影响婴幼儿反复喘息的相关危险因素

目的:探讨影响婴幼儿反复喘息的相关危险因素,并提出针对性的预防策略和措施。方法:选取2019-2020年绍兴市柯桥区妇幼保健院收治的316例喘息患儿进行调查,依据喘息次数是否≥3次,将其分为反复喘息组(90例)与对照组(226例);比较两组间的性别、年龄、分娩方式、早产、母乳喂养、哮喘家族史、家族过敏史、药物过敏史、过敏性鼻炎、食物过敏、湿疹、反复呼吸道感染、饲养宠物、被动吸烟、病毒感染、支原体感染、未补充维生素AD、总IgE阳性、牛奶蛋白sIgE、鸡蛋蛋白sIgE等因素的差异性;采用逐步logistic回归法对影响婴幼儿反复喘息的危险因素进行筛查。结果:316例喘息婴幼儿的反复喘息发生率为28.48%(90/316),多数为支气管哮喘;两组间分娩方式、早产、母乳喂养、哮喘家族史、家族过敏史、过敏性鼻炎、食物过敏、湿疹、反复呼吸道感染、被动吸烟、病毒感染、未补充维生素AD、总IgE阳性、牛奶蛋白sIgE等因素的差异有统计学意义(P<0.05);多因素分析结果显示:影响婴幼儿反复喘息的危险因素包括哮喘家族史(OR=2.552)、过敏性鼻炎(OR=3.600)、湿疹(OR=3.019)、反复呼吸道感染(OR=4.166)、病毒感染(OR=3.547)、未补充维生素AD(OR=5.302)、总IgE阳性(OR=4.554)、牛奶蛋白sIgE(OR=2.392)等。结论:喘息婴幼儿具有较高的反复喘息发生率,尤其是支气管哮喘患儿;应根据以上高危因素,进行积极预防和治疗,降低反复喘息发生率,阻止或延缓病情进展。     

婴幼儿反复喘息危险因素Logistic回归分析

目的：寻找婴幼儿反复喘息的危险因素,为预防和干预婴幼儿反复喘息发作提供理论依据。方法：以60例反复喘息的婴幼儿作为病例组,60例正常婴幼儿为对照组,采用向家长书面问卷调查方法询问各组婴儿既往病史、家族史、过敏史及婴幼儿喂养情况、生活条件等,并检测微量元素、免疫功能、过敏原。将30个因素作为变量进行赋值,进行数量化处理。应用单因素和多因素分析方法对资料进行分析。结果：多因素Logistic回归分析发现共有4个因素被选入回归方程,父母有哮喘病史（OR=4.969）、居住的城市（OR=3.054）、有过敏原阳性（OR=3.363）、有皮肤湿疹史（OR=3.180）。结论：父母有哮喘病史、有过敏原阳性、居住的城市、有皮肤湿疹史是导致婴幼儿发生反复喘息的关键危险因素。     

3 岁以下患儿反复喘息的相关因素研究

目的 探究≤ 3 岁患儿反复喘息的相关因素。方法 选取2015 年6 月—2017 年6 月齐齐哈尔医学 院附属第三医院收治的523 例喘息患儿作为研究对象,所有患儿年龄均≤ 3 岁,依据患儿喘息发作次数将其分 为反复喘息组（喘息次数≥ 3 次）和对照组（喘息次数≤ 2 次）。回顾性分析两组患儿临床资料,单因素和 Logistic 多因素分析≤ 3 岁患儿反复喘息的相关因素。结果 经单因素方差分析,两组患儿出生方式、纯母乳喂养 时间、家族过敏史、其他个人过敏史、血清免疫球蛋白E（IgE）、感冒次数、血嗜酸细胞（EOS）、胎龄、体重 增长、食物过敏史、湿疹、被动吸烟、饲养宠物及肺炎史比较差异有统计学意义（P <0.05）;经Logistic 多因素 进一步分析,剖宫产、纯母乳喂养时间≤ 4 个月、有家族过敏史、有其他个人过敏史、血清IgE>60 IU/ml、感 冒次数>6 次、血EOS>5%、有湿疹、有被动吸烟、有饲养宠物、有肺炎史为≤ 3 岁儿童反复喘息的危险因 素（P <0.05）。结论 应对具备危险因素的≤ 3 岁反复喘息患儿加强监控,以期降低其反复喘息的发生率。     

