不同严重程度的远端胃食管反流哮喘患儿，其哮喘临床表现也不同
2011/05/12
摘要
背景：与健康对照相比，哮喘患儿的胃食管反流发生率显著增加，但两者的直接相关性尚不清楚。
目的：本研究旨在评价食管酸暴露与哮喘患儿临床特征间的相关性。
方法：66名存在慢性肺部症状、满足持续性哮喘诊断标准的儿童（平均年龄122.8个月；SD：44.89）入选，监测24-h食管pH值，完成问卷调查。问卷调查内容包括环境因素、家族史、当前和前期临床症状、过敏症、哮喘严重程度和用药。
结果：28名(42.4%)患儿存在24-h食管pH值异常。年龄、性别、哮喘严重程度、环境因素、肺活量结果以及不同用药，均与食管酸暴露无关。然而，存在食管pH值异常的儿童，出现哮喘的时间更早(哮喘发作时间：3.63岁，SD：2.52 vs 5.77岁，SD：3.82]; P<0.01)。与过敏性哮喘患儿相比，非过敏性哮喘患儿，其食管酸暴露更为严重(Boix-Ochoa评分：28.19，SD：18.26 vs 18.26，SD：12.84]; P<0.048)。胃食管反流的严重程度与夜间哮喘频繁发作和难治性夜间哮喘相关。
结论：不同严重程度的胃食管反流哮喘患儿，其哮喘临床特征也不一样。非过敏性哮喘患者哮喘发生年龄早，而且常出现夜间难治性哮喘，说明哮喘与胃食管反流具有临床相关性。
（林江涛 审校）
J Asthma. 2011 Mar 9. [Epub ahead of print]
Clinical Features of Asthma in Children Differ with Regard to the Intensity of Distal Gastroesophageal Acid Reflux.
Kwiecien J, Machura E, Halkiewicz F, Karpe J.
Department of Pediatrics, Medical University of Silesia, Zabrze, Poland.
Abstract
Background. The prevalence of gastroesophageal reflux (GER) in children with asthma is higher than in healthy controls, but the nature and direction of this association is unclear.
Objective. The aim of our study was to assess the relationship between esophageal acid exposure and the clinical features of asthma in children.
Methods. In total, 66 children (mean age 122.8 months [SD 44.89 months]) with chronic pulmonary symptoms, fulfilling diagnostic criteria of persistent asthma, underwent 24-hour esophageal pH monitoring and answered a detailed questionnaire-based survey. The questionnaire topics included environmental factors, familial history, current and previous clinical symptoms, atopy, asthma severity, and medication.
Results. Abnormal results of 24-hour esophageal pH monitoring were found in 28 out of 66 children (42.4%). Age, sex, severity of asthma, environmental factors, spirometry results, and the type of medication did not correlate with esophageal acid exposure. However, children with abnormal pH results developed asthma significantly earlier (asthma onset 3.63 years [SD 2.52 years] vs 5.77 years [SD 3.82 years]; p < .01). Nonatopic individuals had more intensive esophageal acid exposure than atopic ones (Boix-Ochoa score 28.19 [SD 18.26] vs 18.26 [SD 12.84]; p < .048). The intensity of GER was also significantly correlated with frequent or difficult-to-control nighttime asthma attacks.
Conclusions. There are differences in clinical features of asthma in children with regard to the intensity of esophageal acid exposure. Symptoms of asthma in nonatopic individuals with early onset and difficult-to-control nighttime asthma attacks suggest the possibility of concomitant, clinically relevant GER.
J Asthma. 2011 Mar 9. [Epub ahead of print]
背景：与健康对照相比，哮喘患儿的胃食管反流发生率显著增加，但两者的直接相关性尚不清楚。
目的：本研究旨在评价食管酸暴露与哮喘患儿临床特征间的相关性。
方法：66名存在慢性肺部症状、满足持续性哮喘诊断标准的儿童（平均年龄122.8个月；SD：44.89）入选，监测24-h食管pH值，完成问卷调查。问卷调查内容包括环境因素、家族史、当前和前期临床症状、过敏症、哮喘严重程度和用药。
结果：28名(42.4%)患儿存在24-h食管pH值异常。年龄、性别、哮喘严重程度、环境因素、肺活量结果以及不同用药，均与食管酸暴露无关。然而，存在食管pH值异常的儿童，出现哮喘的时间更早(哮喘发作时间：3.63岁，SD：2.52 vs 5.77岁，SD：3.82]; P<0.01)。与过敏性哮喘患儿相比，非过敏性哮喘患儿，其食管酸暴露更为严重(Boix-Ochoa评分：28.19，SD：18.26 vs 18.26，SD：12.84]; P<0.048)。胃食管反流的严重程度与夜间哮喘频繁发作和难治性夜间哮喘相关。
结论：不同严重程度的胃食管反流哮喘患儿，其哮喘临床特征也不一样。非过敏性哮喘患者哮喘发生年龄早，而且常出现夜间难治性哮喘，说明哮喘与胃食管反流具有临床相关性。
（林江涛 审校）
J Asthma. 2011 Mar 9. [Epub ahead of print]
Clinical Features of Asthma in Children Differ with Regard to the Intensity of Distal Gastroesophageal Acid Reflux.
Kwiecien J, Machura E, Halkiewicz F, Karpe J.
Department of Pediatrics, Medical University of Silesia, Zabrze, Poland.
Abstract
Background. The prevalence of gastroesophageal reflux (GER) in children with asthma is higher than in healthy controls, but the nature and direction of this association is unclear.
Objective. The aim of our study was to assess the relationship between esophageal acid exposure and the clinical features of asthma in children.
Methods. In total, 66 children (mean age 122.8 months [SD 44.89 months]) with chronic pulmonary symptoms, fulfilling diagnostic criteria of persistent asthma, underwent 24-hour esophageal pH monitoring and answered a detailed questionnaire-based survey. The questionnaire topics included environmental factors, familial history, current and previous clinical symptoms, atopy, asthma severity, and medication.
Results. Abnormal results of 24-hour esophageal pH monitoring were found in 28 out of 66 children (42.4%). Age, sex, severity of asthma, environmental factors, spirometry results, and the type of medication did not correlate with esophageal acid exposure. However, children with abnormal pH results developed asthma significantly earlier (asthma onset 3.63 years [SD 2.52 years] vs 5.77 years [SD 3.82 years]; p < .01). Nonatopic individuals had more intensive esophageal acid exposure than atopic ones (Boix-Ochoa score 28.19 [SD 18.26] vs 18.26 [SD 12.84]; p < .048). The intensity of GER was also significantly correlated with frequent or difficult-to-control nighttime asthma attacks.
Conclusions. There are differences in clinical features of asthma in children with regard to the intensity of esophageal acid exposure. Symptoms of asthma in nonatopic individuals with early onset and difficult-to-control nighttime asthma attacks suggest the possibility of concomitant, clinically relevant GER.
J Asthma. 2011 Mar 9. [Epub ahead of print]
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严重哮喘患者中肥胖与哮喘控制差的相关性
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