哥斯达黎加儿童哮喘患者中父辈哮喘、霉菌暴露和气道反应性增加因素的研究
2008/04/30
鉴于对西班牙美国地区儿童哮喘中气道高反应性（AHR）的决定因素方面的了解很少，Ly等人对403例Costa Rican哮喘儿童（年龄6～14岁）进行了横向研究，在此研究中我们检测了某些家族和环境因素、过敏标志物、肺功能中肺量计的指标以及气道高反应性间的关系。受试对象需完成以下试验程序，包括问卷调查、呼吸功能测定、血清总IgE及过敏特异性IgE检测、外周血嗜酸性粒细胞计数、体重指数（BMI）和气道对乙酰胆碱反应性的评估（如乙酰胆碱激发试验[MCT]）。将乙酰胆碱激发试验中应用一定剂量乙酰胆碱使FEV1降低20%定义为气道高反应，所用的乙酰胆碱的剂量为激发剂量。应用线性回归进行单因素和多因素分析。结果403例受试儿童中，350例(86.8%)对乙酰胆碱具有气道高反应。多因素分析显示，在Costa Rican地区的哮喘儿童中，父辈患哮喘(p = 0.004)、家长诉孩子房间中有霉菌或发霉的情况(p = 0.04)、FEV1/FVC比值(p < 0.0001)以及IgE阳性结果(p = 0.008)都与气道高反应性显著相关。
此研究结果表明，父辈哮喘和霉菌/发霉物质的环境暴露是Costa Rican哮喘儿童气道高反应性强有力的决定因素。而对于目前还没有FEV1参考值的Costa Ricans和其他西班牙美国人， FEV1/FVC比值，作为评价哮喘严重程度的一项指标，可能对测定气道高反应性也有用。
（于娜 中国医科大学附属第一医院呼吸内科 110001 摘译）
(Chest. 2008; 133:107-114)
Paternal Asthma, Mold Exposure, and Increased Airway Responsiveness Among Children With Asthma in Costa Rica
Background: Little is known about the determinants of airway hyperresponsiveness (AHR) among children with asthma in Hispanic America.
Methods: We examined the relations among selected familial and environmental factors, markers of allergy, spirometric measures of lung function, and AHR in a cross-sectional study of 403 Costa Rican children with asthma between the ages of 6 and 14 years. Study participants completed a protocol that included questionnaires, spirometry, measurements of serum total and allergen-specific IgE, peripheral blood eosinophil count, and body mass index, and the assessment of airway responsiveness to methacholine (ie, a methacholine challenge test [MCT]). AHR to MCT was defined as the provocative dose of methacholine causing a 20% fall in FEV1. Linear regression was used for the univariate and multivariate analyses.
Results: Of the 403 asthmatic children who underwent an MCT, 350 (86.8%) had AHR to methacholine. In a multivariate analysis, paternal asthma (p = 0.004), parental report of mold/mildew in the child’s home (p = 0.04), FEV1/FVC ratio (p < 0.0001), and a positive IgE response to Der p 1 (p = 0.008) were significantly associated with AHR among Costa Rican children with asthma.
Conclusion: Our results suggest that paternal asthma and environmental exposure to mold/mildew are strong determinants of AHR in Costa Rican children with asthma. FEV1/FVC ratio may be a useful measure of AHR (a marker of asthma severity) among Costa Ricans and other Hispanic Americans for whom reference values for FEV1 are not currently available.
Key Words: airway hyperresponsiveness • asthma • FEV1/FVC ratio • Hispanics • mold • paternal asthma
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一项哮喘患儿被动吸烟的调查――有关暴露因素的来源、双亲对于儿童暴露的认知以及双亲行为变化
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生命早期持续面对母亲的抑郁情绪使儿童哮喘风险增加
