青少年支气管哮喘与气道反应性的遗传流行病学分析

利用遗传流行病学的方法，调查了230个子女为青少年（6－16岁）的哮喘核心家系，分析了父或母对子女患哮喘和气道高反应性的影响。结果显示：在哮喘核心家系中，儿子比女儿更易患哮回与气道高反应性；与父母均无哮喘史家系的子女比较，父母亲的哮喘史将使子女患哮喘的危险性增加10-30倍（P＜0．01），其中母亲对子女的影响更为明显，是父亲对子女影响的两倍。父母的气道高反应性也显著增加子女气道高反应性的危险性（OR=2.49，P＜0．01）。不仅遗传因素是支气管哮喘的重要危险因素之一，而且气道高反应性与遗传因素密切相关。两者可能既有共同的遗传基础又有各自不同的遗传易感基因。     

16岁以下青少年支气管哮喘的危险因素分析

收集了仅有１６岁以下青少年为子女的支气管哮喘核心家系的资料。２３０个家系资料的分析结果表明：１６岁以下的青少年中，男性患哮喘的危险性是女性的１．６２倍（Ｐ＜０．０１），饮用塘河水的人产生哮喘的危险性明显比饮用自来水的人高（ＯＲ＝１．６７，Ｐ＜０．０５）。父母的哮喘史是青少年最为突出的危险因素，使青少年患哮喘的危险性分别增加２．０６和２．７３倍，且均具有高度显著性意义。此家系分析也显示，母亲的哮喘史对子女产生哮喘的影响更大，约为父亲的两倍。青少年自身的气道高反应性和过敏体质也是青少年产生哮喘的危险因素之一，优势比分别为１．９２和２．０１（Ｐ＜０．０１）。本文揭示了遗传因素在哮喘发病过程中可能的重要作用。     

支气管哮喘遗传流行病学的初步分析

利用遗传流行病学的理论与方法，对６４１个核心家系完整资料分析的结果表明，父母患哮喘是其子女患哮喘的重要因素，患哮喘的危险性比父母均不患哮喘家系的子女增加４．０～８．０倍，这种差别具有高度显著性意义。父母对子女患哮喘危险性的影响呈现显著的线性趋势（Ｐ＜０．０１）。显示了哮喘的发病具有家族聚集性。同时分析了父母患哮喘的儿子与女儿患哮喘危险性，没有发现两者间的显著性差别（Ｐ＞０．０５）。本研究没有发现父母的气道反应性与其子女的气道反应性有显著相关性。本文初步研究结果提示哮喘发病过程中，遗传因素起着重要的作用。     

哮喘患者气道反应性的流行病学分析

６４１个哮喘核心家系的资料分析结果显示，利用乙酰甲胆碱（ＭＴＣＨ）激发试验测定的气道高反应性，做为哮喘诊断标准的灵敏度和特异度分别是７２％、７０％。气道反应阳性者患哮喘的危险性是气道反应阴性者的５．０１倍，其中，男女患哮喘的危险性分别是４．９７倍和５．０６倍，都具有高度显著性意义。患哮喘的危险性随着气道反应性的增强而增大。同一ＭＴＣＨ剂量激发的气道反应阳性者，患哮喘的危险性随着年龄的增加而增加，且有明显的线性趋势（Ｐ＜０．０１）。无论是临床还是预防医学，气道反应性的测定都具有重要意义     

女性肺癌的遗传流行病学研究

通过对１７６个女性肺癌先证者核心家系和１９４个女性对照的核心家系资料分析。发现女性肺癌先证者的一级亲属（父母、同胞）患肺癌的危险性是对照一级亲属（父母、同胞）的１．６７倍，且差异具有显著性。其中女性亲属患肺癌的危险性显著高于对照的女性亲属，ＯＲ值为２．８１（Ｐ＜０．０１）。女性肺癌的遗传度为２０．５４％，遗传因素是女性肺癌的重要危险因素。女性肺癌先证者的女性亲属对肺癌的遗传易感性比男性亲属高。这些结果有助于全面阐明云南省宣威县女性肺癌高发的原因。     

