乌鲁木齐地区喘息患儿发生支气管哮喘的危险因素

目的 探讨乌鲁木齐地区喘息患儿发生支气管哮喘(哮喘)的危险因素.方法 对2008年1 -12月在新疆医科大学第五附属医院门诊及住院的300例喘息患儿的临床资料进行统计.用统一的调查表调查其年龄、性别、湿疹、变应性鼻炎、食物过敏、家族过敏史/哮喘史、运动相关性喘息等.出院后通过门诊或电话进行随访.采用 Logistic回归分析方法对各因素与哮喘发生的关系及相关程度进行分析.结果 随访2a,275例获得随访;25例失访.275例喘息患儿在随访期内86例(31.2％)发生哮喘.Logistic回归分析发现湿疹、变应性鼻炎、家族过敏史/哮喘史、运动相关性喘息、反复下呼吸道感染( LRTI)、外周血嗜酸性粒细胞(EOS)增高与喘息患儿发生哮喘有关(湿疹:OR=2.376,95％ CI0.098～0.935,P=0.039;变应性鼻炎:OR=1.052,95％ CI2.267 ～14.283,P =0.024;家族过敏史/哮喘史:OR=1.886,95％CI1.004～3.542,P =0.048;运动相关性喘息:OR=1.881,95％ CI2.267 ～18.983,P =0.001;LRTI:OR=5.341,95％ CI1.676～ 10.983,P =0.016;外周血EOS增高:OR=3.915,95％ CI1.459～ 10.501,P=0.002).结论 个人过敏史(湿疹和变应性鼻炎)、家族过敏史/哮喘史、运动相关性喘息、LRTI、外周血EOS增高是乌鲁木齐地区喘息患儿发生哮喘的危险因素.     

婴幼儿喘息的病因及相关危险因素分析

目的：调查婴幼儿喘息的病因及相关危险因素。方法：回顾性复习180例喘息婴幼儿的临床资料,采用logistic回归分析调查喘息发作的危险因素。结果：病因分布中由病毒诱发的喘息占33.3%,哮喘占19.4%,支原体感染占6.7%,胃食道反流占12.8%,支气管肺发育畸形占4.4%,早产占7.8%,父母吸烟以及特殊环境占15.6%。多因素logistic回归分析显示,父母过敏史、患儿食物以及吸入变应原致敏、病毒感染、支原体感染、早产、特殊环境等7个因素最终进入主效应模型,与喘息发作有显著相关性。结论：婴幼儿喘息发作以病毒诱发为主,哮喘的比例也相对较高,遗传因素、自身特应性、环境因素与喘息发作密切相关。     

中山市婴幼儿喘息相关危险因素分析

目的分析婴幼儿喘息相关危险因素。方法采用多中心、大样本病例对照研究方法,以问卷访查的形式收集资料,先进行单因素分析,再以多因素逐步Logistic回归分析婴幼儿喘息发生的独立危险因素。结果单因素分析婴幼儿喘息发生的危险因素与父母过敏史、生产方式、呼吸道合胞病毒感染、肺炎支原体感染、个人过敏史、爱哭、父母常闹矛盾、临近马路、周围工厂共9个因素有关,差异有统计学意义(P0.05),而与其余22个因素无关。Logistic回归分析发现,父母过敏史(OR=3.441,95%CI:1.914~6.186,P0.001)、呼吸道合胞病毒感染(OR=2.910,95%CI:1.793~4.723,P0.001)、肺炎支原体感染(OR=2.277,95%CI:1.110~4.667,P=0.025)、临近马路(OR=2.036,95%CI:1.280~3.239,P=0.003)、爱哭(OR=1.521,95%CI:1.049~2.206,P=0.027)是婴幼儿喘息发作的独立危险因素。结论婴幼儿喘息发生与父母过敏史、呼吸道合胞病毒感染、肺炎支原体感染、临近马路、爱哭、个人过敏史等9个因素有关,而前5者为其独立危险因素。     

肺炎支原体感染与小儿喘息性疾患

1 小儿喘息性疾患的范畴包括喘息性支气管炎(以下简称喘支)、哮喘性支气管炎、婴幼儿哮喘、哮喘等。其中主要为喘支与哮喘,两者是不同疾病还是同一疾病,目前尚有争论。作者对146例喘支患儿随访观察发现,从家族遗传史,个人过敏史,吸入性过     

