超重肥胖与被动吸烟对儿童哮喘及哮喘样症状交互效应

Interactive effect of overweight and obesity and passive smoking on asthma and asthma-like symptoms in children

目的 探讨超重肥胖与被动吸烟对儿童哮喘及哮喘样症状的交互效应，为采取控制和预防措施提供理论依据。方法 采用分层整群随机抽样方法对在辽宁省沈阳市大东、沈河、和平、皇姑、铁西5个行政区抽取的5所小学和10所幼儿园共8 733名儿童进行问卷调查和体格检查。结果 儿童持续咳嗽、持续咳痰、哮喘、哮喘现患、喘鸣现患的发生率分别为9.57%、4.42%、6.40%、2.46%、6.05%，超重和肥胖患病率分别为11.97%和12.13%，被动吸烟暴露率为46.34%；调整儿童的性别、年龄、父母受教育水平、母乳喂养、生活用煤、父母过敏史等混杂因素后，多因素非条件logistic回归分析结果表明，与既不超重肥胖又不被动吸烟的儿童比较，有超重肥胖或被动吸烟的儿童患哮喘的风险分别增高了47%（OR=1.47，95%CI=0.95-2.27）和53%（OR=1.53，95%CI=1.08-2.16），而同时暴露于这2个因素的儿童患哮喘的风险增加了117%（OR=2.17，95%CI=1.46-3.23），近似于2个因素单独效应之和，超重肥胖与被动吸烟对儿童患哮喘的影响存在相加效应，但相乘效应并不显著。结论 超重肥胖和被动吸烟均可增加儿童患哮喘及哮喘样症状的风险，且两者对儿童患哮喘的影响存在相加效应。

Objective To explore interactive effect of overweight,obesity and passive smoking on asthma and asthma-like symptoms in children and to provide reference for control and prevention of the illnesses. Methods Totally 8 733 children were selected with stratified cluster random sampling from 5 primary schools and 10 kindergartens in 5 urban districts of Shenyang city,Liaoning province.A questionnaire survey and physical examination were conducted among the children. Results The prevalence of persistent cough,persistent sputum,asthma history,current asthma,and current wheezing was 9.57%,4.42%,6.40%,2.46%,and 6.05%,respectively,among the children.The prevalence rate of overweight and obesity were 11.97% and 12.13 % and the proportion of the children exposed to passive smoking was 46.34%.After adjusting for gender,age,parents＇ education level,breastfeeding,familial coal use,allergy history of parents,and other confounding factors,multivariate unconditional logistic regression analyses showed that,compared with the children without passive smoking exposure and overweight and obesity,the risk of suffering from asthma increased by 47%（odds ratio [OR]=1.47,95% confidence interval [95%CI]=0.95-2.27）for the children with overweight or obesity,53%（OR=1.53,95% CI：1.08-2.16）for those with passive smoking exposure,and 117%（OR=2.17,95% CI=1.46-3.23）for the children with both overweight or obesity and passive smoking exposure,indicating an additive effect of the two factors on asthma and asthma-like symptoms in the children. Conclusion With an additive effect,overweight and obesity and passive smoking can increase the risk of suffering from asthma and asthma-like symptoms in children.