2~5岁年幼儿哮喘学龄期转归的随访研究

A follow-up study on the outcome of 2 to 5 years old children with asthma at school age

目的探讨年幼儿确诊哮喘3年后至学龄期疾病转归及影响因素。方法采用问卷调查的方式,对2016年至2017年北京市5家医院诊断的2~5岁哮喘患儿共494例进行电话随访,收集并分析其近3年哮喘发作情况、症状控制水平以及伴发过敏性疾病情况等资料。结果完成电话随访并纳入本研究387例,男261例(67.4%),女126例(32.6%)。3年内哮喘无发作(临床缓解)246例(63.6%),3年内有哮喘发作(临床未缓解)141例(36.4%)。3年内有哮喘发作患儿,其症状表现为喘息116例(82.3%)、反复咳嗽59例(41.8%)、气促45例(31.9%)、胸闷或夜间憋醒22例(15.6%)。其哮喘发作诱因依次为呼吸道感染80例(56.7%)、变应原暴露46例(32.6%)、气候改变或寒冷空气刺激59例(41.8%)、剧烈运动36例(25.5%)、刺激性气味3例(2.1%)。单因素分析结果显示,随访时年龄、出生后烟草暴露史、哮喘起病前反复呼吸道感染、个人过敏史、打鼾、过敏性鼻炎、近1年存在过敏性鼻炎、近1年存在过敏性结膜炎等在近3年临床缓解组和近3年临床未缓解组患儿中差异存在统计学意义(P<0.05)。多因素非条件Logistic回归分析结果显示,出生后烟草环境暴露、近1年存在过敏性鼻炎、近1年存在过敏性结膜炎为哮喘症状持续至学龄期的独立危险因素(P<0.05)。结论年幼儿哮喘至学龄期,仍有1/3以上的患儿临床症状未缓解;出生后烟草环境暴露、近1年存在过敏性鼻炎、近1年存在过敏性结膜炎是哮喘未缓解的危险因素。

Objective To investigate the outcome of asthma in young children after 3 years and the factors associated with the outcome.Methods A total of 494 children aged 2 to 5 years with asthma diagnosed in 5 hospitals in Beijing from 2016 to 2017 were followed up by telephone using questionnaire survey.Information on the asthma attack,the disease control level,and the comorbidities of allergic diseases in the past 3 years was collected and analyzed.Results Questionnaires were conducted in 387 children,including 261 males(67.4%)and 126 females(32.6%).Two hundred and forty-six patients(63.6%)had no any asthma symptom(remission)within 3 years,while 141 patients(36.4%)were found with asthma symptom(without remission).The main symptoms were as follows:wheezing in 116 cases(82.3%),recurrent cough in 59 cases(41.8%),shortness of breath in 45 cases(31.9%),chest tightness or waking up at night due to wheezing in 22 cases(15.6%).The causes of asthma attack were respiratory tract infection in 80 cases(56.7%),allergen exposure in 46 cases(32.6%),climate change or cold air stimulation in 59 cases(41.8%),strenuous exercise in 36 cases(25.5%),and irritating odor in 3 cases(2.1%).One-way anova analysis showed that significant difference(P<0.05)was respectively observed in age at follow-up,postnatal tobacco smoke exposure history,repeated respiratory tract infection before asthma onset,personal allergy history,snoring,allergic rhinitis,allergic rhinitis within 1 year,allergic conjunctivitis within 1 year between the remission group and without remission group.Multivariate unconditional logistic regression analysis showed that tobacco exposure after birth,allergic rhinitis and allergic conjunctivitis within 1 year were independent risk factors for the continuation of asthma symptoms to school age(P<0.05).Conclusion Till the school age,more than 1/3 children still had asthma symptom and the risk factors for the unalleviated symptom were postnatal tobacco exposure,allergic rhinitis within 1 year and allergic conjunctivitis within 1 year.