哮喘相关因素调查分析

目的　了解小儿哮喘发病相关因素和防治状况 ,推广全球哮喘防治创议 (GINA)方案 ,规范化治疗儿童哮喘。方法　对在我院儿科哮喘门诊就诊或住院治疗并确诊为哮喘 116例患儿进行问卷调查及门诊随访观察。结果　 116例中以儿童哮喘为多占 80 .17% ,婴幼儿哮喘仅占 19.83% ,71.5 6 %首次喘息发生在 6岁以前。发病以春秋季节为多 ,尤以秋季最多占 31.0 3%。诱发因素以上呼吸道感染多见 ,其次为天气变化。一、二级亲属中有哮喘及其他过敏史分别为 5 .17%和 2 7.5 9% ,有婴幼儿湿疹、过敏性鼻炎等个人过敏史分别为30 .1%、5 8.6 2 %。 1年内诊断情况显示 ,误诊率为 18.10 %。4 4 .83%哮喘患儿能接受哮喘知识教育和规范化管理 ,坚持吸入激素治疗 ,其疗效明显优于非规范化治疗组 (P <0 .0 0 5 )。结论　哮喘发病与年龄、季节、诱因、家族史及个人过敏史等多种因素有关 ,及时诊断 ,规范化管理治疗十分重要     

中国儿童哮喘危险因素的Meta分析

目的 探讨中国儿童哮喘的主要危险因素,为哮喘的防治提供参考依据。方法 系统收集中国知网、万方数据库、中国生物医学文献数据库、维普中文科技期刊全文数据库、Web of Science和PubMed等数据库从建库至2017年9月有关中国儿童哮喘危险因素的研究。采用Stata 12.0软件进行Meta分析。结果 共纳入24篇病例对照研究,其中病例组5 309例,对照组6 404例。Meta分析显示,家族哮喘史（OR=5.246,95% CI：3.435~8.011）、家族过敏史（OR=4.627,95% CI：2.450~8.738）、特应性体质（OR=4.659,95% CI：2.511~8.644）、变应性鼻炎（OR=11.510,95% CI：6.769~19.574）、湿疹/皮炎史（OR=4.919,95% CI：3.514~6.886）、患儿过敏史（OR=4.732,95% CI：2.802~7.989）、食物过敏史（OR=5.890,95% CI：3.412~10.166）、药物过敏史（OR=4.664,95% CI：2.637~8.252）、家中有霉斑（OR=2.483,95% CI：1.671~3.690）、家中种花草（OR=1.748,95% CI：1.383~2.209）、房屋装修史（OR=2.823,95% CI：2.206~3.935）、剖宫产（OR=1.894,95% CI：1.166~3.077）是儿童哮喘的危险因素,母乳喂养是儿童哮喘的保护因素（OR=0.508,95% CI：0.396~0.653）。结论 中国儿童哮喘的发生与多种因素有关,其中家族哮喘史、家族过敏史、个体特应性体质、过敏史、过敏合并症、剖宫产出生及不良的家庭环境因素可增加儿童哮喘的患病风险,而母乳喂养可降低儿童哮喘的患病风险。     

安徽省芜湖市城区0~24月龄婴幼儿过敏性疾病的危险因素分析

目的了解安徽省芜湖城区0~24月龄婴幼儿过敏性疾病既往发病情况,探讨婴幼儿过敏性疾病的危险因素,为今后婴幼儿过敏性疾病的防治工作及发病机制的深入研究提供理论参考。方法采取整群随机抽样的方法对600名安徽省芜湖市城区0~24月龄婴幼儿母亲进行问卷调查,询问疾病史、家族史、孕期及育儿等情况,运用单因素和多因素logistic回归分析方法对资料进行分析。结果在纳入分析的597名婴幼儿中,既往被确诊为过敏性疾病者共56例(9.4%)。单因素分析显示,月龄、解热镇痛药物使用、父亲过敏史、直系祖辈亲属过敏史和孕期母亲鱼虾蟹贝类食用5项因素与既往罹患过敏性疾病相关联(P0.05)。多因素回归分析显示,月龄、父亲过敏史、直系祖辈亲属过敏史与既往罹患过敏性疾病存在正关联(OR依次为:4.0~4.9、2.7、2.4,均P0.05),而母亲孕期经常食用鱼虾蟹贝类与既往罹患过敏性疾病存在负关联(OR=0.3,P0.05)。结论过敏家族史是安徽省芜湖城区0~24月龄婴幼儿过敏性疾病发生的独立危险因素,而母亲孕期经常食用鱼虾蟹贝类是其保护因素。     

