幼儿期喘息表型影响青春期哮喘、肺功能及呼出一氧化氮(FENO)水平
2015/12/29
摘要
研究背景：哮喘是一个复杂的异质性疾病，包括许多独立表型。儿童喘息是哮喘发作最常见的临床表现。严重且持续的喘息表现与轻度短暂的喘息相比，更容易导致日后罹患哮喘及肺功能异常。研究目的：探讨儿童喘息表型与青春期哮喘、肺功能及呼出气一氧化氮(FENO)的关系。
研究方法：在基于人群的6841名儿童的前瞻性队列研究中，应用潜在类别分析方法(latent class analysis)确定7岁以内喘息表型。14-15岁时进行哮喘临床诊断、肺活量和FeNO评估。
研究结果：与无/间歇喘息的儿童相比，频发/持续喘息与哮喘风险更高紧密相关（风险率（95% CI）分别为10.9（8.97-13.16）和9.13（7.74-10.77）），FEV1/FVC比值降低(标准误的均数之差（95%CI）分别为-0.34(-0.54—-0.14)和-0.50（-0.62—-0.38）)，FEF25-75%降低(标准误的均数之差分别为（-0.30（-0.49—-0.10）和-0.42（-0.54—-0.30））以及吸入支气管扩张剂后FEV1增高(标准误均数差（95%CI）分别为（0.12（0.02—0.22）和0.13（0.06—0.19））。早期长期喘息和持续喘息儿童与8-9岁到14-15岁期间FEV1/FVC和FEF25-75%下降相关。中、晚期及持续喘息儿童与从不/很少喘息组比较，其FeNO比值更高（（95%CI）均数分别为1.90（1.59—2.29）、1.57（1.39—1.77）和1.37（1.22-1.53））。
研究结论：持续至18月龄的早发型喘息表型与成年后哮喘、肺功能下降、甚至从幼儿中期开始即出现加重，以及FeNO水平升高明显相关。
评论：研究表明儿童早期喘息表型与儿童中期直到青春期哮喘发病率增加和肺功能下降相关。早期慢性喘息和持续喘息表型与儿童中期直到青春期肺功能进一步下降相关。研究发现早期发生并持续至18月龄的喘息表型与青春期过敏性气道炎症增加有关。还需要更多深入研究探索其可能的潜在机制，从而采取有效的干预措施早期改善肺功能并预防青春期肺功能进一步下降。
（南方医科大学南方医院 赵文驱 赵海金 ）
Duijts, L., et al., Childhood wheezing phenotypes influence asthma, lung function and exhaled nitric oxide fraction in adolescence. Eur Respir J, 2015.
Duijts, L., et al., Childhood wheezing phenotypes influence asthma, lung function and exhaled nitric oxide fraction in adolescence. Eur Respir J, 2015.
Childhood wheezing phenotypes influence asthma, lung function and exhaled nitric oxide fraction in adolescence
ABSTRACT
The objective of this study was to examine the associations of childhood wheezing phenotypes with asthma, lung function and exhaled nitric oxide fraction (FeNO) in adolescence.
In a population-based, prospective cohort study of 6841 children, we used latent class analysis to identify wheezing phenotypes during the first 7 years of life. Physician-diagnosed asthma, spirometry and FeNO were assessed at 14–15 years.
Compared with never/infrequent wheeze, intermediate-onset and persistent wheeze were consistently strongest associated with higher risk of asthma (risk ratio (95% CI) 10.9 (8.97–13.16) and 9.13 (7.74–10.77), respectively), lower forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio (mean difference in standard deviation units (SDU) (95% CI) −0.34 (−0.54–−0.14) and −0.50 (−0.62–−0.38), respectively), lower forced expiratory flow at 25–75% of FVC (FEF25–75%) (mean difference in SDU (95% CI) −0.30 (−0.49–−0.10) and −0.42 (−0.54–−0.30), respectively) and increased FEV1 bronchodilator reversibility (mean difference in SDU (95% CI) 0.12 (0.02–0.22) and 0.13 (0.06–0.19), respectively). Prolonged early and persistent wheeze were associated with a decline in FEV1/FVC ratio and FEF25–75% between 8–9 and 14–15 years. Intermediate-onset, late-onset and persistent wheeze were associated with higher FeNO ratios (ratio of geometric means (95% CI) 1.90 (1.59–2.29), 1.57 (1.39–1.77) and 1.37 (1.22–1.53), respectively, compared with never/infrequent wheeze).
Early-onset wheezing phenotypes persisting after 18 months of age show the strongest associations with asthma, lower lung function, even worsening from mid-childhood, and higher FeNO levels in adolescence.
Duijts, L., et al., Childhood wheezing phenotypes influence asthma, lung function and exhaled nitric oxide fraction in adolescence. Eur Respir J, 2015.
上一篇：
生命早期暴露于空气污染，儿童时期易发生哮喘
下一篇：
以生物标记物为基础检测慢阻肺人群中ACOS
