无症状气道高反应性和变应性是哮喘的危险因素吗？一项纵向研究
2008/09/28
关键词：青少年，气道高反应性，哮喘，无症状，日常实践，纵向
众所周知，气道高反应性（Airway hyperresponsiveness， AHR）是哮喘的特征之一，但无症状AHR与哮喘发病之间的关系尚未明确。为了阐明青少年期无症状AHR与成年期哮喘发病的关系，Nieuwenhof等对一组青少年进行了一项队列随访研究，同时调查过敏症和哮喘发生的关系。
在1989年对199例研究对象的呼吸状况进行基线测定，并在2003~2004年对研究对象进行问卷调查、肺功能测定和组胺激发试验，同时评估其过敏状态。
研究对象的基线评估显示，91例（46%）存在AHR和呼吸症状。校正年龄、性别、过敏症、哮喘家族史和吸烟史后，无症状的AHR与14年后哮喘的发生间没有关联，比值比（odds ratio, OR) 2.15 ( 95% CI, 0.67–6.83)。而对于入选时存在过敏症的研究对象，哮喘发生的OR为4.45(95% CI 1.46–13.54)。
通过研究，作为认为，青少年无症状气道高反应性并不能提示哮喘发生的危险，相反，青少年是否存在过敏症似乎是哮喘发生的危险因素之一。
(韩伟 青岛大学附属青岛市立医院东院呼吸科266071 摘译)
（Eur Respir J 2008; 32:70-76)
Are asymptomatic airway hyperresponsiveness and allergy risk factors for asthma? A longitudinal study
L. van den Nieuwenhof, T. Schermer, Y. Heijdra, et al.
Keywords: Adolescents, airway hyperresponsiveness, asthma, asymptomatic, general practice, longitudinal
Airway hyperresponsiveness (AHR) is a characteristic feature of asthma, but it is unclear whether asymptomatic AHR is associated with a higher risk of asthma. The present study assessed whether there is an association between asymptomatic AHR in adolescence and asthma in adulthood. The association between allergy and development of asthma was also investigated.
A follow-up study of a general population cohort of adolescents was performed 14 yrs after baseline. Respiratory status was assessed at baseline in 1989 and at follow-up in 2003–2004 by a respiratory symptoms questionnaire, spirometry and histamine challenge. Allergy status was also assessed.
The respiratory status of 199 subjects was assessed twice. In total, 91 (46%) subjects had the same AHR status in combination with respiratory symptoms at follow-up as at baseline. Adjusted for age, sex, allergy, family history of asthma and smoking history, having asymptomatic AHR was not significantly related to having asthma 14 yrs later (odds ratio (OR) 2.15, 95% confidence interval (CI) 0.67–6.83). For subjects with allergy at baseline, the OR for developing asthma was 4.45 (95% CI 1.46–13.54).
Screening for asymptomatic airway hyperresponsiveness in adolescence does not identify subjects at risk of developing asthma. Conversely, the presence of allergy in adolescence does seem to be a risk factor for asthma development.
Eur Respir J 2008; 32:344-349
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