儿童胸闷变异性哮喘的临床特征及危险因素分析

Analysis of clinical characteristics and risk factors of chest tightness variant asthma in children

目的分析儿童胸闷变异性哮喘(CTVA)的临床特征及其危险因素,为疾病的预防和管理提供依据。方法采用横断面研究,以2021年1月至2023年1月因胸闷就诊于首都儿科研究所附属儿童医院变态反应科的6~17岁患儿为研究对象,共纳入178例,其中男性89例(50%)、女性89例(50%),年龄8.83(7.50,11.58)岁,根据是否诊断CTVA分为CTVA组130例,48例非CTVA患儿为对照组。收集患儿的人口学资料、个人既往史、家族史、临床特征、辅助检查结果等数据,分析比较两组患儿的临床特征、变应原、FeNO水平及肺功能各参数指标,并采用logistic回归分析探讨疾病发生的危险因素。结果CTVA组学龄期儿童(6~11岁)较青春期儿童(≥12岁)占比更高[(113/130,86.9%)vs(26/48,54.2%),Z=21.985,P<0.01]。CTVA组合并湿疹[(74/130,56.9%)vs(19/48,39.6%),χ^(2)=4.225,P<0.05]及伴发鼻部症状[(98/130,75.4%)vs(27/48,56.2%),χ^(2)=6.138,P<0.05]比例较高,吸入变应原霉菌致敏[(52/130,40.0%)vs(11/48,22.9%),χ^(2)=4.474,P<0.05]及多重致敏[(71/130,54.6%)vs(18/48,37.5%),χ^(2)=4.108,P<0.05]的阳性率显著高于对照组。CTVA患儿FeNO升高(>20 ppb)的比例为20.8%(27/130),显著高于对照组4.2%(2/48)(χ^(2)=7.086,P<0.01)。CTVA患儿的肺通气功能参数FEV1、FVC与对照组无统计学差异(P均>0.05),FEV1/FVC、PEF、FEF25、FEF50、FEF75、MMEF均显著低于对照组(P均<0.05)。logistic回归分析显示伴发鼻部症状(OR=2.351,95%CI 1.105~5.002,P=0.026)、多重致敏(OR=2.184,95%CI 1.046~4.557,P=0.038)、tIgE>60 kU/L(OR=3.080,95%CI 1.239~7.654,P=0.015)、FeNO>20 ppb(OR=6.734,95%CI 1.473~30.796,P=0.014)、小气道功能障碍(OR=3.164,95%CI 1.089~9.194,P=0.034)为胸闷变异性哮喘发病的危险因素。FeNO联合FEF50诊断CTVA的AUC最大(Z=2.744,P<0.01)。结论CTVA学龄期儿童较青春期更常见,伴发鼻部症状、多重致敏、tIgE>60 kU/L、FeNO>20 ppb、小气道功能障碍为CTVA发病的危险因素。FeNO联合小气道指标可提高对CTVA的诊断价值。

Objective To analyze the clinical features and risk factors of chest tightness variant asthma(CTVA)in children,so as to provide basis for the prevention and management of the disease.Methods A cross-sectional study was conducted to analyze 178 children aged 6-17 years old who were admitted to the Department of Allergy,Capital Institute of Pediatrics Affiliated Children′s Hospital from January 2021 to January 2023 due to chest tightness.The age was 8.83(7.50,11.58)years old,with 89 males(50%)and 89 females(50%).According to the diagnosis of CTVA,130 cases were divided into CTVA group and 48 non-CTVA cases were divided into control group.Demographic data,personal history,family history,clinical features,auxiliary examination results and other data were collected.The clinical characteristics,allergens,FeNO level and pulmonary function parameters of the two groups were analyzed.Logistic regression analysis was used to explore the risk factors of the disease.Results The proportion of school-age children(6-11 years old)in CTVA group was higher than that of adolescent children(≥12 years old)[(113/130,86.9%)vs(26/48,54.2%),Z=21.985,P<0.01].The proportion of CTVA combined with eczema[(74/130,56.9%)vs(19/48,39.6%),χ^(2)=4.225,P<0.05]and rhinitis symptoms[(98/130,75.4%)vs(27/48,56.2%),χ^(2)=6.138,P<0.05]was higher.The positive rates of mold sensitization[(52/130,40.0%)vs(11/48,22.9%),χ^(2)=4.474,P<0.05]and multiple sensitization[(71/130,54.6%)vs(18/48,37.5%),χ^(2)=4.108,P<0.05]in inhaled allergens were significantly higher than those of control group.The proportion of elevated FeNO(>20 ppb)in CTVA children was 20.8%(27/130),which was significantly higher than that in control group 4.2%(2/48)(χ^(2)=7.086,P<0.01).There were no statistical differences in spirometry parameters FEV1 and FVC between CTVA group and control group(P both>0.05).FEV1/FVC,PEF,FEF25,FEF50,FEF75 and MMEF were significantly lower than those in control group(P all<0.05).Logistic regression analysis showed that rhinitis symptoms(OR=2.351,95%CI 1.105-5.002,P=0.026),multiple sensitizations(OR=2.184,95%CI 1.046-4.557,P=0.038),tIgE>60 kU/L(OR=3.080,95%CI 1.239-7.654,P=0.015),FeNO>20 ppb(OR=6.734,95%CI 1.473-30.796,P=0.014)and small airway dysfunction(OR=3.164,95%CI 1.089-9.194,P=0.034)were risk factors for chest tightness variant asthma.FeNO combined with FEF50 has the largest area under the curve(Z=2.744,P<0.01)in diagnosing CTVA.Conclusion CTVA is more common in school-age children than in adolescent children.Rhinitis symptoms,multiple sensitization,tIgE>60 kU/L,FeNO>20 ppb and small airway dysfunction are risk factors for chest tightness variant asthma.FeNO combined with small airway indexes can improve the diagnostic value of CTVA.