脉冲振荡法对气道反应性测定的诊断标准初探

目的 以肺通气功能进行支气管激发试验的方法作为“金标准”，探讨脉冲振荡法肺功能测定（IOS）对气道反应性测定的可行性及诊断标准。方法 对50例门诊哮喘疑诊患者进行组织胺支气管激发试验，于基础状态及每次吸药激发后，先用IOS法测定呼吸道阻力各主要指标：共振频率（Fres）、呼吸总阻抗（Zrs）、呼吸道总黏性阻力（R5）、中心气道黏性阻力（R20）、周边气道黏性阻力（R5-R20）、周边弹性阻力（X5）、中心阻力（Rc）、周边阻力（Rp），然后进行肺通气功能检测，测定第1秒用力呼气量（VEV1）。结果 气道高反应性的阳性率为70％。在激发试验终止时，阴性组IOS各阻力较基础值变化差异无统计学意义（P〉0．05），而阳性组IOS各阻力除Rc外均较基础值增加（P〈0．05）。各IOS阻力指标与FEV1均呈显著的直线相关关系（P〈0．05），除X5呈正相关外，余均呈负相关。Fres、Zrs、R5、X5、Rp的增加率与FEV1下降率间存在直线关系（P〈0．05）。激发试验终止时，Fres、Rp增加80％或Zrs、R5增加50％或X5增加1倍，可作为IOS法气道高反应性阳性判断标准。结论 IOS法可作为气道反应性测定另一可选择的肺功能测定方法，Fres是IOS法各参数中用于诊断气道高反应性敏感性及特异性最高的指标。     

气道高反应性与皮肤过敏反应之间关系分析

为了探讨气道高反应性与皮肤过敏反应之间关系 ,依据哮喘患者作为指示病例确定了 30 0 0个哮喘核心家系 ,对各家系的每位成员逐一询问调查、测定气道反应性和进行皮肤过敏试验。主要计算优势比(or值 )等指标。 1 2 51 6位哮喘核心家系亲属皮肤过敏实验的结果表明 :1 2 5 %的人皮斑阳性 ,而出现皮疹阳性的人占 51 3 %。且男性高于女性、低年龄组 (≤ 35岁 )高于高年龄组 (>35岁 ) ,其差别均有高度显著性 (P<0 0 1 )。哮喘家系中有 1 1 9%的人气道反应阳性 ,其中皮斑阳性与皮疹阳性人群出现气道高反应性分别为1 5 5 %和 1 2 7%。皮斑阳性与皮疹阳性者的气道高反应性发生的危险性均较高 ,OR值分别为 1 1 7和 1 44(P <0 0 1 )。并随着引起皮斑阳性或皮疹阳性过敏原的增多而出现气道高反应性的危险性逐渐增大。显示气道高反应性可能与皮肤过敏反应密切相关     

慢性阻塞性肺部疾病的家族聚集性分析

为了判断慢性阻塞性肺部疾病（ＣＯＰＤ）的家族聚集性，探讨遗传因素对ＣＯＰＤ发病的影响，分析了２０６对核心家系的资料。结果表明：ＣＯＰＤ的发病具有家族聚集性。ＣＯＰＤ先证者的亲属（父母、兄弟姐妹）患ＣＯＰＤ的危险性增加，是对照家系亲属（父母、兄弟姐妹）的２．０７倍。除母亲之外，两家系父亲间，兄弟间及姐妹间患ＣＯＰＤ危险性的差异均具有显著性。故ＣＯＰＤ先证者的亲属对ＣＯＰＤ的易感性比对照的亲属高，说明遗传因素是ＣＯＰＤ的危险因素之一。     

哮喘患者诱导痰中内皮素活性研究

目的：探讨内皮素（ET）在哮喘发病过程中的作用及其与肺功能的相关性。方法：用高渗盐水诱痰法收集25例轻,中度哮喘发作期患者,26例哮喘缓解期患者及30名健康者的痰标本,用放射免疫法测定其中ET的浓度。结果：（1）FEV1／FVC发作组最低,缓解组次之,正常组最高,各组比较差异均有显著性（均P＜0．01）。（2）发作组和缓解组诱导痰中炎症细胞数均明显高于正常组（均P＜0．01）。（3）发作组诱导痰中ET浓度明显高于缓解组和正常组（均P＜0．01）,（4）发作组诱导痰中ET浓度与FEV1／FVC和氧分压均呈负相关（r分别为－0．762,－0．878）,而与巨噬细胞数呈正相关（r=-0.653),结论：哮喘发作期和缓解期患者气道腔内均存在慢性非特异性炎症,ET可能参与了哮喘的病理进展过程,并在哮喘的气道炎症和气道重塑中起了重要作用。诱导痰中ET的浓度可较好地反映气道腔局部ET浓度的变化。     