婴幼儿毛细支气管炎后反复喘息现状及影响因素分析

目的调查婴幼儿毛细支气管炎后反复喘息发生情况,并探讨其相关影响因素。方法选择102例毛细支气管炎婴幼儿,随访1年了解患儿喘息发作情况。同时根据患儿是否发生喘息进行分组,比较2组患儿的一般资料、哮喘家族病史、宠物接触史、过敏疾病史、毛细支气管炎病情等。结果102例患儿中,共有3例失访。随访3、6、9、12个月,至少出现1次喘息发作的例数分别为16例(16.16%)、34例(34.34%)、39例(39.39%)、43例(43.43%),其中,随访12个月内,发生1次喘息8例,发生2次喘息11例,≥3次喘息24例。经单因素分析,反复喘息组与非反复喘息组患儿在母乳喂养少于3个月、被动吸烟史、湿疹病史、反复下呼吸道感染史、家族过敏疾病史、重度毛细支气管炎、呼吸道合胞病毒感染、食物过敏史方面差异均有统计学意义(P < 0.05~P < 0.01)。经logistic多因素分析,重度毛细支气管炎、湿疹病史、家族过敏疾病史以及反复下呼吸道感染毛细支气管炎后反复喘息的危险因素均为毛细支气管炎后反复喘息的危险因素(P < 0.05),而母乳喂养>3个月是毛细支气管炎后反复喘息的保护因素(P < 0.01)。结论重度毛细支气管炎、家族过敏疾病史、湿疹、反复下呼吸道感染是毛细支气管炎后反复喘息发作的高危因素,临床应针对性做好防治工作,以减少喘息发作。     

学龄前儿童反复喘息相关危险因素 Logistic 回归分析

目的：研究安徽地区学龄前儿童反复喘息相关危险因素。方法用调查表搜集816例儿童的临床资料,采用Logistic 回归分析研究学龄前儿童反复喘息相关危险因素。结果早产、剖宫产、0~3个月体重增长速度快、食物过敏、过敏性鼻炎、湿疹、父母过敏性鼻炎或哮喘、被动吸烟、病毒感染及支原体感染这10个因素与学龄前儿童反复喘息有关(P <0．05)。通过 Logistic 回归分析得出早产、0~3个月体重增长速度快、湿疹、父母过敏性鼻炎或哮喘、被动吸烟、病毒感染及支原体感染是学龄前儿童反复喘息的危险因素(P<0．05)。结论早产、0~3个月体重增长速度快、湿疹、父母过敏性鼻炎或哮喘、被动吸烟、病毒感染及支原体感染是学龄前儿童反复喘息的危险因素。     

