哮喘是否影响青少年学校表现？来自瑞典人群出生队列研究结果
2018/01/19
摘要
背景：哮喘是学龄期儿童常见的疾病，其会影响生活质量以及学校出勤率。然而，哮喘是否会影响儿童学校表现并不明确。本研究旨在评价不同哮喘表型对于青少年学校表现的影响。
方法：研究人群共计1715人，均为人群为基础出生队列研究中的青少年，随访至16岁，接受问卷和临床检查。哮喘定义为在过去12个月中至少发生4次喘息或应用ICS情况下至少发生1次喘息。学校评级数据来自于瑞典统计局，通过回归方程分析评价最终小学整体评级和哮喘表型之间的关系。
结果：在青少年中，20.8%既往有过哮喘病史；24.2%为早期一过性，47.2%学龄期起病，24.2%为持续性哮喘。在16岁时，7.8%有哮喘，71.7%有共患病，73.9%有过敏性哮喘。对于既往哮喘患者，统计学分析提示其学校表现欠佳 (ORadj =1.43, CI=1.09-1.88)。在哮喘起病分析中，尽管可信区间有所重叠，学龄期起病(ORadj =1.49, CI=1.02-2.16)以及持续性哮喘的发展趋势(ORadj =1.61, CI=0.98-2.66)显著相关。此外，与部分控制(ORadj =1.12, CI=0.68-1.83)和完全控制哮喘(ORadj =1.29, CI=0.55-3.01)混着相比，未控制哮喘患者表现较差(ORadj =2.60, CI=0.87-7.80)。
结论：研究结果提示哮喘影响青少年学校表现。此外，部分证据提示学龄期起病的哮喘和未控制哮喘表现可能会更差。
Abstract
BACKGROUND:Asthma is common among schoolchildren and may influence quality of life and school attendance. However, it is unclear if asthma affects school performance. The aim of this study was to examine if different phenotypes of asthma affect school performance during adolescence.
METHODS:The study population consisted of 1,715 adolescents from a population-based birth cohort, followed to age 16 with questionnaires and clinical examinations. Asthma was defined as at least 4 wheeze episodes or at least 1 wheeze episode in combination with inhaled steroids in the last 12 months. School grades were obtained from Statistics Sweden and logistic regression analysis was performed to investigate the association between the final overall grade from elementary school and asthma phenotypes.
RESULTS:Among the adolescents, 20.8% have had ever asthma; 24.2% early-transient, 47.2% school age onset and 24.2% persistent asthma. At 16 years, 7.8% had asthma; 71.7% multimorbidity and 73.9% allergic asthma. A statistically significant association for performing less well was seen for ever asthma (ORadj =1.43, CI=1.09-1.88). In analyses of asthma onset an association was seen for school age onset (ORadj =1.49, CI=1.02-2.16) and a tendency for persistent asthma (ORadj =1.61, CI=0.98-2.66), although with overlapping confidence intervals. Further, adolescents with uncontrolled asthma tended to perform less well (ORadj =2.60, CI=0.87-7.80) compared to adolescents with partly controlled (ORadj =1.12, CI=0.68-1.83) and fully controlled (ORadj =1.29, CI=0.55-3.01) asthma.
CONCLUSIONS:Our results indicate that asthma impairs school performance in adolescence. Moreover, some evidence suggests the adolescents with asthma during school age and with poorer asthma control to be more likely to perform less well.
背景：哮喘是学龄期儿童常见的疾病，其会影响生活质量以及学校出勤率。然而，哮喘是否会影响儿童学校表现并不明确。本研究旨在评价不同哮喘表型对于青少年学校表现的影响。
方法：研究人群共计1715人，均为人群为基础出生队列研究中的青少年，随访至16岁，接受问卷和临床检查。哮喘定义为在过去12个月中至少发生4次喘息或应用ICS情况下至少发生1次喘息。学校评级数据来自于瑞典统计局，通过回归方程分析评价最终小学整体评级和哮喘表型之间的关系。
结果：在青少年中，20.8%既往有过哮喘病史；24.2%为早期一过性，47.2%学龄期起病，24.2%为持续性哮喘。在16岁时，7.8%有哮喘，71.7%有共患病，73.9%有过敏性哮喘。对于既往哮喘患者，统计学分析提示其学校表现欠佳 (ORadj =1.43, CI=1.09-1.88)。在哮喘起病分析中，尽管可信区间有所重叠，学龄期起病(ORadj =1.49, CI=1.02-2.16)以及持续性哮喘的发展趋势(ORadj =1.61, CI=0.98-2.66)显著相关。此外，与部分控制(ORadj =1.12, CI=0.68-1.83)和完全控制哮喘(ORadj =1.29, CI=0.55-3.01)混着相比，未控制哮喘患者表现较差(ORadj =2.60, CI=0.87-7.80)。
结论：研究结果提示哮喘影响青少年学校表现。此外，部分证据提示学龄期起病的哮喘和未控制哮喘表现可能会更差。
（上海交通大学医学院附属瑞金医院呼吸与危重症医学科 周剑平 万欢英 摘译）
（J Asthma. 2018 Jan 4:1-3. doi: 10.1080/02770903.2017.1414239. [Epub ahead of print]）
（J Asthma. 2018 Jan 4:1-3. doi: 10.1080/02770903.2017.1414239. [Epub ahead of print]）
Does asthma affect school performance in adolescents?-Results from the Swedish population-based birth cohort BAMSE.
Pediatr Allergy Immunol. 2018 Jan 4. doi: 10.1111/pai.12855. [Epub ahead of print]
Nilsson S et al.Abstract
BACKGROUND:Asthma is common among schoolchildren and may influence quality of life and school attendance. However, it is unclear if asthma affects school performance. The aim of this study was to examine if different phenotypes of asthma affect school performance during adolescence.
METHODS:The study population consisted of 1,715 adolescents from a population-based birth cohort, followed to age 16 with questionnaires and clinical examinations. Asthma was defined as at least 4 wheeze episodes or at least 1 wheeze episode in combination with inhaled steroids in the last 12 months. School grades were obtained from Statistics Sweden and logistic regression analysis was performed to investigate the association between the final overall grade from elementary school and asthma phenotypes.
RESULTS:Among the adolescents, 20.8% have had ever asthma; 24.2% early-transient, 47.2% school age onset and 24.2% persistent asthma. At 16 years, 7.8% had asthma; 71.7% multimorbidity and 73.9% allergic asthma. A statistically significant association for performing less well was seen for ever asthma (ORadj =1.43, CI=1.09-1.88). In analyses of asthma onset an association was seen for school age onset (ORadj =1.49, CI=1.02-2.16) and a tendency for persistent asthma (ORadj =1.61, CI=0.98-2.66), although with overlapping confidence intervals. Further, adolescents with uncontrolled asthma tended to perform less well (ORadj =2.60, CI=0.87-7.80) compared to adolescents with partly controlled (ORadj =1.12, CI=0.68-1.83) and fully controlled (ORadj =1.29, CI=0.55-3.01) asthma.
CONCLUSIONS:Our results indicate that asthma impairs school performance in adolescence. Moreover, some evidence suggests the adolescents with asthma during school age and with poorer asthma control to be more likely to perform less well.
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重症过敏性哮喘接受奥玛珠单抗治疗伴发自身免疫性2型多内分泌综合征