男性肺癌的遗传流行病学研究

为深入研究宣威县男性肺癌的病因，探讨遗传因素的作用，分析了１９４例男性肺癌先证者的核心家系和１７６例男性对照的核心家系资料。结果发现，肺癌先证者的亲属（父母、同胞）患肺癌的危险性是对照组的１．７８倍，且差异有显著性。其中，父母及女性亲属患肺癌的危险性分别是对照组的２．９０倍和２．４３倍，差异均有显著性意义。肺癌的遗传度为２４．６８％。女性对肺癌的遗传易患性比男性高，遗传因素是肺癌的重要危险因素。     

儿童铅暴露与哮喘发病风险的病例对照研究

背景:环境中某些因素会明显影响儿童哮喘的发生以及转归。铅是显著影响儿童生长发育的主要环境因素之一。目的:探讨儿童不同程度铅暴露水平与哮喘发病风险之间的关系。方法:使用成组的病例对照研究方法,主要采用问卷调查方式对调查数据进行单因素和多因素条件Logistic回归分析。结果:哮喘儿童血铅水平明显高于正常健康儿童,而不同哮喘发作程度儿童的血铅水平无显著差异。单因素Logistic回归分析结果显示,有9个因素与儿童哮喘有关联;多因素条件Logistic回归分析显示5个因素被纳入方程,分别为儿童过敏史和特异性体质(OR为15.76)、家族哮喘病史(OR为11.59)、家族同居人员吸烟(OR为4.02)、儿童血铅水平(OR为3.17)和父母铅职业暴露(OR为1.98)。结论:哮喘儿童与健康儿童血铅水平存在差异,且铅暴露可能增加儿童哮喘的发病风险。     

Rethinking race/ethnicity, income, and childhood asthma: racial/ethnic disparities concentrated among the very poor

OBJECTIVE: Past studies of the prevalence of childhood asthma have yielded conflicting findings as to whether racial/ethnic disparities remain after other factors, such as income, are taken into account. The objective of this study was to examine the association of race/ethnicity and family income with the prevalence of childhood asthma and to assess whether racial/ethnic disparities vary by income strata. METHODS: Cross-sectional data on 14,244 children aged <18 years old in the 1997 National Health Interview Survey were examined. The authors used logistic regression to analyze the independent and joint effects of race/ethnicity and income-to-federal poverty level (FPL) ratio, adjusting for demographic covariates. The main outcome measure was parental report of the child having ever been diagnosed with asthma. RESULTS: Bivariate analyses, based on weighted percentages, revealed that asthma was more prevalent among non-Hispanic black children (13.6%) than among non-Hispanic white children (11.2%; p<0.01), but the prevalence of asthma did not differ significantly between Hispanic children (10.1%) and non-Hispanic white children (11.2%; p=0.13). Overall, non-Hispanic black children were at higher risk for asthma than non-Hispanic white children (adjusted odds ratio [OR]=1.20; 95% confidence interval [CI] 1.03, 1.40), after adjustment for sociodemographic variables, including the ratio of annual family income to the FPL. Asthma prevalence did not differ between Hispanic children and non-Hispanic white children in adjusted analyses (adjusted OR=0.85; 95% CI 0.71, 1.02). Analyses stratified by income revealed that only among children from families with incomes less than half the FPL did non-Hispanic black children have a higher risk of asthma than non-Hispanic white children (adjusted OR=1.99; 95% CI 1.09, 3.64). No black vs. white differences existed at other income levels. Subsequent analyses of these very poor children that took into account additional potentially explanatory variables did not attenuate the higher asthma risk for very poor non-Hispanic black children relative to very poor non-Hispanic white children. CONCLUSIONS: Non-Hispanic black children were at substantially higher risk of asthma than non-Hispanic white children only among the very poor. The concentration of racial/ethnic differences only among the very poor suggests that patterns of social and environmental exposures must overshadow any hypothetical genetic risk.     

