不同大气污染程度地区学龄儿童呼吸系统疾病及症状发生的比较

目的：：了解北京市不同大气污染程度地区学龄儿童呼吸系统健康状况的差异。方法：在北京市选取污染程度较重的城区A区和较轻的郊区B区作为研究地点,按照整群抽样的方法,分别选取A区的4所小学和B区的3所小学1~4年级学生为研究对象,采用国际标准化问卷对儿童呼吸系统疾病及症状的流行情况进行调查。结果：与污染程度较轻的B区相比,A区儿童的咳嗽(62.2% vs.59.9%)、持续性咳嗽(6.3% vs.3.1%)、咳痰(42.4% vs.37.4%)、持续性咳痰(3.6% vs.2.4%)、喘鸣(13.3% vs.9.9%)和哮喘(9.5% vs.5.4%)等症状的发生率均较高,且经统计学检验,除咳嗽、感冒时咳嗽、不感冒时咳嗽外,儿童呼吸系统其他疾病及症状发生率在两区之间的差异均有统计学意义(P<0.05)。运用Logistic回归模型控制混杂因素后,A区儿童持续性咳嗽、不感冒时咳痰、哮喘发生的危险性仍高于B区的儿童,差异有统计学意义(P<0.05)。结论：污染程度较重的地区儿童呼吸系统疾病及症状发生率高于污染程度较轻的地区,提示大气污染与学龄儿童呼吸系统疾病和症状发生情况有关。     

临床证据（五）儿童哮喘的治疗效果

背景知识定义　儿童哮喘 :以慢性、复发性咳嗽及喘鸣为特征 ,能做峰流速或肺功能测定的儿童显示可逆性气道阻塞 ,并需除外其他引起复发性呼吸道症状的病因。婴儿喘鸣 :可由急性病毒感染、发作性病毒相关喘鸣或哮喘引起 ,在临床上难以区分。发病率 /患病率　研究表明 ,虽然更易于诊断为哮喘 ,但喘鸣、气短及哮喘的诊断在儿童中逐渐增多 ,这种上升趋势超出了以往的估计。使用一份来自苏格兰Ａｂｅｒｄｅｅｎ的问卷 ,分别在 1964年和 1989年调查了 2 5 10名 ( 8～ 13岁 )和3 4 0 3名儿童。在这 2 5年间 ,喘鸣的发生率从 10 4 %上升到19 8% ,气…     

喘鸣婴幼儿血清总IgE水平及其与临床的关系

对108例喘鸣婴幼儿进行了有关过敏史的调查及血清总IgE水平的检测,结果表明哮支和哮喘患儿均有较高的湿疹史和家族哮喘史阳性率,血清总IgE水平亦明显高于同年龄正常儿童,说明哮支和婴幼儿哮喘均有较强的过敏体质,并可能在遗传上存在着共性,但过敏因素与喘鸣起病年龄、发作频度及临床严重程度之间并无明显相关性。对毛支组患儿的研究则未发现有明显过敏因素的参与。     

哮喘儿童焦虑症状现状及相关因素分析

目的了解哮喘儿童焦虑症状及其影响因素,为哮喘儿童进行健康宣教提供依据。方法使用基本情况调查表和儿童焦虑障碍自评量表(SCARED)对2011年8～11月就诊于重庆医科大学附属儿童医院哮喘中心的408例8～16岁城市哮喘儿童进行焦虑症状现状及影响因素的调查。结果哮喘儿童焦虑症状检出率为38.0%,焦虑评分高于全国健康儿童常模,躯体化/惊恐、广泛性焦虑、社交焦虑各分量表得分13～16岁年龄组高于8～<13岁年龄组;分离性焦虑8～<13岁组女孩得分最高,焦虑障碍量表总得分8～<13岁组男孩最低,差异具有统计学意义(P<0.01);多元逐步回归分析显示父母对哮喘的认识程度、肺功能测试情况和父母婚姻3个变量是影响哮喘儿童焦虑症状的主要因素。结论哮喘儿童的焦虑症状较为普遍,临床工作人员应该结合其影响因素,实施针对性的健康教育,从而提高哮喘儿童生活质量。     

