学龄期和学龄前过敏性和非过敏性哮喘患儿对乙酰甲胆碱的支气管高反应性
2010/11/04
摘要
背景：过敏症和支气管高反应性是儿童严重、持续性哮喘的相关因素，然而，这些因素在不同年龄段儿童其发生比例也存在差异。
目的：研究乙酰甲胆碱支气管高反应性（BHR）在过敏性和非过敏性学龄前和学龄期轻度至中度哮喘患儿中得差异。
方法：对340名哮喘或复发性喘息患儿进行研究，组间过敏状态（阳性和阴性皮肤针刺试验）和年龄匹配，患者进行乙酰甲胆碱支气管激发试验（学龄期儿童采用肺活量检测，学龄前儿童采用经皮氧分压检测）。
结果：136名学龄期儿童（9.07 ± 2.5岁）中，过敏性哮喘患者BHR阳性发生率显著高于非过敏性哮喘患者（分别为75% vs 48.5%, p = .001），对性别和营养状态控制后（校正后优势比aOR= 3.2129, 95%CI：1.5-6.8; p = .002）仍然存在该关系。此外，与非过敏性患儿相比，过敏性学龄期哮喘儿童具有较低的PC20（0.53 vs 0.82 mg/ml, p = .055），乙酰甲胆碱诱导的反应阈值也较低（0.5 vs 1 mg/ml, p = .02）。然而，基线状态和第一秒用力呼气容积（FEV1）预测值两组相似。相反，204名学龄前儿童（4.74 ± 1.1岁）中，过敏性哮喘与非过敏性哮喘患儿中，BHR阳性率无显著差异（74.5% vs 72.5%, p = 0.75,）。此外，基线状态TcPo(2)、TcPo(2)下降、乙酰甲胆碱阈值在过敏性和非过敏性学龄前哮喘患儿间也相当。
结论：学龄期过敏性哮喘患儿较非过敏性患儿具有较高的支气管反应性（仅限于营养状态正常者）。然而，学龄前儿童中，过敏性和非过敏性哮喘患儿具有相似的高反应性。因此，在年幼儿童中，除过敏症外的其他因素可能与喘息有关。
（陈欣 审校）
J Asthma. 2010 Sep 13. [Epub ahead of print]
Bronchial Hyperreactivity to Methacholine in Atopic Versus Nonatopic Asthmatic Schoolchildren and Preschoolers.
Castro-Rodriguez JA, Navarrete-Contreras P, Holmgren L, Sanchez I, Caussade S.
Department of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
Abstract
Background. Atopy and bronchial hyperreactivity are factors related to severe and unremitting asthma of childhood; however, the prevalence of these factors could be different according to age of the child.
Objective. To determine if methacholine bronchial hyperreactivity (BHR) differs between atopic and nonatopic preschoolers and schoolchildren with mild-moderate asthma.
Methods. Data obtained from 340 children with diagnosis of asthma or recurrent wheezing, matched by atopic conditions (positive or negative skin prick test) and age, and who underwent a methacholine bronchial challenge test (by spirometry in schoolchildren and by transcutaneous oxygen pressure [TcPo(2)] in preschoolers) were reviewed.
Results. Among 136 schoolchildren (9.07 ± 2.5 years), the prevalence of positive BHR was significantly higher among atopics than nonatopics (75% versus 48.5%, p = .001, respectively), even after controlling for gender and nutritional status (adjusted odds ratio [aOR] = 3.2129, 95% confidence interval [CI]: 1.5-6.8; p = .002). In addition, atopic schoolchildren had lower PC(20) and required a lower threshold dose of methacholine to induce a reaction (0.53 versus 0.82 mg/ml, p = .055 and .5 versus 1 mg/ml, p = .02, respectively) than nonatopics. Nevertheless, basal and predicted forced expiratory volume in one second (FEV(1)) were similar between groups. In contrast, among 204 preschoolers (4.74 ± 1.1 years), there were no differences in the prevalence of positive BHR between atopics and nonatopics (74.5% versus 72.5%, p = .75, respectively). Furthermore, basal TcPo(2), a higher fall of TcPo(2) and lower threshold doses of methacholine required for induction as measured by TcPo(2) were similar between the atopic and nonatopic preschoolers.
Conclusions. Atopic asthmatic schoolchildren have greater hyperresponsiveness to methacholine than nonatopics (only among those with normal nutritional status). However, atopic and nonatopic asthmatic preschoolers have similar hyperresponsiveness to methacholine. Therefore, factors different from atopy may be responsible for wheeze in younger children.
