年龄对儿童哮喘严重恶化风险和哮喘控制的影响
2010/12/31
摘要
背景：哮喘是一种异质性疾病，但临床上经常观察到随着儿童的成长哮喘症状可能得到一定的缓解。
目的：本试验旨在接受治疗的哮喘患儿中，特异性评价年龄对严重哮喘恶化（2009年国际标准：至少3天全身使用皮质类固醇治疗）和哮喘控制（GINA标准）的影响。本研究对治疗的剂量和治疗的季节进行了控制。
方法：接受皮质类固醇吸入治疗（ICS）2个月以上（秋季和春季）的哮喘患儿入选本项研究。记录过去3个月内口服激素治疗的时间和症状持续时间、ICS的剂量和长效b受体激动剂的剂量。
结果：359名患儿（110名女孩）入选，其中48名<2岁，116名2-6 岁，107名6-10岁，88名>10岁。秋季入选175名患儿，春季入选184名患儿，所有患儿均采用ICS治疗（平均每日剂量378 ± 250 μg）。在359名患儿中，133名(37%)至少有1次哮喘严重恶化，111名患儿 (31%)存在哮喘控制。多变量logistic回归模型显示，年龄、季节、ICS剂量是哮喘恶化的独立危险因素，而年龄是哮喘控制的预测因子。每增加一岁，哮喘恶化和控制的优势比分别为0.85 (95% CI, 0.78-0.92, p <0.0001)和0.85 (95% CI, 0.79-0.91, p <0.0001)。
结论：从婴儿到青少年，每增长1岁，能降低严重哮喘恶化风险约15%，而且能增加哮喘患儿的哮喘控制。
（刘国梁 审校）
J Asthma. 2010 Nov 1. [Epub ahead of print]
Influence of Age on the Risk of Severe Exacerbation and Asthma Control in Childhood.
Mahut B, Trinquart L, Delclaux C.
Cabinet La Berma, Antony, France.
Abstract
Background. Asthma is a heterogeneous disease but it is a common observation that children tend to "grow out of their asthma." Objective. The aim was to specifically assess the influence of age on the occurrence of a severe exacerbation (at least 3 days use of systemic corticosteroid - international 2009 definition) and of the achievement of control (GINA guidelines) in children treated for asthma. Our study was controlled for amount of therapy and for season.
Methods. Children under inhaled corticosteroid (ICS) were enrolled over two 2-month periods (autumn, spring). Duration of oral steroid treatment and of symptoms, dose of ICS and long-acting beta-agonist were recorded for the past 3 months.
Results. Three hundred and fifty-nine children (110 girls) were included (48 [<2 years], 116 [2-6 years], 107 [6-10 years], 88 [>10 years]) during autumn (n = 175) and spring (n = 184), all treated by ICS (mean daily dose ± SD = 378 ± 250 μg). Among the 359 children, 133 (37%) experienced at least one severe exacerbation, and control was observed in 111 (31%) children. A multivariate logistic regression model demonstrated that age, season, and ICS dose are independent risk factors for exacerbation, whereas age is the only predictor of control. The odds ratio of exacerbation and control are 0.85 (95% CI, 0.78-0.92, p < .0001) and 0.85 (95% CI, 0.79-0.91, p < .0001) per year of increase in age, respectively.
Conclusions. From infancy to adolescence, each year of life reduces per se the risk of a severe exacerbation by 15% and similarly increases the achievement of control in children treated for asthma.
J Asthma. 2010 Nov 1. [Epub ahead of print]
背景：哮喘是一种异质性疾病，但临床上经常观察到随着儿童的成长哮喘症状可能得到一定的缓解。
目的：本试验旨在接受治疗的哮喘患儿中，特异性评价年龄对严重哮喘恶化（2009年国际标准：至少3天全身使用皮质类固醇治疗）和哮喘控制（GINA标准）的影响。本研究对治疗的剂量和治疗的季节进行了控制。
方法：接受皮质类固醇吸入治疗（ICS）2个月以上（秋季和春季）的哮喘患儿入选本项研究。记录过去3个月内口服激素治疗的时间和症状持续时间、ICS的剂量和长效b受体激动剂的剂量。
结果：359名患儿（110名女孩）入选，其中48名<2岁，116名2-6 岁，107名6-10岁，88名>10岁。秋季入选175名患儿，春季入选184名患儿，所有患儿均采用ICS治疗（平均每日剂量378 ± 250 μg）。在359名患儿中，133名(37%)至少有1次哮喘严重恶化，111名患儿 (31%)存在哮喘控制。多变量logistic回归模型显示，年龄、季节、ICS剂量是哮喘恶化的独立危险因素，而年龄是哮喘控制的预测因子。每增加一岁，哮喘恶化和控制的优势比分别为0.85 (95% CI, 0.78-0.92, p <0.0001)和0.85 (95% CI, 0.79-0.91, p <0.0001)。
结论：从婴儿到青少年，每增长1岁，能降低严重哮喘恶化风险约15%，而且能增加哮喘患儿的哮喘控制。
（刘国梁 审校）
J Asthma. 2010 Nov 1. [Epub ahead of print]
Influence of Age on the Risk of Severe Exacerbation and Asthma Control in Childhood.
Mahut B, Trinquart L, Delclaux C.
Cabinet La Berma, Antony, France.
Abstract
Background. Asthma is a heterogeneous disease but it is a common observation that children tend to "grow out of their asthma." Objective. The aim was to specifically assess the influence of age on the occurrence of a severe exacerbation (at least 3 days use of systemic corticosteroid - international 2009 definition) and of the achievement of control (GINA guidelines) in children treated for asthma. Our study was controlled for amount of therapy and for season.
Methods. Children under inhaled corticosteroid (ICS) were enrolled over two 2-month periods (autumn, spring). Duration of oral steroid treatment and of symptoms, dose of ICS and long-acting beta-agonist were recorded for the past 3 months.
Results. Three hundred and fifty-nine children (110 girls) were included (48 [<2 years], 116 [2-6 years], 107 [6-10 years], 88 [>10 years]) during autumn (n = 175) and spring (n = 184), all treated by ICS (mean daily dose ± SD = 378 ± 250 μg). Among the 359 children, 133 (37%) experienced at least one severe exacerbation, and control was observed in 111 (31%) children. A multivariate logistic regression model demonstrated that age, season, and ICS dose are independent risk factors for exacerbation, whereas age is the only predictor of control. The odds ratio of exacerbation and control are 0.85 (95% CI, 0.78-0.92, p < .0001) and 0.85 (95% CI, 0.79-0.91, p < .0001) per year of increase in age, respectively.
Conclusions. From infancy to adolescence, each year of life reduces per se the risk of a severe exacerbation by 15% and similarly increases the achievement of control in children treated for asthma.
J Asthma. 2010 Nov 1. [Epub ahead of print]