大气污染对儿童体液免疫功能影响的研究

目的：探讨大气污染对儿童体液免疫功能的影响,为提高生存质量,改善生存环境,预防呼吸道等疾患提供依据。方法：选择重污染区和轻污染区的没有职业接触且近3个月未用抗生素类药物的6－8岁儿童作为研究对象,用酶联免疫吸附法检测血清免疫球蛋白IgG,IgM,IgA,IgE含量,进行对比分析。结果：免疫球蛋白水平受外环境的影响较大,重污染区儿童IgA,IgM水平明显低于轻污染区,IgG,IgE水平明显高于轻污染区,并有显著性差异（P＜0．01或P＜0．05）,而不同性别儿童在重污染区和轻污染区的免疫球蛋白水平没有显著差异（P＞0．05）,结论：大气污染对儿童体液免疫功能有明显的影响,可使人体免疫球蛋白水平发生改变,可能是导致呼吸道感染和变态反应性疾病发病率增高的重要因素。     

8～12岁市区学龄儿童感觉统合失调与不良行为及家庭因素调查分析

目的调查本市区小学儿童感觉统合失调现状与不良行为及家庭因素的关系.方法用感觉统合诊断量表和自制儿童生长发育 调查表对1775名学龄儿童进行心理行为问题调查.结果感觉统合轻 度失调23.4%、重度失调13.5%,男童失调发生率(42.86%)明显高于女童(31.36%)P ＜0.01,前庭功能失衡发生率最高(21.30%);统合失调组儿童不良行为发生率高达64.38% 明显高于统合正常组(31.11 %)P＜0.01, 失调组不良行为各因子的发生率亦明显高于统合正常组P＜0.01;学习能力不足儿童与父母文化程度和不同职业有关P＜0.01. 结论儿童感觉统合失调现状易成为成人心理障碍的潜在因素,应引起重视.     

二维平均差向量的假设检验及其在环境卫生学中应用(TI—59计算机程序)

本文介绍了二维平均差向量的假设检验在环境卫生学中的应用。对沈阳市不同地区配对的9个差向量借助于TI—59型计算机进行了计算,结果重污染区的飘尘浓度高于轻污染区;紫外线强度则相反。重污染区小儿佝偻病发病率高于轻污染区。初见重污染区的飘尘浓度已对该地区小儿健康产生了影响。     

重庆地区哮喘儿童生命早期高危因素及过敏原分布调查分析

目的 调查重庆地区哮喘儿童生命早期高危因素及过敏原分布情况,为区域化早期防控提供经验.方法 问卷调查310例哮喘患儿的产前、产后易感因素和过敏原皮肤点刺试验(SPT)结果,并与同期310例正常儿童进行比较,采用二项logistic回归进行独立危险因素分析.结果 产前哮喘影响单因素有10项,包括:母孕期吸烟、接触宠物、剖...     

WONCA研究论文摘要汇编(五十六)——母亲贫血与婴幼儿喘鸣及哮喘关联

背景有关妊娠期母亲的营养和微量营养素状况,及其后代发生呼吸疾病问题越发得到了关注。目的 调查妊娠期母亲贫血与婴幼儿喘鸣及哮喘的相关性。方法 研究人群,经妊娠期跟踪至孩子6岁再接触对女性的孩子做呼吸健康评估。将分娩住院期间母亲贫血诊断及血红素(Hgb)<11评估为暴露。研究结果包括婴幼儿喘鸣;从出生至6岁各型喘鸣(早发一过性喘鸣,迟发喘鸣,早发持续喘鸣);及儿童期哮喘的诊断。结果 有11.9%的母亲有贫血报告,第1年反复发生新生儿喘鸣[校正优势比(ORa)=2.17,95%CI(1.18,4.00)]、3岁前喘鸣[ORa=2.42,95%CI(1.38,4.23)]、及早发一过性喘鸣和早发各型喘鸣[分别为:ORa=2.81,95%CI(1.38,5.72)及ORa=2.07,95%CI(1.02,4.22)]。母亲患哮喘儿童中,母亲贫血与第1年反复发生喘鸣[ORa=4.22,95%CI(1.65,10.80)]及3岁前喘鸣[ORa=2.73,95%CI(1.17,6.35)]关联。母亲患哮喘增加了后代哮喘诊断[ORa=2.53,95%CI(1.04,6.17)]及发生哮喘[ORa=3.46,95%CI(1...     

