幼儿上下气道通畅相互关联
2010/12/07
背景：虽然过敏性鼻炎与哮喘经常共存，但是有关两者间的关系本质还缺乏充分理解。因此，我们探索上、下气道通畅是否关联。
方法：我们调查221例源于哥本哈根前瞻性儿童出生队列与哮喘相关研究的6岁儿童，对使用α激动剂前后通过声学鼻腔测量检测上气道通畅状况，以及使用β激动剂前后通过肺功能检测下气道通畅状况。此外，我们检测外周血嗜酸性粒细胞数量，鼻嗜酸性粒细胞增多，总IgE水平，呼出气一氧化氮（fraction of exhaled nitric oxide, FENO）。通过构建线性模型观察其相关性。
结果：解除鼻充血的鼻气道通畅状况和使用β2激动剂后的第1秒用力呼气容积（FEV1）具有明显的相关性（P=.007）。该相关性在调整性别、体型、用力肺活量（FVC）和特应性疾病后仍然存在（β=2.85 cm3，95% CI=[0.42, 5.29]，P = .02)。上、下气道通畅的基线值亦有明显的相关性(β=0.89cm3，95%CI=[0.26, 1.51]，P = .01)。此外，外周血嗜酸性粒细胞数量、鼻嗜酸性粒细胞增多与解除充血后的上气道通畅状况呈相反的关系（β=–0.42 cm3，95% CI=[–0.77, –0.07]，P = .02；β=–0.47 cm3，95% CI=[–0.89, –0.05]，P = .03)。
结论：我们发现上、下气道通畅间存在明显且一致性相关性。这可能归因于共同的病理学基础，即表现为解除充血的上气道通畅与外周血嗜酸性粒细胞数量、鼻部嗜酸性粒细胞增多间的相反关系。同样，上、下气道通畅间的的联系可能反映出共同合并疾病的生理学基础。
（王刚 四川大学华西医院中西医结合科呼吸组 610041 摘译）
(Chest. 2010;137(6);1332-1337)
Upper and lower airway patency are associated in young children
Chawes BL, Kreiner-Møller E, Bisgaard H.
Chest. 2010;137(6);1332-1337
Background: Although allergic rhinitis and asthma frequently coexist, the nature of this associationis poorly understood. Therefore, we examined whether upper and lower airway patency areassociated.
Methods: We investigated 221 6-year-old children from the Copenhagen Prospective Study onAsthma in Childhood birth cohort, assessing upper airway patency by acoustic rhinometry beforeand after a -agonist, and lower airway patency by spirometry before and after b 2-agonist.Furthermore, we measured blood eosinophil count, nasal eosinophilia, total IgE, and fraction ofexhaled nitric oxide. Associations were investigated by generalized linear models.
Results: Decongested nasal airway patency and post- b 2 FEV 1 were signifi cantly associated( P 5 .007). The association remained signifi cant after adjustments for sex, body size, FVC, andatopic diseases ( b -coeffi cient 2.85 cm 3 ; 95% CI, 0.42 to 5.29; P 5 .02). Baseline values of upperand lower airway patency were also signifi cantly associated ( b -coeffi cient 0.89 cm 3 ; 95% CI,0.26-1.51; P 5 .01). In addition, blood eosinophil count and nasal eosinophilia were inverselyassociated with decongested nasal airway patency, b -coeffi cient –0.42 cm 3 (95% CI, –0.77 to –0.07;P 5 .02) and b -coeffi cient –0.47 cm 3 (95% CI, –0.89 to –0.05; P 5 .03), respectively.
Conclusions: We found a strong and consistent association between upper and lower airway patency.This may be due to a common pathology, as suggested by the inverse association between decongestednasal airway patency, blood eosinophil count, and nasal eosinophilia. Alternatively, theassociation between upper and lower airway patency might refl ect a physiologic background forthe common comorbidity.
CHEST 2010; 137(6):1332–1337
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