围产因素与儿童哮喘关系研究进展

儿童哮喘发病率在世界范围内有不断升高的趋势,但相关病因仍然不清楚.近年来大量的流行病学研究证据说明遗传因素、围产儿子宫内外环境暴露与儿童哮喘发生密切相关.该文从遗传因素、母亲孕期吸烟、胎儿宫内生长环境、胚胎发育水平、胎儿的免疫状况等几个角度,对近年来有关围产因素与儿童哮喘关系的流行病学研究结果进行简要综述.     

儿童哮喘相关因素分析

儿童哮喘发病率在世界范围内有不断升高的趋势,但相关病因仍然不清楚。近年来大量的流行病学研究发现,儿童哮喘危险因素包括：患儿父母有喘息及过敏史,母孕期有妊娠高血压综合征,母妊娠期间早孕反应重等：以及患儿为剖宫产,早产儿,低体重儿,自身有过敏性鼻炎,药物过敏史,湿疹,肥胖,病毒感染等因素。本研究针对以上因素对儿童哮喘进行简要论述。     

云浮市城区儿童哮喘危险因素1∶1病例对照分析

目的探讨云浮市城区儿童哮喘的危险因素。方法应用1∶1配对病例-对照研究方法 ,对城区152例哮喘儿童(病例组)和152例非哮喘儿童(对照组)的哮喘危险因素进行调查,并进行单因素和多因素条件Logistic回归分析。结果儿童过敏史、家族哮喘史、急性呼吸道感染史、被动吸烟及接触粉尘和有害气体是本城区儿童哮喘的危险因素。结论儿童哮喘是遗传和环境双重因素共同作用导致的一种复杂疾病,但可通过预防呼吸道感染、减少过敏原接触等方面来进行儿童哮喘防治。     

儿童哮喘的流行病学研究现状及控制策略

本文对儿童哮喘的流行病学研究现状，该病发生与持续存在的危险因素以及预防控制策略作一综述     

气象因素与儿童哮喘关系的研究

哮喘是目前世界上较为常见的一种慢性气道疾病，好发于儿童。当前全球气候变化莫测，大量的流行病学研究和实验研究均表明，气象因素的变化可能会引起儿童哮喘的发作和/或加重。气象因素可以通过多种途径作用于哮喘患儿，主要是通过影响大气污染物或过敏原来进一步对哮喘发挥作用，作用机制主要有气道炎症、气道高反应性、氧化应激、肺功能下降等。本文就气象因素与儿童哮喘之间的关系作一综述。     

上海市0～14岁儿童哮喘的影响因素及防制对策

目的探讨014岁儿童哮喘的影响因素及防制对策。方法采用1∶1配对病例-对照研究,以年龄和性别为匹配因素,采用系统抽样方法选择在上海市某儿童专科医院就诊的107名014岁哮喘患儿为病例组,以及无哮喘的儿童为对照组,调查个人病史、一级亲属病史、过敏史、妊娠喂养、家庭环境等暴露信息,分析和探讨影响儿童哮喘发作的主要因素。结果多因素条件分析发现儿童哮喘发作的危险因素包括尘螨过敏、频繁呼吸道感染史、居住较低楼层、过敏性鼻炎、大量使用抗生素,预防儿童哮喘发作的保护因素包括使用湿拖把清洁地面和较长时间纯母乳喂养,单因素分析显示家庭特应性疾病史、食物过敏、花粉过敏、早产、家中有霉斑等也可能是潜在的危险因素,补充鱼肝油可能有一定的预防价值。结论儿童哮喘的影响因素涉及遗传、环境、行为、免疫等多方面,提出的防制对策包括保持室内通风和干燥、防尘防螨、加强筛查和健康宣教等。     

儿童哮喘相关因素的Logistic回归分析

【目的】调查儿童哮喘发病相关因素。【方法】收集2005年6月~2007年5月河北省儿童医院呼吸科收治的哮喘患儿共311例,以问卷形式,由医师询问,查找哮喘发病相关因素。【结果】本研究调查了43个因素,其中高危因素7个、危险因素15个、低危因素2个、保护因素8个。高危因素有母孕期妊娠高血压综合征、哮喘家族史、过敏性鼻炎、湿疹史等。危险因素有肥胖、母亲用化妆品、父母过敏史、荨麻疹史等。保护因素有母孕期常吃苹果及鱼、地面瓷砖、护墙板、母乳喂养等。【结论】遗传因素与哮喘密切相关,母孕期疾病史及不良生活习惯,会增加儿童哮喘的危险性,特应性体质是儿童发展为持续性哮喘的危险因素,室内外环境不良、家庭经济状况与哮喘有关。     

卵巢癌的病因流行病学研究进展

卵巢癌因发病隐匿,就诊时多已届晚期,治疗效果及预后很差,积极开展病因学研究及早期阻断卵巢癌的诱因很有必要。该文复习了近几年有关卵巢癌的病因流行病学文献,从环境、生殖、行为和遗传因素4个方面进行综述,发现卵巢癌的发生与以上诸多因素有关,早期预防甚为重要。     