先天性巨结肠患儿母孕前期致畸因素调查分析

目的：调查分析先天性巨结肠患儿母孕前期致畸因素。方法笔者随机选取先天性巨结肠患儿及其同龄健康儿童母亲各100例,根据自设患儿母孕前期致畸因素调查问卷表进行调查。结果巨结肠母亲一般性情况调查中山区、孕期10～12月份、以及生育二胎者的比率高于健康儿童母亲,差异有统计学意义（P＜0.01）;巨结肠母孕前期致畸因素中病毒感染、噪音与空气污染、重体力劳动、抑郁及焦虑的比率高于健康儿童母亲,差异有统计学意义（P＜0.05）。结论此次调查结果有利于医务人员对患儿家长进行预防先天性疾病发生的详尽解释,提高其健康知识水平。对于育龄女性要进行健康教育,以期降低先天性畸形疾病发生率,提健康水平和生活质量,减少社会负担。     

沈阳市城市人口咳嗽喘息症状抽样调查结果分析

目的：调查沈阳市城市人口咳嗽、喘息症状的发生率。方法：1998年12月至1999年6月经随机抽样以沈阳市某工业区和某文化区各一个街道的常住人口24176人（男11955人，女12221人）为调查对象，进行咳嗽、喘息症状的问卷调查，对可疑患者行肺功能检测。结果：有咳嗽，喘息症状者904例，占总调查人口的3．74％，工业区（4．54％），明显高于文化区（2．83％），P＜0．01，结论：本研究基本反映了沈阳市城市人口咳嗽，喘息症状的发生情况，工业区发生率高可能与该区吸烟人口多和环境污染有关。     

室内环境与学龄儿童呼吸系统健康的关联性研究

目的：探讨室内环境因素与学龄儿童呼吸系统健康之间的关联性。方法：调查对象为广州市3个不同空气污染程度地区8所小学的2179例3、4年级小学生。通过标准化问卷了解调查儿童的家庭、社会经济状况和呼吸道症状、疾病史,并测量其身高、体质量和肺功能。结果：在室内环境诸多因素中,地毯、新家具、装修、熏香、发霉、宠物和被动吸烟均显著增加儿童呼吸道症状和疾病的患病风险,OR值1．34～2．88。室内熏香和房间夏季通风多与儿童肺功能水平呈负相关（P〈0．05）。结论：室内环境中存在多种因素显著影响学龄儿童呼吸系统健康。     

广州市区青少年哮喘和过敏性疾病流行变化趋势调查

目的了解广州市区青少年哮喘、过敏性鼻炎、湿疹的患病率变化趋势.方法按照儿童哮喘及其他过敏性疾病的国际间对比研究（ISAAC）阶段Ⅲ方案,对广州市4个中心城区10所中学的3516名13～14岁青少年进行横断面问卷调查,并将结果与1994～1995年ISAAC阶段Ⅰ作对比.结果书面问卷中,近12个月喘息和运动后喘息症状的患病率,分别由阶段I的3.4%和17.4%上升为阶段Ⅲ的4.8%和23.4%（P〈0.01）,而医生诊断哮喘的患病率（阶段Ⅰ为3.9%,阶段Ⅲ为4.6%）在两阶段间比较差异无统计学意义.录像问卷中,阶段Ⅲ的近12个月休息时喘息和运动后喘息患病率分别为3.8%和11.3%,也高于阶段Ⅰ的2.0%和6.9%（均P〈0.01）.无感冒时有鼻炎和鼻结膜炎症状的近12个月患病率,分别由阶段Ⅰ的39.5%和8.7%上升为阶段Ⅲ的45.5%和11.1%（均P〈0.01）;同时,医生诊断为季节性花粉过敏和过敏性鼻炎的患病率,分别由阶段Ⅰ的2.9%和17.4%上升为阶段Ⅲ的4.1%和22.7%（均P〈0.05）.近12个月湿疹症状的患病率,由阶段Ⅰ的1.3%上升为阶段Ⅲ的2.2%（P〈0.01）,而医生诊断湿疹的患病率,两阶段间比较差异无统计学意义（P＞0.05）.男性哮喘、过敏性鼻炎、湿疹的近12个月症状及医生诊断患病率上升的幅度均较女性明显.结论广州市13～14岁青少年哮喘及过敏性鼻炎、湿疹患病率均较7年前高,且以男性上升明显.     

