儿童支气管哮喘和过敏性鼻炎稳定控制的相关因素研究

Factors related to the control and stability of asthma and allergic rhinitis in children

目的:分析儿童支气管哮喘(哮喘)和过敏性鼻炎稳定控制的相关因素。方法:采用病例登记前瞻性观察性研究,收集符合纳入标准的2015年4月1日至12月30日就诊于首都医科大学附属北京儿童医院过敏反应科和耳鼻喉咽喉头颈外科门诊确诊的气道过敏性疾病儿童的病史资料,采用协同诊疗管理方式管理,每间隔3个月评估哮喘和鼻炎控制水平,调整治疗方案。管理12个月时,根据患儿哮喘和过敏性鼻炎的控制治疗反应性分为控制水平稳定组和不稳定组,比较两组间性别、年龄、哮喘和鼻炎病程、湿疹史、一级亲属过敏史、过敏原致敏模式、肺功能指标、呼出气一氧化氮检测(FeNO)的差异。结果:纳入147例患儿,管理12个月时106例患儿,根据12个月时的控制水平分稳定组和不稳定组,稳定组60例(56.6%),不稳定组46例(43.4%)。不稳定组湿疹史患儿比例高于稳定组[88.9%(32/46)比71.7%(43/60),χ^(2)=3.91,P=0.048];基线期鼻炎控制评估视觉近似标尺(VAS)评分高于稳定组[(4.7±1.9)分比(3.7±2.3)分,t=2.12,P=0.037];血清总IgE水平高于稳定组[269.0(163.0,578.5)kU/L比195.5(69.7,420.8)kU/L,Z=2.01,P=0.044];尘螨致敏比例高于稳定组[76.1%(35/46)比55.0%(33/60),χ^(2)=5.19,P=0.025];支气管舒张试验第1秒用力呼气容积(FEV 1)改善率高于稳定组[(14.2±11.5)比(7.3±5.9),t=2.42,P=0.018]。结论:儿童湿疹史、鼻炎严重度、血清总-IgE水平、尘螨致敏、支气管舒张试验反应性是影响气道过敏性疾病控制稳定的重要因素。

Objective To analyze the factors related to the control and stability of asthma and allergic rhinitis in children.Methods Children with airway allergic diseases who visited Department of Allergy and Department of Otorhinolaryngology of Beijing Children′s Hospital from April to December 2015 were enrolled in the prospective study.Patients underwent baseline assessment and regular management every three months.The stability of disease control was evaluated after one year of treatment;according to the control level,children were divided into stable control group and unstable group.The gender,age,history of asthma,allergic rhinitis and eczema,family history,allergen sensitization,pulmonary function,fractional exhaled nitric oxide were compared between the two group.Results A total of 147 children with airway allergic diseases were included and 106 children were followed up for 12 months.According to the control level at 12 months,there were 60 cases(56.6%)in stable group and 46 cases(43.4%)in unstable group.The proportion of children with eczema history in the unstable group was significantly higher than that in the stable group[88.9%(32/46)vs.71.7%(43/60),χ^(2)=3.91,P=0.048].The allergic rhinitis VAS in the unstable group was significantly higher than that in the stable group at the baseline[(4.7±1.9)vs.(3.7±2.3),t=2.12,P=0.037].The serum T-IgE level in unstable group was significantly higher than that in the stable group at the baseline[269.0(163.0,578.5)kU/L vs.195.5(69.7,420.8)kU/L,Z=2.01,P=0.044].The sensitivity rate to dust mite in the unstable group was significantly higher than that in the stable group[76.1%(35/46)vs.55.0%(33/60),χ^(2)=5.19,P=0.025].The improvement rate of forced expiratory volume in one second(FEV1)in the unstable group was significantly higher than that in the stable group[(14.2±11.5)vs.(7.3±5.9),t=2.42,P=0.018].Conclusion Eczema history,the severity of allergic rhinitis,serum T-IgE level,atopy and pulmonary physiology are associated with unstable status of airway allergic diseases in children.