中国5个地区母乳喂养现状及影响因素研究

目的了解婴幼儿母乳喂养水平,探讨影响母乳喂养方式的相关因素。方法采用多阶段分层整群随机抽样,抽取了来自中国5个省份中5个城市的市区、镇和农村。以2006年1月1日至2008年12月31日出生的婴幼儿及父母为调查对象,共调查17 094名婴幼儿。采用现况研究方法,使用统一设计的调查表对调查对象进行面对面问卷调查。用Logistic回归分析方法估计影响母乳喂养因素的比值比（OR）及95%可信区间（CI）。结果哺乳期妇女纯母乳喂养率为62.56%。多因素调整的Logistic回归分析结果显示：汉族（OR=1.388,P〈0.01）、城市人口（OR=1.748,P〈0.01）、胎儿早产（OR=1.693,P〈0.01）、低出生体质量（OR=1.439,P〈0.01）以及母亲孕期疾病史（OR=1.340,P〈0.01）、年龄≥30岁（OR=1.155,P〈0.01）、流产史（OR=1.409,P〈0.01）、引产史（OR=1.872,P〈0.01）、文化程度高（OR=1.590～2.148,P〈0.01）等因素降低了母乳喂养率,而女婴（OR=0.928,P〈0.05）、胎次为2胎及以上（OR=0.882,P〈0.05）则母乳喂养率高。结论我国部分地区母乳喂养率超过50%,民族为汉族、城市人口、胎儿早产、低出生体质量及母亲孕期疾病史、年龄≥30岁、流产史、引产史和文化程度高是纯母乳喂养的影响因素,降低了母乳喂养率。     

婴儿湿疹与婴幼儿喘息性疾病发病相关性研究

目的：探讨婴儿湿疹与婴幼儿喘息性疾病发病是否具有相关性,为临床预防和治疗婴幼儿喘息性疾病提供理论依据。方法选取312例婴儿湿疹患儿并跟踪随访其患喘息性疾病的发病率,与对照组发病率比较差异是否具有统计学意义,从而推断婴幼儿喘息性疾病的发病是否与婴儿湿疹具有相关性。检测湿疹组（n=312）及喘息性疾病组（n=78）患儿血清总IgE水平与对照组比较。结果湿疹组喘息性疾病发病率为21.5%,明显高于对照组5.88%（χ2=8.45,P<0.05）。湿疹组血清总IgE水平为(92.45±11.23)IU/mL,明显高于对照组(39.91±17.75)IU/mL（t=5.122,P<0.05）。喘息性疾病组血清总IgE水平为(212.67±45.32)IU/ml,明显高于对照组(39.91±17.75)IU/mL（t=7.131,P<0.05）。结论婴幼儿喘息性疾病的发病与婴儿湿疹相关,其具有相同的IgE介导的免疫机制。     

FeNO、EOS与喘息性支气管炎患儿肺功能的相关性及对哮喘的预测价值

目的 探究呼出气一氧化氮（FeNO）、外周血嗜酸性粒细胞（EOS）与喘息性支气管炎患儿肺功能的相关性及对哮喘的预测价值。方法 回顾性分析2020年6月—2022年6月武汉市第一医院儿科收治的132例喘息性支气管炎患儿的病历资料。参考改良哮喘预测指数（mAPI）将患儿分为哮喘发作组26例和喘息性支气管炎组106例。收集患儿入院时FeNO、EOS及肺功能指标的水平；Pearson法分析FeNO、EOS与喘息性支气管炎患儿肺功能指标的相关性，绘制受试者工作特征（ROC）曲线评估FeNO、EOS对喘息性支气管炎患儿发生哮喘的预测效能。结果 哮喘发作组的FeNO、EOS高于喘息性支气管炎组（P <0.05）。哮喘发作组的呼吸道总阻力、中心呼吸道阻力、周边弹性阻力及响应频率均高于喘息性支气管炎组（P <0.05）；喘息性支气管炎患儿的FeNO与呼吸道总阻力（r=0.801,P=0.001）、中心呼吸道阻力（r=0.648,P=0.001）、周边弹性阻力（r=0.723,P=0.001）及响应频率（r=0.651,P=0.001）均呈正相关；喘息性支气管炎患儿的EOS与呼吸道总阻力（r=...     

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.     

