哮喘患儿的带状疱疹风险
2015/11/20
摘要
背景:有文献指出了哮喘和常见及严重微生物感染增加的相关性。我们近期报告了疫苗可预防性疾病风险的增加，比如由预定哮喘标准确定的哮喘确诊儿童的带状疱疹 (HZ)。如果以不同的标准，比如哮喘危险指数（API）确定哮喘状态，考虑到哮喘的异质性我们对这种相关性是否稳固所知甚少。
目的:为了评价儿童中哮喘和HZ风险相关性的稳定性。
方法:这是一项基于人群的病例对照研究，根据明尼苏达州奥姆斯特德1996年到2001年全部的HZ儿科患者，1:1匹配年龄性别，无HZ病史的对照，他们是在我们先前的研究中登记在册的。经典的哮喘危险指数标准是以生命前三年中每年2次或更多次喘息发作加上一项主要项（父或母被内科确诊哮喘或病人被确诊为湿疹）或两项次要项（病人被内科确诊过敏性鼻炎，感冒以外的喘息发作，或者嗜酸性粒细胞增多 [≥4%]）。数据纳入传统的logistic回归模型计算OR值和95%置信区间。
结果:在原始的队列中 (n = 554), 95 (17%) 例被观察者不满足本项研究纳入标准，剩余459名。在221 名患者中， 53%为女性, 年龄的平均值 (标准差) 为9.7 ± 4.2 岁。在控制了水痘疫苗接种史和过敏状态（调整后的OR值为 2.56 [95% 置信区间为 1.08-6.56]的情况下）API确定的哮喘儿童HZ的风险是增加的。
结论:儿童及青少年中哮喘和HZ风险增加的相关性是稳定的，独立于哮喘定义。在HZ疫苗的研究中，哮喘可能是一种要考虑到的重要的临床状态。
（苏欣 审校）
Allergy Asthma Proc. 2015 Sep;36(5):372-8. doi: 10.2500/aap.2015.36.3864.
Risk of herpes zoster in children with asthma.
Wi CI1, Kim BS, Mehra S, Yawn BP, Park MA, Juhn YJ.
Abstract
BACKGROUND:There is literature that indicates the association of asthma with an increased risk of common and serious microbial infections. We recently reported an increased risk of vaccine-preventable diseases, e.g., herpes zoster (HZ) among children with asthma, defined by predetermined asthma criteria. Little is known about whether this association is persistent if the asthma status is defined by different asthma criteria, e.g., the Asthma Predictive Index, given the heterogeneity of asthma.
OBJECTIVE:To assess the consistency of the association between asthma and the risk of HZ in children.
METHODS:This is a population-based case-control study based on all pediatric patients with HZ between 1996 and 2001 in Olmsted County, Minnesota, and 1:1 age- and sex-matched controls without a history of HZ who were enrolled in our previous study. The original Asthma Predictive Index criteria was operationalized by two or more wheezing episodes in a year for the first 3 years of life plus one of the major (physician-diagnosed asthma for a parent or physician-diagnosed eczema for a patient) or two of the minor criteria (physician-diagnosed allergic rhinitis for a patient, wheezing apart from cold, or eosinophilia [≥4%]). Data were fit to traditional logistic regression models to calculate odds ratios and 95% confident intervals.
RESULTS:Of the original cohort (n = 554), 95 (17%) did not meet the enrollment criteria for this study, which left 459. Of the 221 patients, 53% were female, with a mean (standard deviation) age of 9.7 ± 4.2 years. The risk of HZ was increased in children with asthma defined by the API controlling for a varicella vaccine history and atopic status (adjusted odds ratio 2.56 [95% confidence interval, 1.08-6.56]).
CONCLUSIONS:The association between asthma and increased risk of HZ in children and adolescents is consistent, independent of asthma definitions. Asthma might be an important clinical condition to be considered in HZ vaccine studies.
Allergy Asthma Proc. 2015 Sep;36(5):372-8. doi: 10.2500/aap.2015.36.3864.