影响儿童支气管哮喘急性发作的危险因素调查分析

目的 探讨儿童哮喘急性发作的危险因素并提出预防措施,为早期预防、及时规范治疗、改善患儿预后提供参考依据。方法 选取412例急性发作的哮喘患儿作为病例组,同时随机选取206例健康体检的儿童作为对照组,对两组儿童进行问卷调查,筛选影响儿童哮喘急性发作的相关危险因素。结果 影响儿童哮喘急性发作的危险因素包括过敏病史(OR=4.200)、花粉接触史(OR=2.918)、冬春季节(OR=3.476)、近期呼吸道感染(OR=5.376)、Vit D缺乏(OR=3.096)、Ig E升高(OR=4.035)等。结论 影响儿童哮喘急性发作的危险因素较多,应结合以上危险因素早期采取综合预防措施,降低儿童哮喘急性发作的发生率。     

February asthma outbreaks in NSW: a case control study

OBJECTIVES: To investigate individual factors associated with an asthma outbreak among children aged one to 14 years in Sydney in February 1999. METHODS: A case control study was undertaken with cases (n=92) defined as all children admitted to Sydney Children's Hospital for asthma in February 1999. Unmatched controls (n=76) were all children admitted for asthma in the previous three months. We obtained information by a structured telephone survey of parents. Logistic regression analyses were used to determine odds ratios for risk factors for hospital admission. RESULTS: Mean age for hospital admission of 4.7 years for cases and 4.4 years for controls. The presence of one or more siblings reduced the risk of admission during an asthma outbreak (OR=0.59, 95% CI 0.37 to 0.93). Children with older siblings aged 10 to 14 years were also less likely to be admitted (OR=0.3, 95% CI 0.12 to 0.74). An age effect was observed. Other demographic, clinical and environmental characteristics, including smoking, were not associated with admission during the outbreak. CONCLUSIONS: The main findings of this study are the protective effect of siblings and an age-dependent effect in risk of hospital admission during an asthma outbreak. These findings are consistent with an infective cause of the outbreak. IMPLICATIONS: Children without siblings, particularly older siblings, appear to be at highest risk of hospital admission during an asthma outbreak. Environmental and other factors need to be examined to further explain the episodicity of such outbreaks and to determine means of predicting and preventing future episodes.     

A case-control study of risk factors for asthma in New Zealand children

OBJECTIVE: As in other English-speaking countries, asthma is a major and increasing health problem in New Zealand. This study examined the risk factors for asthma in children aged 7-9. METHODS: Cases and controls were randomly selected from participants in the Wellington arm of the International Study of Asthma and Allergies in Childhood (ISAAC). Cases were children with a previous diagnosis of asthma and current medication use (n=233), and controls were children with no history of wheezing and no diagnosis of asthma (n=241). RESULTS: After controlling for confounders, factors significantly associated with asthma were maternal (OR=3.36, 95% CI 1.88-5.99) and paternal asthma (OR-2.67, 95% CI 1.42-5.02), and male sex (OR=1.81, 95% CI 1.17-2.81). Children from social classes 5 and 6 or with unemployed parents (OR=2.32, 95% CI 1.22-4.44) were significantly more likely to have asthma than children in social classes 1 and 2. There was no significant association between having polio vaccination (OR=2.48, 95% CI 0.83-7.41), hepatitis B vaccination (OR=0.66, 95% CI 0.42-1.04) or measles/mumps/rubella vaccination (OR=1.43, 95% CI 0.85-2.41) and asthma. CONCLUSIONS: This study has confirmed the associations of family history and lower socio-economic status with current asthma in 7-9 year old children. The role of vaccinations requires further research.     

Maternal health in pregnancy and intellectual disability in the offspring: a population-based study

PURPOSE: The aim of the study is to investigate the relationship between common maternal conditions and intellectual disability (ID) of unknown cause in the offspring. METHODS: Information about the maternal health of children with and without ID was obtained by using record linkage. For mothers with specific medical conditions, proportions of children with mild to moderate ID, severe ID, and autism spectrum disorder (ASD) with ID were compared with those who did not have ID. RESULTS: There was an increased risk for mild to moderate ID in children of mothers with asthma (odds ratio [OR], 1.52; confidence interval [CI], 1.26-1.83]), diabetes (OR, 1.69; CI, 1.26-2.27), a renal or urinary condition (OR, 2.09; CI, 1.39-3.14), and epilepsy (OR, 3.53; CI, 2.56-4.84). ASD risk was increased for children of women with diabetes (OR, 2.89; CI, 1.28-6.51) and epilepsy (OR, 4.57; CI, 1.69-12.31). For anemia (n = 1101), there was an increased risk for severe ID (OR, 5.26; CI, 2.16-12.80). CONCLUSIONS: The increased risk for ID in offspring of mothers with such conditions as asthma and diabetes is particularly important for disadvantaged or ethnic populations, for whom these conditions are more prevalent and may be less well managed.     

