婴幼儿反复喘息危险因素Meta分析

Meta analysis of the risk factors of recurrent wheezing in infants

目的 分析婴幼儿（＜3岁）反复喘息（发作次数≥3次）的相关危险因素.方法 以“喘息、危险因素、影响因素”为中文关键词,“wheezing、stridor、respiratory sounds、risk factor”为英文关键词,检索中国生物医学文献服务系统、万方数据库、中文科技期刊数据库等中文数据库,PubMed、Cochrane library、EMbase等英文数据库中2004年5月31日至2014年6月1日的有关文献.使用纽卡斯尔-渥太华量表及美国卫生保健质量和研究机构推荐横断面研究评价标准对纳入的文献进行质量评价,使用GRADEpro软件评价证据质量,用RevMan 5.2软件进行Meta分析.结果 最终纳入13篇文献.其中母孕时吸烟（OR=1.47,95％ CI：1.30～ 1.66）,父母有支气管哮喘（哮喘）史（OR=1.94,95％ CI：1.72～2.19）,家族过敏倾向（OR=1.39,95％ CI：1.03～1.88）,男童（OR=1.42,95％ CI：1.19～1.69）,湿疹史（OR =2.36,95％ CI：1.69～3.30）,多次感冒史（＞6次）（OR=2.02,95％ CI：1.54～2.64）,肺炎史（OR=1.85,95％CI：1.46～ 2.34）,香烟暴露史（OR=2.30,95％ CI：1.68～3.14）,幼托（OR=2.27,95％ CI：1.97 ～ 2.60）是婴幼儿（＜3岁）反复喘息（发作次数≥3次）的危险因素;母亲受教育＞12年（OR =0.80,95％ CI：0.70～0.92）为保护因素.结论 婴幼儿（＜3岁）反复喘息（发作次数≥3次）的危险因素有母孕时吸烟、父母有哮喘史、家族过敏倾向、男童、湿疹史、多次感冒史、肺炎史、香烟暴露史和幼托,保护因素为母亲受教育＞12年.尽可能地规避危险因素,加强保护因素,对于预防婴幼儿反复喘息具有重要作用.

Obgective To analyze the relevant risk factors of recurrent wheezing（≥3 attacks） in the first 3 years of life.Methods ＆quot;Wheezing,respiratory sounds,risk factor＆quot; were used as key words to retrieve papers in Chinese literature databases including Sinomed,Wanfang and Weipu databases.The same strategy was used to retrieve English papers in English literature databases including PubMed,Cochrane library and Embase.Time range was from 31th May 2004 to 1 rd June 2014.The execution of quality evaluation of the included documents was in compliance with Newcastle-Ottawa Scale and cross-sectional study standard recommended by Agency for Healthcare Research and Quality.The evidence quality evaluation was conducted with GRADEpro and followed by the Meta analysis with RevMan 5.2.R^ults A total of 13 studies were included in this Meta-analysis.Several factors were related to recurrent wheezing episodes,including risk factors such as maternal smoking during pregnancy （OR =1.47,95% CI：1.30-1.66）,asthma in parents （OR =1.94,95 % CI：1.72-2.19）,family history of atopy （OR =1.94,95% CI：1.72-2.19）,male （OR =1.42,95 % CI：1.19-1.69）,history of eczema （OR =2.36,95 % CI：1.69-3.30）,colds （〉 6 times） （OR =2.02,95 % CI：1.54-2.64）,history of bronchopneumonia （OR =1.85,95 % CI：1.46-2.34）,exposure to cigarette smoking（OR =2.30,95% CI：1.68-3.14）,daycare attendance（OR =2.27,95% CI：1.97-2.60）;Education received by the mother 〉 12 years （OR =0.80,95% CI：0.70-0.92） was the protective factor.Conclusions The risk factors of recurrent wheezing（≥3 attacks） in the first 3 years of life are maternal smoking during pregnancy,asthma in parents,family history of atopy,male,history of eczema,colds （〉 6 times）,history of bronchopneumonia,exposure to cigarette smoking and daycare attendance.The protective factor is education received by the mother ≥ 12 years.The prerequisite in precaution of infants recurrent wheezing is to ensure the utmost avoidance of hazardous factors and reinforcement of protective factors.