卵巢癌的病因流行病学研究进展

卵巢癌因发病隐匿，就诊时多已届晚期，治疗效果及预后很差，积极开展病因学研究及早期阻断卵巢癌的诱因很有必要。该文复习了近几年有关卵巢癌的病因流行病学文献，从环境、生殖、行为和遗传因素4个方面进行综述．发现卵巢癌的发生与以上诸多因素有关，早期预防甚为重要。     

遗传流行病学研究中的几种设计

许多常见慢性疾病(如癌症、心血管疾病等)的病因都是极其复杂的,遗传因素和环境因素都可能和这些疾病有关。识别这些复杂的病因是流行病学和遗传学研究者共同的目标,两门学科的相互渗透形成了遗传流行病学。相对来说,遗传流行病学是一个比较新的研究领域,它将遗传学和流行病学的设计和方法结合起来,以探索遗传因素和环境因素对疾病的单独作用以及它们对疾病的联合作用。其主要任务是评价环境因素与疾病状态的关联;评价疾病的家庭聚集性;通过分离分析判断疾病的遗传模式;从而最终通过和遗传标记连锁定位出致病基因。     

遗传与环境因素在胎儿生长受限发病中的作用

胎儿生长受限是围生期的重要并发症 ,居围产儿死亡原因第二位 ,远期也影响儿童期及青春期的体能与智能发育。国内外多项研究表明 ,在早孕期间 ,胎儿生长受限主要由遗传因素或基因异常引起 ,而到中孕、晚孕期间 ,由胎儿外来因素造成 ,其中包括各种环境因素。该文就遗传与各种环境因素包括化学因素、物理因素、生物因素、生活习性、营养、地理因素等对胎儿生长的影响作一综述。     

Primary Prevention of Pediatric Asthma through Nutritional Interventions

Asthma is the most common chronic non-communicable disease in children, the pathogenesis of which involves several factors. The increasing burden of asthma worldwide has emphasized the need to identify the modifiable factors associated with the development of the disease. Recent research has focused on the relationship between dietary factors during the first 1000 days of life (including pregnancy)—when the immune system is particularly vulnerable to exogenous interferences—and allergic outcomes in children. Specific nutrients have been analyzed as potential targets for the prevention of childhood wheeze and asthma. Recent randomized controlled trials show that vitamin D supplementation during pregnancy, using higher doses than currently recommended, may be protective against early childhood wheezing but not school-age asthma. Omega-3 fatty acid supplementation during pregnancy and infancy may be associated with a reduced risk of childhood wheeze, although the evidence is conflicting. Data from observational studies suggest that some dietary patterns during pregnancy and infancy might also influence the risk of childhood asthma. However, the quality of the available evidence is insufficient to allow recommendations regarding dietary changes for the prevention of pediatric asthma. This review outlines the available high-quality evidence on the role of prenatal and perinatal nutritional interventions for the primary prevention of asthma in children and attempts to address unmet areas for future research in pediatric asthma prevention.     

Perinatal factors and the risk of asthma in childhood--a population-based register study in Finland

The aim of the study was to assess whether perinatal factors are associated with the risk of asthma in childhood in a register-based, nested case-control study in Finland. All children born between January 1, 1996, and April 30, 2004, who were entitled to a special reimbursement for antiasthmatic drugs (i.e., had diagnosed asthma by 2006 and had purchased inhaled corticosteroids or montelukast at least once), were identified (n = 21,038). For each case, one matched control child was selected. The associations between perinatal factors, derived from the Finnish Medical Birth Register, and the risk of asthma were analyzed by conditional logistic regression. In the final multivariate model, maternal asthma, young age, smoking, previous miscarriages, and a high number of previous deliveries, as well as cesarean section, low gestational age, and low ponderal index, were associated with an increased risk of asthma in children diagnosed before the age of 3 years. Among children diagnosed at the age of 3 years or later, maternal asthma, low gestational age, and low ponderal index were associated with an increased risk, and a high number of previous deliveries was associated with a decreased risk of asthma. In conclusion, perinatal factors play a role in the development of asthma in childhood, but the etiology may differ in early and late-onset asthma.     

Fetal and infant origins of asthma

Previous studies have suggested that asthma, like other common diseases, has at least part of its origin early in life. Low birth weight has been shown to be associated with increased risks of asthma, chronic obstructive airway disease, and impaired lung function in adults, and increased risks of respiratory symptoms in early childhood. The developmental plasticity hypothesis suggests that the associations between low birth weight and diseases in later life are explained by adaptation mechanisms in fetal life and infancy in response to various adverse exposures. Various pathways leading from adverse fetal and infant exposures to growth adaptations and respiratory health outcomes have been studied, including fetal and early infant growth patterns, maternal smoking and diet, children’s diet, respiratory tract infections and acetaminophen use, and genetic susceptibility. Still, the specific adverse exposures in fetal and early postnatal life leading to respiratory disease in adult life are not yet fully understood. Current studies suggest that both environmental and genetic factors in various periods of life, and their epigenetic mechanisms may underlie the complex associations of low birth weight with respiratory disease in later life. New well-designed epidemiological studies are needed to identify the specific underlying mechanisms. This review is focused on specific adverse fetal and infant growth patterns and exposures, genetic susceptibility, possible respiratory adaptations and perspectives for new studies.     

