目的 观察哮喘预测指数(API)与婴幼儿首次毛细支气管炎及以后反复喘息的相关性。方法 将住院或儿科门诊首次发病的146例毛细支气管炎患儿分为API阳性组64例及API阴性组82例,比较API阳性、API阴性组婴幼儿首次喘息症状严重程度;将两组患儿随访1年后比较喘息发生率;1年后将所有婴幼儿进行单因素及多因素Logistic回归分析喘息相关危险因素。结果 API阳性组首次喘息发作时症状严重程度较API阴性组高(P<0.05);1年后API阳性组较API阴性组喘息次数增多(P<0.05);单因素分析婴幼儿反复喘息与吸入过敏原、父母哮喘史、变应性皮炎(湿疹)、嗜酸性粒细胞计数、食入过敏原、过敏家族史、RSV感染、经常哭闹、被动吸烟、母乳喂养等因素有关(P均<0.05),而与剖宫产、饲养宠物无关(P均＞0.05);多因素Logistic回归分析显示API阳性、过敏家族史、RSV感染、被动吸烟、经常哭闹为喘息的独立危险因素,而母乳喂养为喘息的独立保护因素。结论 婴幼儿首次毛细支气管炎及以后反复喘息与多种因素有关,其中与API的相关性最明显。
Abstract
Objective To observe the correlation between the asthma predictive index (API) and bronchiolitis at the first in infants and the forthcoming repeated wheezing. Methods A total of 146 patients with bronchiolitis from inpatient or outpatient pediatric first were randomly divided into API positive group( 64)and API negative group(82).The two groups were treated with the same comprehensive treatment,to compare the severity of wheezing at the first in infants with two groups.The incidence of wheezing between two groups were analyzed after 1 year follow-up.Moreover,the all risk factors of wheezing in infants were analyzed by single factor and multiple factor logistic regression analysis after 1 year follow-up. Results The severity and the incidence of wheezing at the first in API positive group were higher than those of API negative group(all P<0.05).The single factor analysis showed that repeated wheezing was associated with inhaled allergens,parental history of asthma,allergic dermatitis (eczema),eosinophil count,eating allergens,allergic family history,respiratory syncytial virus infection,often crying,passive smoking,breast feeding and other factors(P<0.05) and had no associated with cesarean section and feeding pets(P＞0.05).The multiple factor logistic regression analysis showed that independent risk factor for wheezing included API positive,family history of allergies,respiratory syncytial virus infection,passive smoking and often crying.Moreover,the independent protective factor for wheezing was breast feeding. Conclusion The incidence of infant bronchiolitis and later repeated wheezing are associated with many factors,among which API is the most obvious.
关键词
哮喘预测指数 /
婴幼儿 /
喘息 /
毛细支气管炎
Key words
asthma predictive index /
infants /
wheezing /
bronchiolitis
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.毛细支气管炎诊断、治疗与预防专家共识(2014年版)[J].中华儿科杂志,2015,53(3):168-171.
[2] Guilbert TW,Morgan WJ,Zeiger RS,et al.Atopic characteristics of children with recurrent wheezing at high risk for the development of childhood asthma[J].J Allergy Clin Immunol,2004,114(6):1282-1287.
[3] 中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.儿童支气管哮喘诊断与防治指南[J].中华儿科杂志,2008,46(10):745-753.
[4] Ricart S,Marcos MA,Sarda M,et a1.Clinical risk factors are more relevant than respiratory viruses in predicting bronchiolitis severity[J].Pediatr Pulmonol,2013,48(5):456-463.
[5] 杨赛,王桂兰,容嘉妍,等.中山市婴幼儿喘息相关危险因素分析[J].临床儿科杂志,2014,32(2):126-130.
[6] Almqvist C,Cnattingius S,Lichtenstein P,et al.The impact of birth mode of delivery on childhood asthma and allergic diseases a sibling study[J].Clin Exp Allergy,2012,42(9):1369-1376.
[7] 黄晨,胡宇, 刘炜,等.上海市学龄前儿童哮喘和过敏症与宠物饲养的关联性[J].科学通报,2013,58(25):2527-2534.
[8] Jones LL,Hashim A,Mckeever T,et al.Parental and household smoking and the increased risk of bronchitis,bronchiolitis and other lower respiratory infections in infancy:systematic review and meta-analysis[J].Respir Res,2011,12(1):5-16.
[9] Ralston SL,Lieberthal AS,Meissner HC,et a1.Clinical practice guideline:the diagnosis, management, and prevention of bronchiolitis[J].Pediatrics,2014,134(5):e1474-e1502.
[10] Robison RG,Kumar R,Arguelles LM,et al.Maternal smoking during pregnancy,prematurity and recurrent wheezing in early childhood[J].Pediatric Pulmonology,2012,47(7):666-673.
[11] Turck D,Vidailhet M,Bocquet,et a1.Breastfeeding:health benefits for child and mother[J].Arch Pediatr,2013,20(Suppl 2):29-48.
PDF(508 KB)
