小儿反复呼吸道感染危险因素的病例对照研究

Case-control Study on Risk Factors for Children with RRTIs

目的:调查反复呼吸道感染(recurrent respiratory tract infections,RRTI)患儿发病的相关因素并进行logistic回归分析。方法:(1)以2016年9月-2017年12月来上海中医药大学附属岳阳中西医结合医院、上海中医药大学附属曙光医院、上海交通大学附属新华医院、嘉定中医院门诊就诊及住院RRTI患儿为研究对象,同时随机选取上述医院健康查体儿童作为对照组;(2)采用面对面调查形式,调查研究对象的年龄、性别、胎产方式、胎龄、出生体重、母亲孕龄、喂养方式、家庭居住环境、饮食偏好和发病时节等;(3)采用单因素和多因素logistic回归分析儿童罹患RRTI的危险因素。结果:(1)本次研究共纳入1124例RRTI患儿,健康儿童1033例。4-6岁RRTI患儿构成比最高,季节更替为最频繁的发病时节;(2)单因素logistic分析显示年龄、母孕年龄、胎产方式、胎龄、出生体重、喂养方式和饮食偏嗜是RRTI影响因素;(3)多因素logistic分析显示年龄段在7-14岁的儿童患RRTI的风险是0-3儿童的近3倍(OR 3.452,95%CI:2.219-5.370),母亲生育年龄不适龄的儿童患RRTI的风险比是适龄的近2倍(OR 1.964,95%CI:1.560-2.473),剖宫产出生的儿童患RRTI风险是顺产的近2倍(OR 2.238,95%CI 1.778-2.818),早产儿患RRIT风险是足产儿的近2倍(OR 2.387,95%CI:1.067-5.340),出生体重偏轻儿童患RRTI风险是正常体重的近3倍(OR 3.114,95%CI:1.097-8.842),母乳喂养及混合喂养患RRTI风险比人工喂养的儿童分别要低40%(OR 0.362,95%CI:0.250-0.526)和20%(OR 0.247,95%CI:1.067-5.340),偏嗜辛辣、甜食和肉食的儿童患RRTI风险分别要高于正常饮食儿童7倍(OR 7.023,95%CI:2.400-20.549)、3倍(OR 2.635,95%CI:1.843-3.768)和3倍(OR 2.912,95%CI:1.967-4.311)。结论:出生体重偏小、胎龄偏小、非顺产、非母乳喂养、年龄段在7-14岁时、换季及饮食偏嗜与RRTI的发病密切相关。因此,对于有上述危险因素的儿童,父母应该更加重视小儿呼吸道感染性疾病的治疗和防护,以免诱发RRTI。

Objective:To investigate the factors that were related with recurrent respiratory infections(RRTI)onset in children and to analyze them by logistic regression analysis.Methods:The subjects of this study were recruited from September 2016 to December 2017 at inpatient and outpatient of Xinhua Hospital,Yueyang Hospital,Shuguang Hospital and Jiading Hospital.Meanwhile,the healthy children who took routine medical examinations were randomly selected as the control group.A face-to-face interview survey was conducted to investigate the age,sex,and gestational age,birth weight,maternal gestational age,feeding style,family living environment,diet preference and onset time of the disease.The risky factors were analyzed using univariable and multivariable logistic regression.Result:a total of 2157 cases were included in this study,including 1124 children with RRTI and 1033 healthy children.The composition ratio of 4-6 years old children with RRTI was the highest,and the most frequent RRTI-onset time was seasonal change.Univariable logistic regression showed that age,maternal age,gestational age,feeding practices,food partiality,the way and weight of birth were the influence factor for RRTI-onset.Multivariate logistic analysis showed that children 7-14 years old were at a threefold increased risk of RRTI than children 0-3 years old(OR 3.452,95%CI∶2.219-5.370).Children with maternal age inappropriate were at a twofold increased risk of RRTI than children with maternal age appropriate(OR 1.964,95%CI∶1.560-2.473).Children with caesarean section were at a twofold increased risk of RRTI than children with eutocia(OR 2.238,95%CI∶1.778-2.818).Premature infant were at a twofold increased risk of RRTI than normal term infant(OR 2.387,95%CI∶1.067-5.340).Children with low birth weight were at a threefold increased risk of RRTI than children with normal birth weight(OR 3.114,95%CI∶1.097-8.842).The risks of RRTI in children with breast feeding and partial breastfeeding were declined almost 40%(OR 0.362,95%CI∶0.250-0.526)and 20%(OR 0.247,95%CI∶1.067-5.340),respectively,compared to children with milk feeding.Children who prefer spicy food were at a seven fold increased risk of RRTI than children without food partiality(OR 7.023,95%CI∶2.400-20.549).Children who prefer sweetmeat and meat were at a threefold increased risk of RRTI than children without food partiality(OR 2.635,95%CI∶1.843-3.768 and OR 2.912,95%CI∶1.967-4.311,respectively).Conclusion:Low birth weight,small for gestational age,caesarean section,non-breast-feeding,children age at 7-14 years old,seasonal change and food partiality were related with RRTI-onset.Hence,parents should pay more attention to treatment and protection of their children with above risky factors who suffering from respiratory tract infections,which avoid to trigger RRTI-onset.