Maternal smoking in pregnancy, fetal development, and childhood asthma

OBJECTIVES: We examined the relationships among maternal smoking in pregnancy, fetal development, and the risk of asthma in childhood. METHODS: We conducted a population-based cohort study, where all 58 841 singleton births were followed for 7 years using nationwide registries. RESULTS: Maternal smoking increased the risk of asthma (adjusted odds ratio = 1.35; 95% confidence interval = 1.13, 1.62 for high exposure). Low birthweight and preterm delivery increased the risk of asthma at the age of 7, whereas being small for gestational age did not. CONCLUSIONS: Maternal smoking in pregnancy increases the risk of asthma during the first 7 years of life, and only a small fraction of the effect seems to be mediated through fetal growth.     

妊娠期高血压疾病发病规律及高危因素分析

目的:探讨妊娠期高血压疾病(HDCP)严重并发症相关高危因素。方法:对住院分娩诊断为HDCP孕妇年龄、孕、产次、双(多)胎、地区、是否系统产检、高血压病史和妊娠期高血压病史及家族史、HDCP及其严重并发症发病情况、围生儿情况进行调查分析HDCP发病的一般规律、城市/乡村发病的差别以及导致孕产妇及围生儿严重并发症的高危因素。结果:住院孕妇总数为24 154例,其中HDCP患者921例,发生率为3.81%。妊娠高血压、子痫前期、子痫、慢性高血压并子痫前期、妊娠合并慢性高血压分别占HDCP的29.97%、64.60%、2.39%、2.39%、0.65%,产后出血及胎儿宫内生长受限分别占HDCP的50.00%、44.00%。HDCP患者中城市505例,农村416例,合并严重并发症城市10例,农村36例;围产儿不良结局(包括FGR、死胎、新生儿死亡、流产、新生儿窒息等)城市82例,农村129例,将孕妇年龄分为17～20、21～25、26～30、31～35、36～40和≥41岁年龄段,其HDCP发生率分别为6.73%、28.23%、28.66%、21.82%、11.62%、2.93%;在17～20岁年龄段围产儿不良结局发生率比其他年龄段显著增高(P<0.05),孕妇合并严重并发症在各年龄段间差异无统计学意义(P>0.05)。Logistic逐步回归分析低龄、双胎(多胎)、农村地区、文化程度及无系统产检均为HDCP孕妇严重并发症及围生儿不良结局的高危因素。结论:产后出血、早产及胎儿宫内生长受限仍是江西省HDCP孕妇和围生儿最主要的并发症。年龄、农村人口、文化程度≤初中、无系统产检是HDCP孕妇严重并发症及围生儿不良结局的高危因素。     

新生儿缺氧缺血性脑病围产期危险因素分析

目的分析围产期各种危险因素对新生儿缺氧缺血性脑病(HIE)发病的影响,为其预防提供依据。方法对150例HIE患儿母妊娠期病史及分娩情况进行回顾性分析;随机抽取146例同期出生无HIE新生儿作对照,分析HIE发病危险因素。结果两组中妊高征、胆汁淤积、脐带异常、胎儿宫内窘迫及新生儿窒息存在统计学差异,为HIE危险因素。结论加强围产期保健,提高产科质量,及时处理妊娠并发症,及早发现和处理胎儿宫内窘迫,避免新生儿窒息,对预防和减少新生儿HIE具有重要意义。     

Child health and the environment: the INMA Spanish Study

The INMA (INfancia y Medio Ambiente [Environment and Childhood]) is a population-based cohort study in different Spanish cities, that focuses on prenatal environmental exposures and growth, development and health from early fetal life until childhood. The study focuses on five primary areas of research: (1) growth and physical development; (2) behavioural and cognitive development; (3) asthma and allergies; (4) sexual and reproductive development; and (5) environmental exposure pathways. The general aims of the project are: (1) to describe the degree of individual prenatal exposure to environmental pollutants, and the internal dose of chemicals during pregnancy, at birth and during childhood in Spain; (2) to evaluate the impact of the exposure to different contaminants on fetal and infant growth, health and development; (3) to evaluate the role of diet on fetal and infant growth, health and development; and (4) to evaluate the interaction between persistent pollutants, nutrients and genetic determinants on fetal and infant growth, health and development. Extensive assessments will be carried out on 3100 pregnant women and children. Data will be collected by physical examinations, questionnaires, interviews, ultrasound and biological samples. Pregnant women are being assessed at 12, 20 and 32 weeks of gestation to collect information about environmental exposures and fetal growth. The children will be followed until the age of 4 years.     

82例妊娠晚期死胎的临床分析

目的探讨妊娠晚期导致胎死宫内的主要原因,制定预防措施,降低围生儿死亡率。方法对昌吉市人民医院2005～2009年收治的82例死胎病例资料进行回顾性分析。结果死胎的原因顺位依次为妊娠并发症、脐带和胎盘因素。结论加强对育龄妇女的孕期保健知识的宣传,加强高危妊娠的监测,对降低围生期母儿死亡率有重要意义。