血清25-羟维生素D水平与婴幼儿食物过敏的关系研究

目的 探讨血清25-羟维生素D水平与婴幼儿食物过敏的关系,并分析食物过敏的危险因素。方法 纳入≤3岁确诊食物过敏的40例婴幼儿作为研究组,同时选取40例年龄匹配的健康儿童作为对照组。比较2组血清25-羟维生素D水平,并分析筛选食物过敏的可能危险因素。结果 2组血清25-羟维生素D水平比较差异无统计学意义（P>0.05）;在食物过敏组中维生素D缺乏与不足患儿所占比例更高（P<0.05）。血清25-羟维生素D水平在IgE介导的食物过敏与非IgE介导的食物过敏患儿中比较,差异无统计学意义（P>0.05）。单因素Logistic回归分析结果表明,过敏性疾病家族史、湿疹史及低维生素D水平可能是食物过敏的危险因素（P<0.05）。多因素Logistic回归分析表明,湿疹史是食物过敏的独立危险因素（P<0.05）。结论 食物过敏患儿维生素D缺乏和不足者较多,但食物过敏和健康婴幼儿的血清25-羟维生素D水平差异无统计学意义;有湿疹史的婴幼儿,发生食物过敏的风险更高。     

Prevalence and severity of symptoms of asthma, allergic rhino-conjunctivitis and atopic eczema in secondary school children in Ibadan, Nigeria

This study was part of the effort of the International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee to evaluate the epidemiology of asthma and allergic diseases around the world. Three thousand and fifty eight randomly selected children aged 13-14 years were studied, using a standard questionnaire developed and field tested by the ISAAC Steering Committee, to establish the prevalence and severity of symptoms of asthma, allergic rhinoconjunctivitis and atopic eczema. Of the 3,058 children, there were 1,659 (54.3%) females and 1,399 (45.7%) males (F:M ratio 1.2:1). The cumulative prevalence rates of wheezing, rhinitis other than common cold, and symptoms of eczema were 16.4%, 54.1% and 26.1%, respectively while within the immediate 12-month period, the rates were 10.7%, 45.2% and 22.4%, respectively. However, rhinitis associated with itchy eyes (allergic rhinoconjunctivitis) was reported by 39.2% of the school children. The prevalence of doctor-diagnosed asthma was 18.4%. Multiple logistic regression analysis showed that a higher prevalence of wheezing and rhinitis was associated with itchy eyes. The prevalence of severe symptoms of asthma, allergic rhinitis and eczema were higher when compared with a similar study in Kenya. However, the prevalence of symptoms of asthma was lower and that of allergic rhinoconjunctivitis higher in our series. There is a need for further studies to investigate the risk factors which might be responsible for the apparently different patterns in these two African countries.     

Asthma, atopic eczema and allergic rhino-conjunctivitis in school children

International Study of Asthma and Allergies of Childhood (ISAAC) phase one study had already been completed in two age groups in 156 collaborating centers of 56 countries involving a total of 721601 children. Bangladesh did not participate earlier in this worldwide study. To determine the prevalence of asthma, allergic rhinitis and eczema in school children of Dhaka district using ISAAC protocol. A school based cross sectional study done in 2000 by using both written questionnaires (WQ) and video questionnaires (VQ). Students of class-VIII (13-14 years) filled up both the WQ and VQ and the parents of class I (6-7 years) filled up only the WQ on behalf of the students. Sixty five (6)5 primary schools and 39 high schools were randomly selected from all 19 thanas to cover equally both the urban and rural schools of the entire area of Dhaka district. A total of 6260 written questionnaires were eligible for the analysis (3029 form 6-7 years of class I and 3231 from 13-14 years of class VIII). In addition, the validated international video questionnaires were used for the older age group (3231). The symptoms of atopic diseases in the previous 12 months or ever in all children, both age groups, both sexes and in both urban and rural areas. The life time (ever) and 12-month period (recent) prevalence of three allergic conditions with 95% CI were as follows : wheezing 13.8% (12.9-14.6), 7.6% (6.9-8.2); allergic rhinitis 25.0% (23.9-26.1), 20.0% (19.1-21.1) and eczema 8.7% (CI 8.0-9.4), 6.5% (5.9-7.2). respectively. The prevalence of wheezing and other atopic features in both age groups of 6-7 years and 13-14 years showed higher features of recent wheeze in the younger children than in the older children, recent wheeze 9.1% Vs 6.1%; but the other atopic features were found lower in younger age group, recent rhinitis 16.3% Vs 23.5%, 0.001; conjunctivitis 6.4% Vs 8.3%, 0.001; recent eczema 6.0% Vs 7.1% 0.001. Male children were found to be more suffering from all types allergic conditions than their female peers: recent wheeze 9.0% Vs 5.9%, recent rhinitis 21.9% Vs 17.9%, recent allergic conjunctivitis 8.7% Vs 6.7% and recent eczema 6.8% Vs 6.2%). Though the prevalence of asthma and atopic eczema was lower than those of developed countries but still appeared to be a major health problem for our children. Allergic rhinitis was the commonest of all atopic problems in children. The younger children (6-7 years) were more likely to suffer from wheeze (asthma) but other allergic problems were more in older group of children (13-14 years). Male children were more prone to all types of allergic problems, whether wheeze or other atopic conditions, than the female peers.     

