中国儿童哮喘患病率的地区差异与生活方式的不同有关

Disparity of asthma prevalence in Chinese schoolchildren is due to differences in lifestyle factors

目的通过对环境因素及生活方式的比较研究，探讨导致中国不同地区儿童人群中哮喘患病率差异的原因。方法对10902名来自北京、广州、香港三城市的儿童进行横断面研究，按照国际儿童哮喘和过敏性疾病研究（ISAAC）第二阶段方案，由儿童家长或监护人完成问卷调查，并随机抽取3479名儿童进行吸人性过敏原的皮肤点刺试验，对哮喘、特应性与环境和生活方式危险因素的相关性进行Logistic回归分析。结果过去12个月喘息的现患率分别为：香港5．8％，北京3．8％，广州3．4％，香港显著高于中国大陆（OR1．64，95％CI1．35—1．99）。多变量Logistic回归分析显示，应用煤气煮食（OR2．08，95％CI1．32—3．26）、海绵枕头（OR1．94，95％CI1．19—3．16）、房间潮湿（OR1．84，95％CI1．25—2．71）均是“近期喘息”的危险因素。而棉被的使用（OR0．70，95％CI0．56—0．87）、母乳喂养（OR0．79，95％CI 0．66—0．96）及参加日托（OR0．73，95％CI0．59—0．88）是“近期喘息”的保护性因素。结论具有中国大陆生活特征的环境因素及生活方式（母乳喂养、参加日托、使用棉被、使用非海绵的枕头、非煤气的煮食燃料、家中墙上或天花板没有潮湿霉点）是导致中国香港与大陆儿童哮喘患病率差异的重要影响因素。

The prevalence of asthma has been documented to be increasing over the past few decades. Within the Chinese population, the prevalence of childhood asthma has been found to be the highest in Hong Kong compared with Beijing and Guangzhou. Objective To investigate the environmental lifestyle risk factors which may explain the disparity of asthma prevalence in the Chinese population. Methods In a cross-sectional study, 10 902 schoolchildren were recruited from Hong Kong （n = 3110）, Beijing （ n = 4277）, and Guangzhou （ n = 3565 ） using the ISAAC Phase II protocol. The average age of the children among three cities was 10. 1 - 10. 4 years and 50% - 55% were male. Each subject was given an ISAAC Phase II questionnaire to be completed by the parents or guardians. Random subgroups of at least 1000 children from each city, added up to 3479 children underwent skin-prick testing. The sensitivity to eight common aeroallergens was assessed. Logistic regression analysis was used to determine the environmental and lifestyle risk factors for asthma and atopy. Results The prevalence of wheezing in the past 12 months （ Hong Kong, 5.8% ; Beijing, 3.8% ; Guangzhou, 3.4% ） was significantly higher in schoolchildren from Hong Kong than that from the Mainland of China （ OR 1.64, 95% CI 1.35-1.99）. Multivariate logistic regression analyses revealed that the use of gas cooking （ OR 2. 08,95% CI 1.32-3.26）, foam pillow （ OR 1.94,95% CI 1.19-3.16）, and house dampness （OR 1.84,95% CI 1.25-2. 71 ） were significant risk factors for ＂current wheezing＂. The use of cotton quilt （ OR 0. 70,95% CI 0. 56-0. 87）, breast-feeding （ OR 0. 79, 95 % CI 0. 66-0. 96 ）, and attendance of daycare （ OR 0. 73,95 % CI 0. 59-0. 88 ） were protective factors against ＂current wheezing＂. When a summary measure of these variables was introduced into a regression model, the Mainland residency was no longer associated with ＂current asthma＂ or ＂ current wheezing＂ suggesting that either these factors or other unmeasured factors associated with above factors are responsible for the lower prevalence of asthma in the Mainland of China. Conclusion Several environmental and lifestyle factors represented characteristic of life in Mainland of China, including breast feeding, attendance of daycare, use of cotton quilt, use of pillow other than foam pillow, use of cooking fuel other than gas, and the absence of damp spots on the walls or ceiling, were the significant risk factors contributed to the disparity of asthma prevalence in children from Hong Kong and the Mainland of China.