2013-2014年我国中心城市29家医院支气管哮喘急性发作住院患者诱发因素的回顾性调查

A retrospective study of the inducing factors and clinical characteristics of patients hospitalized for asthma exacerbation in China in 2013-2014

目的 了解我国支气管哮喘（以下简称哮喘）急性发作住院患者的发作诱因.方法 在全国哮喘研究协作组成员所在29个城市的29家三级甲等医院呼吸内科进行哮喘急性发作住院患者的回顾性调查,分析哮喘急性发作住院患者的诱发因素、发作严重程度的影响因素.结果 共纳入3240例哮喘患者,男性1369例（42.3%）,女性1871例（57.7%）.因哮喘急性发作住院人数占同期呼吸科住院总人数的2.95%（6375/215955）.发作诱因中急性上呼吸道感染[42.3%（1370/3240）]、天气变化[22.8%（738/3240）]、有害气体[4.3%（140/3240）]、过敏原刺激[3.5%（115/3240）]、剧烈运动[1.8%（57/3240）]以及空气污染[1.5%（49/3240）]居前6位.老年人诱发因素中天气变化比例更高;青年人和老年人上呼吸道感染比例高于中年人,青年人和中年人过敏原刺激比例高于老年人,但差异均无统计学意义（P〉0.05）.冬季诱发因素上呼吸道感染比例较高,秋季天气变化、剧烈运动及空气污染比例较高;春季和夏季过敏原刺激比例高于秋冬季,但差异无统计学意义（P〉0.05）.北方患者诱发因素中上呼吸道感染的比例高于南方;而南方患者有害气体比例高于北方;北方患者过敏原刺激、空气污染比例亦高于南方,但差异无统计学意义（P〉0.05）.不同性别、有无吸烟史者、不同程度哮喘患者间哮喘发作诱因均差异无统计学意义（P〉0.05）.重度及危重度发作者年龄≥60岁、男性、病程≥10年、有吸烟史及1年内有因哮喘急性发作住院或急诊就诊史者的比例均显著高于轻中度发作者.结论 哮喘急性发作患者中以急性上呼吸道感染为诱因者的比例最高.高龄、男性、病程长、有吸烟史及因哮喘急性发作反复就诊可能为导致重度及危重度哮喘急性发作的危险因素.

Objective To study the inducing factors and clinical characteristics of patients hospitalized for asthma exacerbation in China. Methods Patients hospitalized for asthma exacerbation at 29 hospitals in China were retrospectively recruited during 2013-2014. Results Clinical data of 3 240 asthmatic patients were collected and analyzed including 1 369（42.3%） males and 1 871（57.7%）females. The patients hospitalized for asthma exacerbation counted for 2.95% （6 375/215 955） of all patients hospitalized during the same period. The leading six inducing factors, in sequence, were acute upper respiratory tract infection[42.3%（1 370/3 240）],changes of weather[22.8%（738/3 240）],noxious gas[（4.3% （140/3 240）, allergy challenges [3.5%（115/3 240）], strenuous exercise [1.8%（57/3 240）], and air pollution [1.5%（49/3 240）].In older patients,more exacerbations were induced by weather changes,yet less sensitive to allergy challenges. As to middle-aged patients, they were less sensitive to upper respiratory tract infections,however the difference was not statistically significant（P〉0.05）.In winter more asthma patients were induced by upper respiratory tract infections,while in autumn more patients were induced by weather changes,strenuous exercise and air pollution.In spring and summer more patients were induced by allergy challenges, but the differences failed to achieve statistical significance （P〉0.05）. In northern cities more patients were induced by upper respiratory infections, whereas in southern cities more by noxious gases. Allergy challenges and air pollution tended to affect more patients in northern cities,but the difference was of no significance （P〉0.05）. The differences of inducing factors among patients of different gender, with or without a smoking history, and with different exacerbation severity didn＇t show any statistical significance. The patients with severe and life-threatening exacerbations counted for 20.1%（652/3 240）.The percentage of patients older than 60 years was higher in patients with severe or life-threatening exacerbations than in whose with mild or moderate exacerbations,so did the percentage of male patients,of patients with disease duration longer than 10 years, with smoking history, and with a history of hospitalization or emergency department visits due to asthma exacerbation during the last year.Conclusion The acute upper respiratory tract infection ranks top among all the inducing factors. Senility, male gender, long duration of disease, smoking history, and a history of frequent hospital visits might be the risk factors for severe or life-threatening asthma exacerbations.