不同咳喘患者气道高反应性测定的探讨

目的　评价支气管哮喘、吸烟、上呼吸道感染、慢性阻塞性肺疾病 (COPD)及过敏性鼻炎患者气道高反应的特点。方法　测定基础肺通气功能后按钟氏法以二磷酸组织胺 (HA)吸入做支气管激发试验。结果　吸烟组、哮喘组、COPD组、上呼吸道感染组及过敏性鼻炎组的BHR阳性率分别为 2 7. 6 %、1 0 0 %、4 0 . 5 %、4 5 . 0 %及 6 9. 2 %。吸烟组、上呼吸道感染组及COPD组与哮喘组、过敏性鼻炎组比较均有显著性差异 (P <0 . 0 0 1 ) ,哮喘组与过敏性鼻炎组比较无显著性差异 (P >0 . 0 5 )。哮喘组支气管激发试验前后 5 0 %及 2 5 %用力肺活量时呼气流速 (V50 、V2 5)比较有显著性差异 ;哮喘组PD2 0 FEV1 His与PEF5 0 %及PEF5 0 % 75 %的降低程度存在显著负相关。结论　哮喘患者均有气道反应性增高 ,但有气道高反应性者并非均为哮喘。     

黏膜免疫在支气管哮喘及变应性鼻炎发病中的作用

目的探讨黏膜免疫在哮喘、变应性鼻炎发病过程中的作用,寻找两种病发病时共同的联系物质,以揭示哮喘与变应性鼻炎发病之间的关联性。方法收集急性发作期哮喘患者82例(其中单纯哮喘44例,哮喘合并鼻炎38例),单纯变应性鼻炎患者30例,正常对照组30例。分别采集受检者唾液、痰液、鼻腔分泌物各2ml,用ELISA法测定分泌型免疫球蛋白A(sIgA)的变化。采肘静脉血各2ml,用流式细胞仪检测CD4+、CD8+淋巴细胞,荧光酶联免疫法检测血清嗜酸性阳离子蛋白(eosinophil cationic protein,ECP)、总免疫球蛋白E(total immunoglobulin E,T-IgE)。结果痰液中sIgA含量在单纯哮喘组、哮喘合并鼻炎组、单纯变应性鼻炎组均较正常组降低(P<0.01);唾液sIgA含量在哮喘组、合并组较正常组有降低趋势但差异无统计学意义。鼻腔分泌物中sIgA各组比较,哮喘组与合并组均高于正常组(P<0.05)及鼻炎组(P<0.01),而鼻炎组与正常组之间差异无统计学意义。血液中CD4+细胞在哮喘组、合并组均高于正常组(P<0.05);血液中CD8+细胞在各组间差异无统计学意义;CD4+/CD8+在哮喘组较正常组和鼻炎组增高(P<0.05)。血清T-IgE在合并组及鼻炎组均较正常组增高(P<0.01)。正常组血清ECP检出率极低;哮喘组血清ECP高于鼻炎组(P<0.05),而哮喘组与合并组、鼻炎组与合并组差异无统计学意义。哮喘组ECP与T-IgE正相关(r=0.467,P<0.05),合并组与鼻炎组ECP与T-IgE无相关性。结论哮喘和变应性鼻炎都与黏膜免疫有密切关系,黏膜免疫可能是其发病过程中相同的病理特征在不同部位的体现。而sIgA、CD4+、CD8+、ECP、T-IgE等免疫介质可能是黏膜免疫的物质基础之一。     