Asthma and hayfever in Aboriginal and non-Aboriginal children living in non-remote rural towns

OBJECTIVE: To compare the prevalence and risk factors for wheeze, asthma diagnosis and hayfever in Aboriginal and non-Aboriginal children living in rural towns in Australia. DESIGN AND SETTING: Cross-sectional study in two towns in rural NSW, Australia, 1997. PARTICIPANTS: Primary school children (aged 7-12 years) classified by their parents as being of Aboriginal (n = 158) or of non-Aboriginal (n = 1,282) origin. Main outcome measures: Atopy measured by skinprick tests and respiratory symptoms measured by parent-completed questionnaire. RESULTS: Aboriginal children were less likely to be atopic (36.2% v 45.6%; 95% CI for the difference, -17.6 to -1.3) and to have hayfever (23.3% v 35.2%; 95% CI for the difference, -19.1 to -4.6) than non-Aboriginal children, but were equally likely to have had wheeze (31.0% v 27.3%) and asthma (39.4% v 39.3%). Among Aboriginal children, having had bronchitis before age two was a strong risk factor for wheeze (adjusted odds ratio (aOR), 9.3; 95% CI, 2.8-30.2) and asthma (aOR, 19.3; 95% CI, 4.7-79.3) and having a parent with hayfever was a strong risk factor for hayfever (aOR, 17.9; 95% CI, 3.5-90.8), but these risk factors were weaker among non-Aboriginal children. CONCLUSIONS: Asthma and wheeze are equally prevalent in Aboriginal and non-Aboriginal children living in the same towns, but appear to have a different aetiology.     

Prevalence and spectrum of asthma in childhood

All the 7 year old schoolchildren in North Tyneside were screened for wheeze with a questionnaire followed by selective clinical assessment: 9.3% of the children had had episodic wheeze within the past year and all those followed up subsequently responded to one or more of the drugs used for asthma. A further 1.8% had had similar symptoms since starting school, though they had not wheezed in the past year. Frequently of symptoms in the 11% of children with features of asthma varied widely and correlated with bronchial reactivity on histamine challenge, but it was not possible to separate children with frequent wheeze from asymptomatic controls by their response to histamine. It was concluded that all these wheezy children had symptoms of a common basic disorder and that they should all be treated as asthmatic.     

Prevalence of asthma in regional Victorian schoolchildren.

OBJECTIVE: To determine whether the high prevalence of reported asthma in Melbourne schoolchildren is seen in rural Victoria. DESIGN: A questionnaire on respiratory symptoms was distributed to children to be completed by parents and returned to the school. Results were compared with a previous Melbourne study. SETTING: Two hundred and twenty-seven government and non-government primary schools in five rural regions of Victoria: coast, wheatbelt, riverland, highland and Latrobe valley. SUBJECTS: All children enrolled in grade 2 were invited to join the study. Parents completed questionnaires for 4661 children after 4886 questionnaires were distributed (response rate, 95%). MAIN OUTCOME MEASURE: History of wheeze in the past 12 months. RESULTS: The overall prevalence of wheeze in the last 12 months was 23.6%. There was a significant difference overall in this rate across the five rural areas and Melbourne, with the Latrobe Valley (26.2%) and highland areas (25.0%) having the highest rate, and the wheatbelt the lowest (19.6%). The spectrum of severity of asthma was similarly distributed across rural regions, although severe episodes were significantly more frequently reported by parents from rural areas than by parents in Melbourne. The reported use of bronchodilators and diagnosis of asthma showed a similar pattern of variation to that of the 12-month prevalence of wheeze. CONCLUSION: The prevalence of asthma in 7-year-old children is similar for rural Victoria as a whole compared with Melbourne, but there is variability in asthma prevalence in individual rural areas which is difficult to account for in terms of known environmental precipitants.     

