右到两个小时左右，\n\n15:34.995 --> 15:36.096\n就一到两个小时。\n\n15:37.760 --> 15:38.411\n直发向呢，\n\n15:38.411 --> 15:43.161\n它的发生时间是在接触变应源之后的两个两到四个小时内。\n\n15:43.411 --> 15:45.385\n然后它的高峰时间呢，\n\n15:45.385 --> 15:47.260\n是在5到十二个小时的时候。\n\n15:47.510 --> 15:47.810\n哎，\n\n15:47.810 --> 15:51.510\n它的持续时间是一天到数天啊。\n\n15:52.361 --> 15:54.210\n对于这个进行程度而言呢，\n\n15:54.210 --> 15:55.611\n速发项，\n\n15:55.960 --> 15:57.161\n它进行的快，\n\n15:57.310 --> 15:58.611\n但是症状比较轻。\n\n15:59.346 --> 15:59.546\n哎，\n\n15:59.596 --> 16:00.695\n迟发项呢，\n\n16:00.796 --> 16:01.796\n它进行的慢，\n\n16:01.945 --> 16:03.020\n但，\n\n16:03.020 --> 16:04.195\n它的症状比较重。\n\n16:06.017 --> 16:06.392\n发生率，\n\n16:06.392 --> 16:10.767\n我们看到单纯的这个速发项发生率可以达到35%。\n\n16:10.916 --> 16:11.242\n哎，\n\n16:11.242 --> 16:14.117\n单纯的迟发性的发生率可以达到25%。\n\n16:14.267 --> 16:14.591\n哎，\n\n16:14.591 --> 16:19.317\n双向就是4发项和实发项都有可以达到40%。\n\n16:21.669 --> 16:21.969\n好，\n\n16:22.270 --> 16:27.419\n然后我们看这个分类和分度啊。\n\n16:28.638 --> 16:30.913\n然后根据症状持续时间呢，\n\n16:30.913 --> 16:35.388\n过敏性鼻炎可以分为间歇性和持续性的过敏性鼻炎。\n\n16:35.487 --> 16:37.187\n什么是间歇性呢？\n\n16:37.187 --> 16:39.788\n它是症状每周小于4天，\n\n16:40.088 --> 16:42.987\n或者说症状持续的时间是小于四周。\n\n16:44.325 --> 16:45.476\n对于持续性来讲，\n\n16:45.476 --> 16:46.625\n它就有两点要求，\n\n16:46.825 --> 16:52.075\n一是症状大于等于大于等于四天每周就是每周要出现4天以上。\n\n16:52.226 --> 16:52.976\n同时呢，\n\n16:52.976 --> 16:55.601\n它要求连续发作四周啊，\n\n16:55.601 --> 16:56.476\n这是持续性。\n\n16:59.521 --> 17:02.521\n然后根据患者症状严重程度，\n\n17:02.622 --> 17:05.996\n以及是否影响患者的生活质量啊，\n\n17:05.996 --> 17:06.771\n包括哪些呢？\n\n17:06.771 --> 17:08.671\n包括睡眠啊，\n\n17:08.671 --> 17:11.521\n日常生活、工作和学习。\n\n17:11.822 --> 17:15.121\n又将过敏性鼻炎分为轻度和中重度。\n\n17:16.409 --> 17:17.058\n轻度化呢，\n\n17:17.058 --> 17:17.609\n顾名思义，\n\n17:17.609 --> 17:18.784\n症状比较轻啊，\n\n17:18.784 --> 17:20.708\n对生活质量没有什么影响。\n\n17:20.808 --> 17:21.109\n哎，\n\n17:21.109 --> 17:21.534\n也就是说，\n\n17:21.534 --> 17:23.609\n我们在门诊的时候碰到轻度的患者，\n\n17:23.609 --> 17:24.859\n有时候我们配药给他，\n\n17:24.909 --> 17:26.759\n患者自己都表示不需要配药，\n\n17:26.759 --> 17:27.659\n没什么不舒服。\n\n17:27.659 --> 17:27.958\n哎，\n\n17:27.958 --> 17:29.609\n就是偶尔有时候会打几个喷嚏，\n\n17:29.708 --> 17:30.284\n然后呢，\n\n17:30.284 --> 17:32.609\n发作率发作的频率也不是很频繁。\n\n17:33.305 --> 17:33.430\n哎，\n\n17:33.430 --> 17:34.755\n对于中重度而言啊，\n\n17:34.755 --> 17:36.180\n就症状明显很多了，\n\n17:36.180 --> 17:38.530\n它有一个明显的一个症状啊，\n\n17:38.530 --> 17:40.005\n或者说比较严重啊，\n\n17:40.005 --> 17:40.854\n对生活质量呢，\n\n17:40.854 --> 17:42.479\n同时也有一个影响啊，\n\n17:42.479 --> 17:45.655\n这个时候就要用药去持续治疗一段时间。\n\n17:48.774 --> 17:49.348\n好的啊，\n\n17:49.348 --> 17:50.874\n我的分享到此结束啊，\n\n17:50.874 --> 17:51.573\n谢谢大家。\n\n17:52.571 --> 17:52.870\n是。\n\n","v0347cg10004d61e61aljht1l5pi4ko0",1085,527,"2026-01-25 00:11:04","变应性鼻炎 - 症状、原因及治疗方法全解析  ","变应性鼻炎,过敏性鼻炎,鼻炎症状,鼻炎治疗,过敏原,鼻塞,打喷嚏,鼻痒  ","变应性鼻炎（过敏性鼻炎）是一种常见鼻部过敏疾病，表现为鼻塞、流涕、打喷嚏和鼻痒。本文详细介绍其症状、病因、诊断方法及有效治疗方案，帮助您科学应对过敏困扰。","2026-04-06 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