小婴儿首发喘息6年后发生反复喘息的回顾性队列研究

Recurrent wheezing 6 years after first wheezing in 3-month-old infants:A retrospective cohort study

背景喘息是婴幼儿时期较常见的呼吸道症状,近年来,婴幼儿喘息的发生率逐年上升。目的 探讨小婴儿(<3月龄)首发喘息的病因及6年内发生喘息情况及其影响因素。设计回顾性队列研究。方法 对小婴儿首发单纯感染相关喘息(排除先天性心脏病和发育不良等)住院患儿于6年后行电话随访,随访内容:母亲分娩年龄、孕产频次、分娩方式,患儿出生体重和胎龄,哮喘家族史、个人过敏史,出院后连续6月内喘息频次、末次喘息年龄,肺功能和过敏原IgE。对首发单纯感染相关喘息病例于6岁时电话随访,依据首次喘息出院后至6岁期间任意6个月≥3次喘息为喘息组,余为对照组,行单因素和多因素Logistic回归分析。主要结局指标小婴儿单纯感染相关喘息6年后反复喘息的影响因素。结果 229例小婴儿首发喘息队列人群中,单纯感染相关喘息187例(81.7%);合并先天性发育异常及畸形所致喘息42例(18.3%),其中先天性心脏病31例(13.5%),先天性喉软骨发育不良6例(2.6%),膈膨升、支气管异物、肺隔离症、气管性支气管、支气管软化症各1例(0.4%)。首发单纯感染相关喘息187例中失访16例,喘息组58例,对照组113例。单因素分析显示,低出生体重儿、巨大儿、高龄产妇、哮喘家族史、个人过敏史、湿疹、外周血嗜酸性粒细胞计数升高、应用IVIG、同时应用抗生素+抗病毒治疗影响因素在喘息组和对照组中差异有统计学意义。多因素Logistic分析显示,有湿疹(OR=2.19,95%CI:1.04~4.62)和过敏史(OR=2.34,95%CI:1.09~5.03)是无湿疹和无过敏史的小婴儿首发感染相关喘息6年后发生反复喘息风险的2倍,母亲为高龄产妇(OR=3.06,95%CI:1.02~9.21)可能是导致小婴儿首发感染相关喘息6年后反复喘息的危险因素,哮喘家族史(OR=5.07,95%CI:1.20~21.45)、低出生体重(OR=4.97,95%CI:1.62~15.21)、巨大儿(OR=9.73,95%CI:1.94~48.94)、外周血嗜酸性粒细胞计数升高(OR=3.46,95%CI:1.07~11.14)对预测小婴儿首发感染相关喘息6年后反复喘息有一定的参考作用,应用较不应用IVIG可降低57%(OR=0.43,95%CI:0.20~0.94)小婴儿首发感染相关喘息6年后反复喘息的风险。结论 有湿疹和过敏史是无湿疹和无过敏史的小婴儿首发感染相关喘息6年后发生反复喘息风险的2倍,应用IVIG可降低57%小婴儿首发感染相关喘息6年后反复喘息的风险。

Background Wheezing is a common respiratory symptom in infants and young children.In recent years,the incidence of wheezing has been increasing year by year.Objective To investigate the etiology of first-onset wheezing in infants(<3 months old)and the wheezing situation and influencing factors of infant patient within 6 years.Design Retrospective cohort study.Methods Hospitalized infants with first-time infection-related wheezing(excluding congenital heart disease and developmental anomalies)were followed up via phone six years later.The follow-up information included mother's delivery age,frequency of pregnancy and delivery,delivery method,birth weight and gestational age,family history of asthma,personal allergy history,frequency of wheezing within,age of last wheezing,lung function,and allergen IgE.Cases with first-time only infection-related wheezing were divided into the wheezing group(wheezing episodes≥3 times)and the control group(wheezing episodes≤2 times)based on wheezing frequency within 6 consecutive months after discharge.Univariate and multivariate logistic regression analyses were performed.Main outcome measures Factors influencing recurrent wheezing six years after initial infection-related wheezing in infants.Results Among 229 infants with initial wheezing,187 cases(81.7%)were due to infection alone,and 42 cases(18.3%)due to infection combined with congenital anomalies,including congenital heart disease(31 cases,13.5%),congenital laryngomalacia(6 cases,2.6%),diaphragm elevation,bronchial foreign bodies,lung sequestration,tracheal bronchus,and bronchomalacia(1 case each,0.4%).Of the 187 only infection-related cases,excluding 16 lost to follow-up,there were 58 cases in the wheezing group and 113 in the control group.Significant differences between the groups were found in factors such as low birth weight,macrosomia,advanced maternal age,family history of asthma,personal allergy history,eczema,elevated peripheral blood eosinophil count,use of IVIG,and combined antibiotic and antiviral therapy.Multivariate logistic analysis showed that eczema(OR=2.19,95%CI:1.04-4.62)and allergy history(OR=2.34,95%CI:1.09-5.03)doubled the risk of recurrent wheezing six years later.Advanced maternal age(OR=3.06,95%CI:1.02-9.21)was a potential risk factor,and family history of asthma(OR=5.07,95%CI:1.20-21.45),low birth weight(OR=4.97,95%CI:1.62-15.21),macrosomia(OR=9.73,95%CI:1.94-48.94),and elevated peripheral blood eosinophil count(OR=3.46,95%CI:1.07-11.14)were significant predictors.IVIG use reduced the risk of recurrent wheezing by 57%(OR=0.43,95%CI:0.20-0.94).Conclusion Eczema and allergy history double the risk of recurrent wheezing six years after initial infection-related wheezing in infants,compared with non-eczema and non-allerty cases.IVIG use can reduce the risk of recurrent wheezing by 57%.