第一次病毒感染引发喘息发作4年后肺功能及气道反应性变化
2018/09/10
摘要
背景：喘息性疾病在儿童中非常常见，是哮喘的危险因素之一。然而，儿童支气管反应性，这一哮喘的一个主要特征的决定因素在很大程度上是未知的。本研究的目的是研究学龄前儿童第一次严重病毒感染引起的喘息性发作期间，患者的临床特征与肺功能之间的关系。
方法：研究包括76名23个月至3岁的第一次喘息发作的儿童。在研究项目中，对病毒病原学、鼻病毒基因组载量、特应性和临床特征、标准化问卷进行分析。在4年后的随访中，进行脉冲振荡和运动激发试验。
结果：研究开始时，儿童平均年龄为12个月（SD 6.0），鼻病毒阳性57例（75%），致敏22例（30%）。四年后的随访中，儿童的平均年龄为60个月（SD 7.9），其中37例（49%）定期使用哮喘药物（25例（68%）儿童在测试前停止使用）。9例（12%）儿童在运动激发或支气管扩张后出现支气管高反应性（≥35%的平均阻力变化）。在第一次喘息发作时有特应性致敏的儿童比没有致敏的儿童更容易发生支气管高反应性（比值比8.8，P=0.03）。没有发现其他显著的关联。
结论：第一次严重喘息发作时的异位致敏是学龄前儿童支气管反应性增加的重要早期危险因素。
Pulmonary function and bronchial reactivity 4 years after the first virus-induced wheezing.
Leino A, Lukkarinen M, Turunen R, Vuorinen T, Söderlund-Wenermo M, Vahlberg T, Camargo CA Jr, Bochkov YA, Gern JE, Jartti T.
Abstract
BACKGROUND: Wheezing illnesses among young children are common, and are a risk factor for asthma. However, determinants of childhood bronchial reactivity, a key feature of asthma, are largely unknown. Aim of this study was to determine how patient characteristics during the first severe virus-induced wheezing episode are associated with pulmonary function at pre-school age.
METHODS: Study consisted of 76 children presenting with their first wheezing episode at the ages of 3 to 23 months. At study entry, viral etiology, rhinovirus genome load, atopic and clinical characteristics, and standardized questionnaire were analyzed. At 4-year follow-up visit, impulse oscillometry with exercise challenge was performed.
RESULTS: At study entry, the mean age of the children was 12 months (SD 6.0), 57 (75%) were rhinovirus positive and 22 (30%) were sensitized. At follow-up visit four years later, the mean age of the children was 60 months (SD 7.9) and 37 (49%) were using asthma medication regularly (discontinued before testing in 25 [68%] children). Bronchial reactivity (≥35% change in mean crude values of resistance) after exercise challenge or bronchodilation was present in 9 (12%) children. Children with atopic sensitization at the time of the first wheezing episode were more often likely to develop bronchial reactivity (odds ratio 8.8, P = .03) than the children without sensitization. No other significant associations were found.
CONCLUSIONS: Atopic sensitization at the time of the first severe wheezing episode is an important early risk factor for increased bronchial reactivity at pre-school age.
背景：喘息性疾病在儿童中非常常见，是哮喘的危险因素之一。然而，儿童支气管反应性，这一哮喘的一个主要特征的决定因素在很大程度上是未知的。本研究的目的是研究学龄前儿童第一次严重病毒感染引起的喘息性发作期间，患者的临床特征与肺功能之间的关系。
方法：研究包括76名23个月至3岁的第一次喘息发作的儿童。在研究项目中，对病毒病原学、鼻病毒基因组载量、特应性和临床特征、标准化问卷进行分析。在4年后的随访中，进行脉冲振荡和运动激发试验。
结果：研究开始时，儿童平均年龄为12个月（SD 6.0），鼻病毒阳性57例（75%），致敏22例（30%）。四年后的随访中，儿童的平均年龄为60个月（SD 7.9），其中37例（49%）定期使用哮喘药物（25例（68%）儿童在测试前停止使用）。9例（12%）儿童在运动激发或支气管扩张后出现支气管高反应性（≥35%的平均阻力变化）。在第一次喘息发作时有特应性致敏的儿童比没有致敏的儿童更容易发生支气管高反应性（比值比8.8，P=0.03）。没有发现其他显著的关联。
结论：第一次严重喘息发作时的异位致敏是学龄前儿童支气管反应性增加的重要早期危险因素。
(中日友好医院呼吸与危重症医学科 李红雯 摘译 林江涛 审校)
(Allergy. 2018 Aug 24. doi: 10.1111/all.13593.)
(Allergy. 2018 Aug 24. doi: 10.1111/all.13593.)
Pulmonary function and bronchial reactivity 4 years after the first virus-induced wheezing.
Leino A, Lukkarinen M, Turunen R, Vuorinen T, Söderlund-Wenermo M, Vahlberg T, Camargo CA Jr, Bochkov YA, Gern JE, Jartti T.
Abstract
BACKGROUND: Wheezing illnesses among young children are common, and are a risk factor for asthma. However, determinants of childhood bronchial reactivity, a key feature of asthma, are largely unknown. Aim of this study was to determine how patient characteristics during the first severe virus-induced wheezing episode are associated with pulmonary function at pre-school age.
METHODS: Study consisted of 76 children presenting with their first wheezing episode at the ages of 3 to 23 months. At study entry, viral etiology, rhinovirus genome load, atopic and clinical characteristics, and standardized questionnaire were analyzed. At 4-year follow-up visit, impulse oscillometry with exercise challenge was performed.
RESULTS: At study entry, the mean age of the children was 12 months (SD 6.0), 57 (75%) were rhinovirus positive and 22 (30%) were sensitized. At follow-up visit four years later, the mean age of the children was 60 months (SD 7.9) and 37 (49%) were using asthma medication regularly (discontinued before testing in 25 [68%] children). Bronchial reactivity (≥35% change in mean crude values of resistance) after exercise challenge or bronchodilation was present in 9 (12%) children. Children with atopic sensitization at the time of the first wheezing episode were more often likely to develop bronchial reactivity (odds ratio 8.8, P = .03) than the children without sensitization. No other significant associations were found.
CONCLUSIONS: Atopic sensitization at the time of the first severe wheezing episode is an important early risk factor for increased bronchial reactivity at pre-school age.
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Toll样受体4通路多态性与环境污染相互作用影响哮喘的诊断和严重程度
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3年随访观察重症哮喘病情恶化的预测因子