儿童哮喘预后相关因素的研究

目的 探讨儿童哮喘预后的相关因素。方法 对110例拒绝全球哮喘防治创议（GINA）方案治疗的哮喘患儿进行2-7年的随访观察，采用多元回归方法就性别、早产、首次发病年龄、母乳喂养、环境暴露、个人过敏史、病情严重度、每年呼吸道病毒感染次数、被动吸烟、家庭过敏史、饮食习惯11项因素对预后的影响进行分析。结果 哮喘自然缓解2年以上31例（29.18%)，未缓解79例。环境暴露、个人过敏史、病情严重度、每年呼吸道病毒感染次数、被动吸烟、家族过敏史、饮食习惯对预后有影响，标准偏回归系数分别是-0.2760、-.3000、-0.2330、-0.1680、-0.1740、-0.1090、0.1100，而性别、早产、首次发病年龄、母乳喂养对预后无直接影响。结论 哮喘预后的危险因素为早期环境暴露、个人过敏史、病情较严重、被动吸烟、有家族过敏史，而增加每年呼吸道病毒感染次数、饮食习惯以鱼类为主有利哮喘的预后。影响儿童哮喘预后的因素是复杂的，哮喘自然缓解的比例毕竟较少，早期GINA方案治疗是明智的选择。     

毛细支气管炎后支气管哮喘发生的相关因素

目的 探讨毛细支气管炎后发生哮喘的相关因素.方法对2002年1月-2003年5月住院的115例毛细支气管炎患儿进行临床资料统计,包括年龄、性别、出生体质量、发病季节、肥胖情况、病情轻重、病原学及过敏原检测、湿疹史、哮喘家族史、母孕期吸烟、喂养方式等;出院后门诊或电话随访5 a,包括呼吸道感染及喘息发作情况,并记录居住环境污染(煤/矿)、养宠物等资料;根据5 a内是否发生哮喘,采用Logistic统计学方法对各可能因素与哮喘发生之间的关系及相关程度进行回归分析.结果毛细支气管炎患儿115例5 a内有39例发生哮喘(占33.9%).哮喘组与非哮喘组单因素比较,在哮喘家族史、1岁内反复下呼吸道感染(LRTI)和患毛细支气管炎时的年龄、病情轻重、肥胖构成方面均有显著差异(P=0,0,0.004,0.004,0.020).毛细支气管炎患病季节、病情轻重、哮喘家族史、婴幼儿湿疹、1岁内反复LRTI等因素共同影响着哮喘的发生(OR=0.49,3.82,6.12,3.76,3.14P=0.000 7,0.026 0,0,0.030 9,0.000 5).性别、出生体质量、先天性心脏病、居住环境污染、动物接触、喂养方式、母孕期吸烟及患毛细支气管炎时的年龄、感染病原、血IgE、肥胖等因素与毛细支气管炎后发生哮喘均无相关性.结论重型毛细支气管炎、哮喘家族史、婴幼儿湿疹、1岁内反复LRTI是毛细支气管炎后发生哮喘的危险因素,而毛细支气管炎冬季患病是其保护因素.     