J Asthma. 2010 Sep 13. [Epub ahead of print]
背景：过敏症和支气管高反应性是儿童严重、持续性哮喘的相关因素，然而，这些因素在不同年龄段儿童其发生比例也存在差异。
目的：研究乙酰甲胆碱支气管高反应性（BHR）在过敏性和非过敏性学龄前和学龄期轻度至中度哮喘患儿中得差异。
方法：对340名哮喘或复发性喘息患儿进行研究，组间过敏状态（阳性和阴性皮肤针刺试验）和年龄匹配，患者进行乙酰甲胆碱支气管激发试验（学龄期儿童采用肺活量检测，学龄前儿童采用经皮氧分压检测）。
结果：136名学龄期儿童（9.07 ± 2.5岁）中，过敏性哮喘患者BHR阳性发生率显著高于非过敏性哮喘患者（分别为75% vs 48.5%, p = .001），对性别和营养状态控制后（校正后优势比aOR= 3.2129, 95%CI：1.5-6.8; p = .002）仍然存在该关系。此外，与非过敏性患儿相比，过敏性学龄期哮喘儿童具有较低的PC20（0.53 vs 0.82 mg/ml, p = .055），乙酰甲胆碱诱导的反应阈值也较低（0.5 vs 1 mg/ml, p = .02）。然而，基线状态和第一秒用力呼气容积（FEV1）预测值两组相似。相反，204名学龄前儿童（4.74 ± 1.1岁）中，过敏性哮喘与非过敏性哮喘患儿中，BHR阳性率无显著差异（74.5% vs 72.5%, p = 0.75,）。此外，基线状态TcPo(2)、TcPo(2)下降、乙酰甲胆碱阈值在过敏性和非过敏性学龄前哮喘患儿间也相当。
结论：学龄期过敏性哮喘患儿较非过敏性患儿具有较高的支气管反应性（仅限于营养状态正常者）。然而，学龄前儿童中，过敏性和非过敏性哮喘患儿具有相似的高反应性。因此，在年幼儿童中，除过敏症外的其他因素可能与喘息有关。
（陈欣 审校）
J Asthma. 2010 Sep 13. [Epub ahead of print]
Bronchial Hyperreactivity to Methacholine in Atopic Versus Nonatopic Asthmatic Schoolchildren and Preschoolers.
Castro-Rodriguez JA, Navarrete-Contreras P, Holmgren L, Sanchez I, Caussade S.
Department of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
Abstract
Background. Atopy and bronchial hyperreactivity are factors related to severe and unremitting asthma of childhood; however, the prevalence of these factors could be different according to age of the child.
Objective. To determine if methacholine bronchial hyperreactivity (BHR) differs between atopic and nonatopic preschoolers and schoolchildren with mild-moderate asthma.
Methods. Data obtained from 340 children with diagnosis of asthma or recurrent wheezing, matched by atopic conditions (positive or negative skin prick test) and age, and who underwent a methacholine bronchial challenge test (by spirometry in schoolchildren and by transcutaneous oxygen pressure [TcPo(2)] in preschoolers) were reviewed.
Results. Among 136 schoolchildren (9.07 ± 2.5 years), the prevalence of positive BHR was significantly higher among atopics than nonatopics (75% versus 48.5%, p = .001, respectively), even after controlling for gender and nutritional status (adjusted odds ratio [aOR] = 3.2129, 95% confidence interval [CI]: 1.5-6.8; p = .002). In addition, atopic schoolchildren had lower PC(20) and required a lower threshold dose of methacholine to induce a reaction (0.53 versus 0.82 mg/ml, p = .055 and .5 versus 1 mg/ml, p = .02, respectively) than nonatopics. Nevertheless, basal and predicted forced expiratory volume in one second (FEV(1)) were similar between groups. In contrast, among 204 preschoolers (4.74 ± 1.1 years), there were no differences in the prevalence of positive BHR between atopics and nonatopics (74.5% versus 72.5%, p = .75, respectively). Furthermore, basal TcPo(2), a higher fall of TcPo(2) and lower threshold doses of methacholine required for induction as measured by TcPo(2) were similar between the atopic and nonatopic preschoolers.
Conclusions. Atopic asthmatic schoolchildren have greater hyperresponsiveness to methacholine than nonatopics (only among those with normal nutritional status). However, atopic and nonatopic asthmatic preschoolers have similar hyperresponsiveness to methacholine. Therefore, factors different from atopy may be responsible for wheeze in younger children.
J Asthma. 2010 Sep 13. [Epub ahead of print]
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儿童哮喘与肥胖的共同性遗传因素分析
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