5岁以下儿童反复喘息3年随访观察

3-Year Follow-Up of Children with Recurrent Wheezing under 5 Years Old

目的探讨5岁以下儿童反复喘息3年期间发作的情况、转归以及危险因素。方法选取2014年5月—2015年5月5岁以下因反复喘息就诊于攀钢集团总医院儿科的147例患儿作为研究对象,3年后进行随访。根据患儿喘息开始年龄及缓解年龄,将患儿分为一过性喘息组、持续性喘息组和晚发性喘息组,比较三组患儿一般资料、过敏相关指标,喘息起始年龄等,并分析患儿反复喘息相关危险因素。结果三组患儿入院时近1年喘息次数(P>0.05);比较三组患儿随访时近1年喘息次数(P>0.05),且一过性喘息患儿未再喘息;但随访时1年喘息次数明显少于入院时近1年喘息次数(P<0.05);比较三组患儿入院时病毒总阳性、RV阳性、RSV阳性(P>0.05);比较三组患儿既往鼻炎史,持续性喘息组、晚发性喘息组既往鼻炎率明显高于一过性喘息组患儿(P<0.05);比较三组患儿既往湿疹史、父母哮喘史(P>0.05);比较三组患儿既往鼻炎史(P<0.05),持续性喘息组、晚发性喘息组既往鼻炎率明显高于一过性喘息组患儿(P<0.05);比较三组患儿既往湿疹史、父母哮喘史P>0.05;比较三组患儿血清过敏原总IgE P<0.05,一过性喘息组血清过敏原IgE分别明显低于持续性喘息组、晚发性喘息组P<0.05,比较持续性喘息组与晚发性喘息组血清过敏原IgE P>0.05;比较三组患儿的吸入性过敏原阳性率P<0.05;比较三组患儿外周血EOS百分比P<0.05,比较外周血EOS绝对计数P>0.05);湿疹、父母过敏性鼻炎或哮喘以及被动吸烟、病毒感染、支原体感染是患儿喘息的主要危险因素。结论患儿随着年龄的增加,喘息发作情况明显减少,喘息转归与过敏、鼻炎等具有明显的相关性。

Objective To investigate the prevalence,outcomes and risk factors of children with recurrent wheezing less than 5 years old during the 3-year follow-up.Methods 147 cases of recurrent wheezing children less than 5 years old treated in the Pediatrics department of Panzhihua Group General Hospital from May 2014 to May 2015 were selected,and all cases were followed up for three years.According to the onset age and relief of wheezing,the children investigated were divided into transient wheezing group,persistent wheezing group and late-onset wheezing group.Then the general data,allergy related index and wheezing onset age among three groups were compared,furthermore,the risk factors of the recurrence were also analyzed.Results The incidence of the wheezing within one year both of hospitalization and follow-up had no significant difference(P>0.05);No recurrence occurred in the transient wheezing group.The number of wheezing at 1 year of follow-up was significantly less than the number of wheezing in the first year at hospitalization(P<0.05);The total viral positive,RV positive,and RSV positive in the three groups of patients at admission had no significant difference(P>0.05),while difference was found in the previous rhinitis history(P<0.05);The proportion of the previous rhinitis in the persistent wheezing group and late-onset wheezing group was higher than that of the transient wheezing group(P<0.05);No difference was found in the previous eczema and the asthmatic history of parent(s)(P>0.05);The difference of the total serum IgE among three groups was statistic(P<0.05);The total serum IgE in the persistent wheezing group and late-onset wheezing group was higher than that of the transient wheezing group(P<0.05),while no difference was found between persistent wheezing group and late-onset wheezing group(P>0.05);The positive rates of inhaled allergens and percentage of EOS in peripheral blood had statistic difference(P<0.05),while the absolute count of EOS in peripheral blood had no difference(P>0.05).The major risk factors were eczema,parental allergic rhinitis or asthma,as well as passive smoking,viral infection,and mycoplasma infection for wheezing in children.Conclusion The incidence rate of the wheezing is decreased with the age increase,furthermore,the outcomes of the wheezing is related to the allergies and rhinitis.