儿童哮喘与喘息性支气管炎关系探讨

本文对80名哮喘儿童和50名喘支患儿进行了“模糊聚类”分析和多元分析等统计方法。结果显示,儿童哮喘有65%于3岁前起病,和喘支组相比,具有更高的阳性家族史、家族过敏史及本人过敏史;但在临床主要指标及体液、细胞免疫、白细胞计数、嗜酸性细胞计数等方面则无明显差別。两组样本经模糊聚类分析在λ=0.82高水平上完全聚为一类;而多元分析也表明支配两病的主要因素是发病年龄、发作频数、家族史、前驱症和婴幼儿期呼吸道疾病史。为此,作者认为,在排除其他喘息原因后,3岁以下不明原因的感染后反复喘息者当为婴幼儿哮喘。     

Breastfeeding and the risk of wheeze and asthma in Japanese infants: The Osaka Maternal and Child Health Study

Epidemiological evidence for an effect of breastfeeding on asthma continues to be inconclusive. The present prospective study examined the relationship between breastfeeding and the risk of wheeze and asthma in Japanese infants. A birth cohort of 763 infants was followed. The first survey during pregnancy and the second survey between 2 and 9 months postpartum collected information on potential confounding factors. Data on breastfeeding, wheeze, and asthma were obtained from questionnaires in the third survey from 16 to 24 months postpartum. Adjustment was made for maternal age, maternal and paternal history of asthma, atopic eczema, and allergic rhinitis, indoor domestic pets (cats, dogs, birds, or hamsters), family income, maternal and paternal education, maternal smoking during pregnancy, baby's sex, baby's older siblings, household smoking in the same room as the infant, and time of delivery before the third survey. By the third survey, the cumulative incidence of wheeze and asthma was 22.1% and 4.3%, respectively. Neither exclusive breastfeeding for 4 months or more nor partial breastfeeding for 6 months or more were materially related to the risk of wheeze. No measurable association was observed between exclusive breastfeeding for 4 months or more and the risk of asthma. Partial breastfeeding for 6 months or more was inversely related to the risk of asthma although the adjusted odds ratio (OR) was not statistically significant. When infants were stratified according to whether there was a negative or positive allergic history in at least 1 parent, a nearly 40% and 60% decrease, respectively, in the ORs were found for exclusive and partial breastfeeding only in infants without a parental allergic history, although the ORs were not statistically significant. The present prospective study showed no statistically significant relationship between breastfeeding duration and the risk of wheeze or asthma in Japanese infants.     

婴幼儿喘息与肺炎支原体感染的关系探讨

目的探讨婴幼儿喘息发作与肺炎支原体(MP)感染之间的关系。方法选取228例下呼吸道感染婴幼儿分为初次喘息组(65例)、反复喘息组(83例)和无喘息组(80例)。收集患儿入院当天或次日空腹血清,采用ELISA法检测MP-Ig M,化学发光法测定血清总免疫球蛋白E(TIg E),欧蒙印迹法检测血清常见过敏原特异性免疫球蛋白E(s Ig E),并且收集患儿特应性体质表现及过敏性疾病家族史临床资料。结果初次喘息组和反复喘息组患儿MP感染阳性率及血清TIg E水平高于无喘息组(P0.05);反复喘息组患儿s Ig E检测阳性率显著高于初次喘息组和无喘息组(P0.05),且这部分患儿特应性体质表现及过敏性疾病家族史与发病密切相关。结论 MP感染与婴幼儿喘息密切相关,MP是诱发婴幼儿喘息发作的主要病原体之一,过敏原、特应性体质和过敏性疾病家族史是婴幼儿反复喘息的主要危险因素。     

Natural history of asthma in children

Asthma is a syndrome of reversible bronchial obstruction in hyperresponsive airways mediated by allergy or other trigger factors. Allergic disease represents true asthma while transient wheezing may be caused by factors such as viral infection, aspiration, prematurity and neonatal lung damage and is likely to outgrow within few years. Personal or family history of atopy, increased serum IgE and positive skin tests may suggest allergic asthma, which persists throughout life irrespective of presence or absence of symptoms. Onset of age beyond 2 years, severity, persistence or recurrence of symptoms beyond 6 years of age, airway hyperresponsiveness and abnormal lung function even in absence of symptoms, strong family history especially in the mother, exposure to allergens, parental smoking and delay in starting appropriate therapy are some of high risk factors in persistence of asthma in adult life. As outcome of asthma depend upon multiple variable factors, it is difficult to predict natural history of asthma in an individual child.     