Risk factors for hospital admissions among asthmatic children and adolescents

OBJECTIVE: To assess the prevalence rate and risk factors for hospital admissions among asthma children and to evaluate care delivered to these patients. METHODS: Three-hundred and twenty-five asthmatic children attending a public outpatient reference clinic were studied. Of them, 202 were hospitalized. Care was evaluated using a questionnaire covering general aspects of hospital stay and biological, demographics, socioeconomic and asthma-related factors. Univariate and multivariate analyses were performed to measure the association between hospital admissions and selected independent variables. RESULTS: Of the total, 62.2% had already been hospitalized due to asthma, 64.9% developed asthma episodes, and 60.9% were hospitalized in their first year of life. Most (76.0%) had moderate to severe asthma. Despite that, 94.2% were not on anti-inflammatory drugs and were treated only during isolated acute episodes. None of these were regularly seen in primary health care centers for a periodic control of their steroid inhalants. Most parents (97.8%) referred not to know how to take care of asthma children. Symptoms onset is normally seen before the age of 12 months (OR=3.20; 95%CI 1.55-6,61) or between 12 and 24 months (OR=3.89; 95%CI 1.62-9.36). Mothers have attended school for less than 7 years (OR=3.06; 95%CI 1.62-5.76). Disease severity (OR=2.32; 95%CI 1.24-3.88), 2 or more monthly visits to emergency wards (OR=2.19; 95%CI 1.24-3.88), and referred recurrent pneumonia (OR=2.00; 95%IC 1.06-3.80) were the main risk factors for hospital admissions. CONCLUSIONS: Organizing health care services is crucial to reduce hospital admissions and provide adequate care for asthma children and adolescents, especially those less than 2 years old.     

安徽地区儿童暴露于农村生活环境对过敏性哮喘的影响

目的 研究暴露于农村生活环境对预防儿童哮喘及致敏的保护作用.方法 向2986名在校儿童父母发放哮喘标准调查表,采用放射性变应原荧光酶免疫吸附实验(RAST-FEIA)检测儿童血清中特异性IgE(sIgE)含量.结果 与在城镇生活的儿童相比,暴露于农村生活环境儿童的过敏性哮喘与非过敏性哮喘、过敏性哮鸣及特应性哮呜危险度显著性降低(OR=0.45,95%CI:0.13～0.96:OR=0.41,95%CI:0.15～0.95;OR=0.32,95% CI:0.11～0.62;OR=0.44,95% CI:0.13～0.91).1周岁内暴露与农村生活环境的儿童过敏性哮喘及特应性致敏危险度较低(OR=0.23,95% CI:0.04～0.91;OR=0.32,95%CI:0.17～0.78);若暴露持续至6周岁,过敏性哮喘及特应性致敏危险度更低(OR=0.21,95%CI:0.03～0.87;OR=0.31,95%CI:0.15～0.78).结论 暴露于农村环境对预防儿童过敏性哮喘及致敏的发生可能有保护作用,持续的暴露能加强此作用.     

Race, asthma, and persistent wheeze in Philadelphia schoolchildren.

OBJECTIVES: Many studies show asthma to be more common in Black than in White children. This study assessed how much of this difference remains after adjustment for other potentially race-associated predictors of asthma. METHODS: We assessed the predictors of active diagnosed asthma and persistent wheeze in 1416 Black and White Philadelphia children aged 9 to 11 years, as reported by parents. RESULTS: Black race remained a significant predictor of active diagnosed asthma (odds ratio [OR] = 2.3; 95% confidence interval [CI] = 1.3, 4.1) but not of persistent wheeze (OR = 1.0; 95% CI = 0.6, 1.8). The excess risk of asthma in Black children was not appreciably altered by adjustment for other demographic and environmental factors. CONCLUSIONS: Black race is an important risk factor for active diagnosed asthma in these urban children, a relationship not explained by social factors. This finding and the lack of an association of race with persistent wheeze after adjustment for social factors suggest that race may be more important to the acquisition of an asthma diagnosis than to the prevalence of the symptoms.