第三次中国城市儿童哮喘流行病学调查

Third nationwide survey of childhood asthma in urban areas of China

目的了解我国城市儿童哮喘的患病率、发病规律及诊治情况。方法于2009年9月至2010年8月在全国27个省或自治区，4个直辖市等共43座城市，开展0～14岁城区儿童哮喘流行病学调查。采用分层随机整群抽样方法，在各城市确定调查学校、幼儿园和社区。使用统一初筛问卷对儿童进行筛查，筛查出的可疑哮喘儿童由临床医生通过现场问诊、体检、查阅患儿病历及以往相关辅助检查结果等，明确其是否患有哮喘。对已确诊哮喘患儿做进一步问卷调查，了解其哮喘诊治情况及伴发过敏性疾病情况。所有数据使用Epi—Inf0软件进行双录入，使用SPSS软件进行统计分析。结果共完成463982名儿童的初筛，诊断哮喘13992例，其中典型哮喘12634例（90．3％），咳嗽变异性哮喘1358例（9．7％）。确诊患者中既往已诊断哮喘9605例（68．6％），新诊断病例4387例（31．4％）。我国城区0～14岁儿童哮喘总患病率为3．02％（95％C1：2．97％～3．06％），其中典型哮喘患病率为2．72％（95％CI：2．68％～2．77％），咳嗽变异性哮喘患病率为0．29％（95％CI：0．28％～0．31％）。近2年（2009和2010年）哮喘现患率为2．32％（95％CI：2．28％-2．37％）。男性儿童哮喘患病率明显高于女性[3．51％（8495／241811）和2．29％（5089／222160）,Xz=608．7，P〈0．01]。以学龄前儿童（3～5岁）患病率最高（4．15％），明显高于学龄儿童（6～14岁）（2．82％）和婴幼儿（0～2岁）（1．77％）。不同地区以华东地区最高（4．23％），东北地区最低（2．00％）。不同城市以上海最高（7．57％），拉萨最低（0．48％）。在确诊的哮喘患儿中45．2％（6321例）有家族过敏史，72．5％（10143例）有个人过敏史，50．1％（7010例）伴有过敏性鼻炎。哮喘发作最常见诱因为呼吸道感染和天气变化（或接触冷空气），分别达87．9％（12299例）和51．5％（7204例）。哮喘患儿58．7％（8209例）曾使用过吸入激素，71．4％（9986例）曾使用过支气管舒张剂，抗生素的使用率为75．1％（10504例）。5岁以上哮喘儿童中，峰流速仪的使用率为14．3％（1449／10145）。结论我国主要城市城区儿童哮喘总患病率为3．02％，2年现患率为2．32％，不同性别、不同年龄、不同地域和不同城市儿童哮喘患病率存在明显差异，仍有近1／3患儿未得到及时和准确诊断，哮喘的用药和管理状况亟待改进。

Objective Asthma is the most common chronic respiratory disease among children. In recent years, the prevalence of childhood asthma was rising in most countries around the world. This nationwide study was conducted to investigate the prevalence of childhood asthma in urban areas of large cities in China, and to find the characteristics of attacks, the diagnosis and treatment status, and provide scientific data for improving the prevention and management of asthma in children. Method This nationalwide, cross-sectional survey was organized by the National Cooperative Group on Childhood Asthma, and conducted in 43 cities all over the country, including 27 capital cities of provinces or autonomous regions, 4 municipalities, from September 2009 to August 2010. Children born from July 1 st 1995 to June 30th 2010 were enrolled in the survey, consisting of children who had been living in the surveyed cities and those born outside the city but had lived in the cities for over 6 months. Schools, kindergartens and communities in each city were selected by phased stratifed random cluster sampling. Standardized preliminary questionnaire was used for screening out possible patients in the survey. Diagnosis of asthma was confirmed by enquiry of history, together with review of previous record and tests, physical examination in suspected asthmatic children. Asthmatic children were further asked for past diagnosis, treatment and concomitant allergic diseases. Double entry and validation was adopted for all data using Epi-Info software, and analysis was carried out by SPSS V19.0. Result Totally 463 982 children were investigated for the survey. Asthma was diagnosed in 13 992 children, 12 634 children with classical asthma （90. 3% ） and 1358 children with cough variant asthma （9.7%） ; 4387 cases （31.4%） were newly diagnosed in all asthmatic children. The total asthma incidence rate was 3.02% （95% CI：2. 97% -3.06% ）, with classical asthma at 2.72 % （ 95 % C1： 2. 68 % - 2. 77 % ） and cough variant asthma at 0. 29% （95 % CI： 0. 28 % - 0. 31% ）. The prevalence in last two-year （2009 - 2010） was 2.32% （95% Cl：2. 28% - 2. 37% ）. The prevalence of asthma in male and female children was 3.51% （8495/241 811 ） and 2. 29% （5089/222 160）respectively with signifcant difference （X： = 608.7, P 〈 0. 01 ）. Preschool children （3 - 5 years old） had the highest prevalence of asthma （4. 15% ） , which was significantly higher than that of school-age children （6 - 14 years old, 2. 82% ） and infants （0 -2 years old, 1.77% ）. In different regions of the country, the highest rate was found in East China （4. 23% ）, and the lowest rate in North-east China （2. 00% ）. Among different cities, highest rate was found in Shanghai （7.57%） and the lowest rate in Lasa （0.48%）. Family allergic history was reported in 45.2% （ n = 6321 ）, personal history of allergy reported in 72. 5% （ n = l0 143 ）, and allergic rhinitis reported in 50. 1% （n = 7010） asthmatic children. Respiratory tract infection （87. 9%, n = 12 299） and changes of weather condition/inhaling cold air （51.5%, n = 7204） were the most common triggers of asthma exacerbation. The common clinical manifestations of asthma were cough （91.3%, n = 12 771 ） and wheezing （76. 2% ,n = 10 659）. Dysphasia （3.1% ,n =438）, orthopnea （6. 5% ,n =905）, cyanosis （3.8% , n = 528） or sweating （5.0% ,n = 696） was relatively less often seen during exacerbation. In last year, more than half （61.4% ,4826/12 518） of the patients experienced asthma attack, 32. 1% （4028/12 530） went to emergency room once, and 16.3% （2039/12 514） were hospitalized for treatment. Bronchodilators were used in 71.4% （n = 9986）, inhaled corticosteroid in 58. 7% （n = 8209） , antibiotics in 75.1% （n = 10 504） of asthmatic children. Peak flow meter was used in 14. 3% （1449/10 145） of asthmatic children 5 years and older for monitoring. Conclusion The total asthma incidence of childhood asthma aged 0 - 14 year old in cities in China was 3.02% and prevalence in last two years was 2.32%. The asthma prevalence was significantly different among regions, cities, ages, and genders. Nearly one third of patients with asthma was not diagnosed in early stage or diagnosed correctly. The treatment and management of asthma in children awaits improvement as well.