Relation between serum IL‐4, IL‐13 and IFN‐γ levels and recurrence of wheezing episodes in infants with acute bronchiolitis

Lower respiratory tract infections are the most important factors among various causes which trigger wheezing in the first year of life. The factors associated with episodic wheezing in children with acute bronchiolitis are still subjects of research. Infections, environmental factors, immunologic mechanisms are sorted as etiologic risk factors of episodic wheezing. We aimed to investigate the relationship between serum interleukin (IL)‐4, IL‐13 and γ‐interferon (IFN‐γ) levels and recurrence of wheezing episodes in infants with acute bronchiolitis. One hundred twenty infants between 3 and 36 months with acute bronchiolitis enrolled in the study. Personal histories, clinical and laboratory data of infants were recorded. The patients were followed for a year. Venous blood samples were obtained to determine serum IL‐4, IL‐13, and IFN‐γ levels during acute bronchiolitis episode. The number of wheezing episodes was significantly higher in infants with a positive family history of allergy. A statistically significant correlation was determined between serum IL‐13 levels of infants and number of wheezing episodes. High serum IL‐13 levels and a positive history of allergy may have important roles in the recurrence of acute bronchiolitis.     

International study of wheezing in infants: risk factors in affluent and non‐affluent countries during the first year of life

Garcia‐Marcos L, Mallol J, Solé D, Brand PLP and EISL group. International study of wheezing in infants: risk factors in affluent and non‐affluent countries during the first year of life.
Pediatr Allergy Immunol 2010: 21: 878–888.
© 2010 John Wiley & Sons A/S Risk factors for wheezing during the first year of life (a major cause of respiratory morbidity worldwide) are poorly known in non‐affluent countries. We studied and compared risk factors in infants living in affluent and non‐affluent areas of the world. A population‐based study was carried out in random samples of infants from centres in Latin America (LA) and Europe (EU). Parents answered validated questionnaires referring to the first year of their infant’s life during routine health visits. Wheezing was stratified into occasional (1–2 episodes, OW) and recurrent (3 + episodes, RW). Among the 28687 infants included, the most important independent risk factors for OW and RW (both in LA and in EU) were having a cold during the first 3 months of life [OR for RW 3.12 (2.60–3.78) and 3.15 (2.51–3.97); population attributable fraction (PAF) 25.0% and 23.7%]; and attending nursery school [OR for RW 2.50 (2.04–3.08) and 3.09 (2.04–4.67); PAF 7.4% and 20.3%]. Other risk factors were as follows: male gender, smoking during pregnancy, family history of asthma/rhinitis, and infant eczema. Breast feeding for >3 months protected from RW [OR 0.8 (0.71–0.89) in LA and 0.77 (0.63–0.93) in EU]. University studies of mother protected only in LA [OR for OW 0.85 (0.76–0.95) and for RW 0.80 (0.70–0.90)]. Although most risk factors for wheezing are common in LA and EU; their public health impact may be quite different. Avoiding nursery schools and smoking in pregnancy, breastfeeding babies >3 months, and improving mother’s education would have a substantial impact in lowering its prevalence worldwide.     

Risk factors in wheezing infants

BACKGROUND: Some lifestyle factors may be important for the occurrence of wheezing and there are considerable differences around the world. METHODS: Risk factors of wheezing were examined in 38 children (aged 6-24 months). Results were compared with healthy age-matched controls. RESULTS: Family history of atopy, asthma and eczematoid dermatitis, and parental and pregnancy smoking were all reported as being substantially more common in wheezing infants than in controls (P < 0.05 for each parameter). Living conditions showed that the incidence of wheezing in infants was more common in households with wooden floor coverings compared with controls, which used plastic floor coverings (P < 0.05). They also showed that 55.3% of wheezing infants and only 20% of controls were living in moist dwelling environments (P < 0.05). With regard to bedding, the incidence of wheezing in infants was higher in households using synthetic materials compared with controls (P < 0.05). A history of in utero and environmental tobacco smoke exposure was associated with increased risk of recurrent wheezing. Odds ratio and logistic regression analysis were done with presence of wheezing as the dependent variable and all risk factors of interest as independent variables. Family history of atopy, high household humidity levels, parental smoking and wooden floors used in the home were significant risk factors for wheezing. Skin test positivity and gastroesophageal reflux were determined in wheezing infants as 18.4 and 13.2%, respectively. CONCLUSION: Recurrent wheezing in infancy may be associated with many environmental and genetic factors. It is possible that allergen avoidance merely delays rather than prevents the development of allergic disorders.     

