出生时肺功能下降与10年后出现哮喘之间关系的研究
2007/03/12
已有研究表明，婴儿早期的肺功能下降与日后发生气道阻塞性疾病有联系。因此作者怀疑出生不久就有肺功能下降的婴儿10年后可能发生哮喘。
作者选取802例健康婴儿进行前瞻性研究，婴儿在出生不久就通过检测潮气呼吸流量-容量环（主要评价指标为：到达潮气呼气峰流量的时间占总呼气时间的比值[t(PTEF)/t(E)]）进行肺功能检测，并对664例婴儿进行包括呼吸系统顺应性检测在内的呼吸力学的检测。在他们10岁的时候，616名孩子（77％）再次进行肺功能检测、运动支气管激发试验和乙酰甲胆碱支气管激发试验，并通过询问病史来确定他们是否曾有或正患有支气管哮喘。
结果表明，相对于出生时t(PTEF)/t(E)在中位数以上的孩子，那些出生时t(PTEF)/t(E)在中位数或以下的孩子在10岁前曾经出现过哮喘的可能性 (24.3% vs. 16.2%, P=0.01)及正患有哮喘的可能性均显著增加(14.6% vs. 7.5%, P=0.005)，同时出现严重的气道高反应性的可能性也增加了 (9.1% vs. 4.9%, P=0.05)（气道高反应性的阳性标准为：累积吸入乙酰甲胆碱1微克后FEV1下降大于20％）
比较出生时呼吸系统顺应性在中位数以上的孩子，出生时呼吸系统顺应性在中位数或以下的孩子在10岁前曾经出现过哮喘的可能性增加(27.4% vs. 14.8%; P=0.001)，正患有哮喘的可能性也增加(15.0% vs. 7.7%, P=0.009)。但进行这些测量时并没有同时检测肺功能。
儿童出生时的t(PTEF)/t(E)与10岁时的最大呼气中期流量呈弱相关，与FEV1或用力肺活量无关。
因此，作者认为出生时肺功能下降会增加其10岁时发生哮喘的风险。
（张清玲 广州呼吸疾病研究所 510120 摘译）
(N Engl J Med. 2006,19:355:1682-1689)Haland G, Carlsen KC, Sandvik L, Devulapalli CS, Munthe-Kaas MC, Pettersen M, Carlsen KH; ORAACLE. Reduced lung function at birth and the risk of asthma at 10 years of age. N Engl J Med. 2006 Oct 19;355(16):1682-9.
BACKGROUND: Reduced lung function in early infancy has been associated with later obstructive airway diseases. We assessed whether reduced lung function shortly after birth predicts asthma 10 years later.
METHODS: We conducted a prospective birth cohort study of healthy infants in which we measured lung function shortly after birth with the use of tidal breathing flow-volume loops (the fraction of expiratory time to peak tidal expiratory flow to total expiratory time [t(PTEF)/t(E)]) in 802 infants and passive respiratory mechanics, including respiratory-system compliance, in 664 infants. At 10 years of age, 616 children (77%) were reassessed by measuring lung function, exercise-induced bronchoconstriction, and bronchial hyperresponsiveness (by means of a methacholine challenge) and by conducting a structured interview to determine whether there was a history of asthma or current asthma.
RESULTS: As compared with children whose t(PTEF)/t(E) shortly after birth was above the median, children whose t(PTEF)/t(E) was at or below the median were more likely at 10 years of age to have a history of asthma (24.3% vs. 16.2%, P=0.01), to have current asthma (14.6% vs. 7.5%, P=0.005), and to have severe bronchial hyperresponsiveness, defined as a methacholine dose of less than 1.0 micromol causing a 20% fall in the forced expiratory volume in 1 second (FEV1) (9.1% vs. 4.9%, P=0.05). As compared with children whose respiratory-system compliance was above the median, children with respiratory compliance at or below the median more often had a history of asthma (27.4% vs. 14.8%; P=0.001) and current asthma (15.0% vs. 7.7%, P=0.009), although this measure was not associated with later measurements of lung function. At 10 years of age, t(PTEF)/t(E) at birth correlated weakly with the maximal midexpiratory flow rate (r=0.10, P=0.01) but not with FEV1 or forced vital capacity.
CONCLUSIONS: Reduced lung function at birth is associated with an increased risk of asthma by 10 years of age.
