哮喘联盟

   摘要
   背景：叶酸、特应性或重症哮喘急性发作是鲜为人知的。我们研究了高风险人群中，叶酸缺乏是否与过敏原皮肤测试阳性患者或重症哮喘急性发作患者的数量有关，并进一步评估了这种关联是否能用维生素D的状态来解释或校正。
   方法：在波多黎的圣胡安，对年龄在6至14岁之间，有哮喘的（N=304）或没有哮喘的（N=278）共计582名儿童进行横断面研究。叶酸缺乏被定义为：血浆叶酸≤20ng/ml。我们的结果是所有儿童中过敏原皮试阳性者的数量--（范围=0-15），和哮喘儿童中在前一年中有≥1次重度急性发作的数量。采用负二项逻辑回归模型进行多变量分析。所有多变量模型经年龄、性别、家庭收入、居住靠近主干道和（对于过敏体质）病例/控制状态进行了校正；重度急性发作的患儿也通过吸入皮质类固醇的使用和维生素D不足（血浆25（OH）D<30纳克/毫升）进行了校正。
   测量和主要结果：经多变量分析，叶酸缺乏与过敏程度增加显著相关，≥1次重症哮喘急性发作的几率增加了2.2倍。（OR95％可信区间（CI）=1.1-4.6）。与叶酸和维生素D正常的儿童相比，那些缺乏叶酸和维生素D的儿童≥1次重症哮喘急性发作几率几乎增加了8倍（OR95％可信限为=2.7-21.6）。
   结论：在波多黎各学龄儿童中，叶酸缺乏与特应性程度的增加及重症哮喘急性发作有关。对于重症哮喘急性发作，维生素D缺乏可进一步加剧叶酸缺乏引起的危害。

（杨冬 审校）
Ann Am Thorac Soc. 2015 Nov 12. [Epub ahead of print]

 

Folate Deficiency, Atopy and Severe Asthma Exacerbations in Puerto Rican Children.
 

Blatter J1, Brehm JM2, Sordillo J3, Forno E4, Boutaoui N5, Acosta-Pérez E6, Alvarez M7, Colón-Semidey A8, Weiss ST9, Litonjua AA10, Canino G11,Celedón JC12.
 

Abstract
BACKGROUND:Little is known about folate and atopy or severe asthma exacerbations. We examined whether folate deficiency is associated with number of positive skin tests to allergens or severe asthma exacerbations in a high-risk population, and further assessed whether such association is explained or modified by vitamin D status.
METHODS:Cross-sectional study of 582 children aged 6 to 14 years with (n=304) and without (n=278) asthma in San Juan, Puerto Rico. Folate deficiency was defined as a plasma folate ≤20 ng/ml. Our outcomes were the number of positive skin tests to allergens (range=0-15) in all children, and (in children with asthma) ≥1 severe exacerbation in the previous year. Logistic and negative binomial regression models were used for the multivariate analysis. All multivariate models were adjusted for age, gender, household income, residential proximity to a major road and (for atopy) case/control status; those for severe exacerbations were also adjusted for use of inhaled corticosteroids and vitamin D insufficiency (a plasma 25(OH)D<30ng/ml).
MEASUREMENTS AND MAIN RESULTS:In a multivariate analysis, folate deficiency was significantly associated with an increased degree of atopy and 2.2 times increased odds of ≥1 severe asthma exacerbation (95% confidence interval [CI] for odds ratio [OR]=1.1-4.6). Compared with children who had normal levels of both folate and vitamin D, those with both folate deficiency and vitamin D insufficiency had nearly eightfold increased odds of ≥1 severe asthma exacerbation (95% CI for adjusted OR=2.7-21.6).
CONCLUSIONS:Folate deficiency is associated with increased degree of atopy and severe asthma exacerbations in school-aged Puerto Ricans. Vitamin D insufficiency may further increase detrimental effects of folate deficiency on severe asthma exacerbations.
 

Ann Am Thorac Soc. 2015 Nov 12. [Epub ahead of print]