尘螨阳性婴幼儿首次喘息后反复喘息发作的危险因素

目的 探讨尘螨阳性婴幼儿首次喘息后反复喘息发作的危险因素。方法 选取2014年8月至2015年2月间住院的首次喘息发作婴幼儿共1 236例,其中尘螨阳性387例,出院后随访1年,随访1年内再发喘息3次及3次以上的患儿设定为反复喘息组（n=67）,随访期间未再发生喘息的患儿设定为对照组（n=84）。采用单因素分析和多因素logistic逐步回归分析,探讨尘螨阳性的婴幼儿反复喘息发作的危险因素。结果 单因素分析显示,入院时年龄、入院前喘息时间、肺炎支原体感染率、流感病毒感染率与反复喘息发作相关联。多因素logistic逐步回归分析显示,入院时年龄较大（OR=2.21,P=0.04）、合并肺炎支原体感染（OR=3.54,P=0.001）为反复喘息发作的独立危险因素。结论 尘螨阳性的婴幼儿,特别是幼儿,若首次喘息时合并有肺炎支原体感染,则反复喘息发作的风险明显升高。     

婴幼儿喘息与呼吸道合胞病毒肺炎支原体感染及过敏的关系

目的了解婴幼儿喘息性疾病与呼吸道合胞病毒、肺炎支原体感染的关系,同时进行常见食物过敏原和吸入过敏原筛查,旨在探讨婴幼儿喘息与呼吸道合胞病毒、肺炎支原体感染及过敏的关系及其与支气管哮喘的相关性。方法对2000-01—2003-12在南京中医药大学附属医院就诊的232例下呼吸道感染的婴幼儿进行呼吸道合胞病毒、肺炎支原体抗体的检测,并进行过敏原检测,收集特异性体质的表现及家族史,对有喘息症状的部分患儿进行随访。结果喘息组患儿以上2种病原体感染率高于非喘息组;81例喘息患儿随访中,有67.90%(55例)的患儿转为哮喘,这部分患儿的特应性体质表现及家族史与发病密切相关。结论婴幼儿喘息性疾病与呼吸道合胞病毒、肺炎支原体感染密切相关,过敏是婴幼儿反复发生喘息性疾病的重要危险因素。     

Association of cord blood cytokine levels with wheezy infants in the first year of life

As antenatal environment may influence the development of atopy-predisposing immune response, cord blood cytokine productions may be an important predictor for wheezing. We investigated cord blood cytokines in a prospective birth cohort, intensively monitored for wheezy infant outcome at 1 yr. Cord blood serum samples from 269 children were assayed for interleukin (IL)-1β, -2, -4 to -8, -10, -12 (p70), -13, and -17, interferon-γ, tumor necrosis factor-α, granulocyte-macrophage colony-stimulating factor, granulocyte colony-stimulating factor (G-CSF), monocyte chemotactic protein-1, and macrophage inflammatory protein-1β. Associations between family histories, antenatal and perinatal factors, cord blood cytokine concentrations, and wheezy infant outcomes (wheezing more than two times) were analyzed. In cord blood sera from 269 children, there were associations between high levels of IL-6, -8 and G-CSF concentrations, and cesarean section. Data at 1 yr were obtained from 213 infants, including 33 wheezy infants. Risk of wheezing was related to gestational age, birth weight, cesarean section, and maternal eczema, but not to bacterial/viral infection during pregnancy, maternal asthma, maternal smoking, or paternal history. High level of cord blood IL-8 concentration had a significant association with wheezy infant outcomes at 1 yr (p = 0.025). By using multivariate logistic regression analysis, birth weight [odds ratio(OR) = 0.998, 95% confidence interval (CI) = 0.997–1.000] and maternal eczema (OR = 5.356, 95% CI = 1.340–21.41), but no other factors, were significant predictors of wheezy infants. Birth weight, gestational age, and maternal history were important risk factors for wheezing in the first year of life. Several cord blood cytokine productions were influenced by cesarean section, and IL-8 may be a predictor for recurrent wheezing at 1 yr.