Asthma screening as part of a routine school health assessment in the Australian Capital Territory

OBJECTIVE: To determine the feasibility and performance of a routine screen for childhood asthma in new entrants to primary school relative to diagnosis by a paediatrician. DESIGN: Cross-sectional study with a validation substudy. PARTICIPANTS AND SETTING: All 4539 new primary school entrants (mean age, 5.72 years; 95% CI, 5.71-5.74) in the Australian Capital Territory (ACT) in 1999; 180 of these children (73% of the 248 contacted) participated in the validation substudy. MAIN OUTCOME MEASURE: Performance of the screening test relative to a paediatrician's diagnosis of current asthma (defined as a history of wheeze suggestive of a clinical diagnosis of asthma within the past 12 months) based on history and examination. RESULTS: 3748 of the 4539 new primary school entrants (83%) returned completed asthma and respiratory questions. The screening test was positive in 38% of children. Estimated sensitivity was 92% (95% CI, 75%-99%); specificity, 76% (95% CI, 72%-80%); positive predictive value, 51% (95% CI, 41%-63%); negative predictive value, 98% (95% CI, 90%-100%); positive likelihood ratio, 3.8 (95% CI, 2.8-4.8); and negative likelihood ratio, 0.14 (95% CI, 0.02-0.33). CONCLUSIONS: It is feasible to conduct population screens for asthma that have good diagnostic test performance against a specialist paediatrician's diagnosis through school health programs. This approach could facilitate monitoring changes in asthma prevalence over time.     

玉溪市0～14岁儿童哮喘流行病学调查

目的了解玉溪市0～14岁儿童哮喘的流行现状、分布特征及影响因素.方法采取整群抽样的方法,随机选取玉溪市城区0～14岁儿童16 717例进行调查.结果玉溪市0～14岁儿童哮喘患病率为1.13%,其中男、女性别之比为109：77,发病季节以秋、春季为主,以性别、呼吸道感染、过敏及遗传因素与哮喘发作有关.儿童哮喘治疗为吸入激素58.1%,支气管舒张剂45.7%,全身激素37.6%,抗白三烯药18.3%,脱敏治疗5.9%.结论玉溪市城区0～14岁儿童哮喘患病率为1.13%.其原因与性别、呼吸道感染、过敏及遗传因素等多种因素有关.对哮喘患儿及其家长进行有关哮喘基础知识的普及和教育是提高哮喘的诊治水平的重要措施.     

Asthma morbidity in Australia: an epidemiological study.

OBJECTIVE: To examine the prevalence and management of asthma in adults and children in a population sample in eastern Australia. SETTING: A random sample of children from 33 primary schools in Sydney, Melbourne, Brisbane, and the Upper Hunter Valley (New South Wales), and their parents. DESIGN: A cross-sectional analytic survey of 8753 primary school children aged between 5 and 12 years, and their parents (n = 13,945 adults). Asthma prevalence and management practices were determined by parental responses to a questionnaire, and spirometry was performed in children with "probable asthma". RESULTS: Of 8753 children whose parents responded, the prevalence of current wheeze was 19.5% and diagnosed asthma was 17.1%. Of the children with "probable asthma", 30% had their lung function measured in the previous year, and 6% possessed both a peak flow meter and an action plan for their asthma. Undertreatment was likely, as preventive asthma medications (inhaled corticosteroids or sodium cromoglycate) were used regularly by only 25.5% of these children and by 44.3% of children who had asthma symptoms more than twice per week. Children with the diagnosis of asthma reported higher rates of preventive medication use and ventilatory function measurement than children with frequent symptoms without the diagnosis. In the 13,945 adults, the reported prevalence of asthma was 7%, of whom 39% were using preventive medications, 34% had their ventilatory function assessed in the previous year, and 7% had both a peak flow meter and an asthma action plan. CONCLUSIONS: The study illustrated the gap between the current level of asthma management in the community and the standards set by the Thoracic Society of Australia and New Zealand. Undertreatment and suboptimal management of asthma remain important problems in Australia.