婴幼儿毛细支气管炎后反复喘息的危险因素分析

Analysis of risk factors of recurrent wheezing after bronchiolitis in infants

目的分析婴幼儿毛细支气管炎后反复喘息的相关危险因素。方法选取医院2018年1月至2019年6月收治的220例首次发病的毛细支气管炎婴幼儿为研究对象,随访2年了解喘息发作情况。根据患儿喘息发作次数,分为反复喘息组(≥3次)63例,非反复喘息组(≤2次)157例。比较2组一般资料及实验室检查结果,采用多因素Logistic回归分析研究毛细支气管炎后反复喘息的独立危险因素,通过受试者工作特征曲线(ROC)分析找到各指标诊断价值最大的cut off值。结果单因素分析结果显示:早产、母乳喂养<3个月、湿疹、过敏性鼻炎、食物过敏、母孕期吸烟、烟草接触、未补充维生素AD、生活在城市、父母有过敏性疾病、吸入性过敏原阳性、血清IgE升高、痰液半胱氨酸白三烯(LTD4)升高、肺功能达峰时间比、达峰容积比下降与毛细支气管炎后反复喘息有关(P<0.05)。多因素Logistic回归分析得出母乳喂养<3个月、湿疹、烟草暴露、未补充维生素AD、父母有过敏性疾病、吸入性过敏原阳性、痰液LTD4升高是毛细支气管炎后反复喘息的独立危险因素(P<0.05),各因素绘制ROC曲线,曲线下面积分别是0.588、0.579、0.671、0.574、0.743、0.612、0.728。痰液LTD4的cutoff值是233.30 pg/ml。结论婴幼儿毛细支气管炎后反复喘息的独立危险因素为母乳喂养<3个月、湿疹、烟草暴露、未补充维生素AD、父母有过敏性疾病、吸入性过敏原阳性、痰液LTD4升高,临床应针对性做好防治工作,以减少喘息发作。

Objective To investigate the risk factors of recurrent wheezing after bronchiolitis in infants.Methods A total of 120 infants with bronchiolitis for the first time who were treated in our hospital from January 2018 to June 2019 were enrolled in the study,who were followed up for 2 years.According to the frequency of wheezing,the patients were divided into recurrent wheezing group(≥3 attacks,n=63),and non-recurrent wheezing group(≤2 attacks,n=157).The general information,laboratory test results were observed and compared between two groups.Multivariate Logistic regression was used to analyze the independent risk factors of recurrent wheezing after bronchiolitis,and the cut off value with the maximum diagnostic value of each indicator was found through receiver operating characteristic(ROC)curve analysis.Results The univariate analysis results showed that 15 factors were related with the occurrence of recurrent wheezing after bronchiolitis,which included premature birth,breast feeding<3 months,eczema,allergic rhinitis,food allergy,maternal smoking during pregnancy,exposure to cigarette smoking,no vitamin AD supplement,living in city,parental allergic diseases,positive of inhalant allergens,rised of serum IgE,rised of cysteinyl-leukotriene LTD4,decreasedof ratio of time to peak tidal expiratory flow and ratio of volume to peak expiratory flow of pulmonary function(P<0.05).The multivariate Logistic regression analysis showed that the independent risk factors of recurrent wheezing after bronchiolitis were breast feeding<3-month,eczema,exposure to cigarette smoking,no vitamin AD supplement,parental allergic diseases,positive of inhalant allergens,rised of cysteinyl-leukotriene LTD4(P<0.05).Draw ROC curve of each factor,the areas under the ROC curve were 0.588,0.579,0.671,0.574,0.743,0.612,0.728,respectively,and the cut off value of LTD4 was 233.30pg/ml.Conclusion Breast feeding<3month,eczema,exposure to cigarette smoking,no vitamin AD supplement,parental allergic diseases,positive of inhalant allergens,the increase of cysteinyl-leukotriene LTD4 are independent risk factors of repeated wheezing after bronchiolitis,therfor,it is necessary to targetedly perform the prevention and treatment to reduce wheezing attack.