Asthma prevalence in Melbourne schoolchildren: have we reached the peak?

OBJECTIVE: To determine the change in prevalence of asthma, eczema and allergic rhinitis in Australian schoolchildren between 1993 and 2002. DESIGN: Questionnaire based survey, using the protocol of the International Study of Asthma and Allergy in Childhood. SETTING: Metropolitan Melbourne primary schools within a 20 km radius of the GPO in 1993 and 2002. SUBJECTS: All children in school years 1 and 2 (ages 6 and 7) attending a random sample of 84 schools in 1993 and 63 schools in 2002. MAIN OUTCOME MEASURES: Parent-reported symptoms of atopic disease; treatment for asthma; country of birth. RESULTS: There was a 26% reduction in the 12-month period prevalence of reported wheeze, from 27.2% in 1993 to 20.0% in 2002. The magnitude of reduction was similar for boys (27%) and girls (25%). The 12-month period prevalence of reported eczema increased from 11.1% in 1993 to 17.2% in 2002, and rhinitis increased from 9.7% to 12.7%. There were reductions in the proportion of children attending an emergency department for asthma in the previous year (3.6% to 2.3%), the proportion admitted to hospital (1.7% to 1.1%) and the proportion taking asthma medication (18.5% to 13.4%). Of those who reported frequent wheeze, there was an increase in the proportion taking regular inhaled steroids (34.5% to 40.9%). CONCLUSION: There has been a significant reduction in the prevalence of reported asthma in Melbourne schoolchildren, whereas the prevalence of eczema and allergic rhinitis has continued to increase.     

The prevalence of allergic diseases among Croatian school children according to the ISAAC Phase One questionnaire.

BACKGROUND: The prevalence of asthma and allergic diseases in children has been increasing worldwide over the past decades. The ISAAC Phase I results supplies valuable information on the worldwide variations in the prevalence of these diseases. Although ISAAC Phase I was completed in 56 countries, not all regions of Croatia were covered. Because of Croatia's high regional diversity, the aim was to explore the prevalence of asthma, allergic rhinitis/rhinoconjuctivitis, and atopic eczema symptoms in the Medimurje region in northern Croatia and compare the results with data from other regions in Croatia and other countries. MATERIAL/METHODS: The study was undertaken between January and April 2005 among 12- to 14-year-old children in 27 elementary schools. Data were collected using the standardized ISAAC written and asthma video questionnaires. RESULTS: A total of 3111 children participated in the study, with a participation rate of 94.33%. 27.6% of the children had symptoms of allergic diseases at some time in their life. Estimated lifetime (ever) prevalence of symptoms were: wheezing 11.86%, allergic rhinitis symptoms 12.21%, and atopic dermatitis symptoms 7.01%. Estimated 12-month prevalence rates were: wheezing 5.11%, allergic rhinitis symptoms 10.87%, allergic rhinoconjunctivitis 7.14%, and atopic dermatitis symptoms 5.34%. CONCLUSIONS: Compared with previous studies conducted in other Croatian regions (the city of Zagreb and a northern Adriatic region) using similar methods, the prevalence of asthma and allergic rhinitis was lower than in the northern Adriatic region but comparable with that in the city of Zagreb, and of atopic dermatitis symptoms in the same range.