儿童哮喘发作的危险因素和可预测的临床评分工具
2011/09/09
背景：哮喘作为重要公共健康问题，影响全世界数以百万计的儿童，哮喘发作是哮喘病程重要部分并占用大部分医疗资源。基层医生缺乏有效工具以确定哮喘发作的高危险儿童。我们旨在制定临床评分来帮助医师确认这些儿童。
方法：我们主要的结局指标是严重的哮喘发作，后者定义为前1年因哮喘而需住院、急诊就医和全身使用激素。临床评分工具是由17个有关哮喘症状、药物使用及卫生保健及病史，需回答“是”或“否”的问题所构建的清单式问卷，并采用横断面研究在哥斯达黎加儿童哮喘中得以验证。然后用儿童哮喘管理项目（CAMP）（一项北美儿童的纵向队列）的数据加以评价。
结果：与哥斯达黎加验证数据中哮喘发作呈中风险的儿童比较，处于低风险和高风险评分分类的儿童，其哮喘发作的风险比分别明显降低【OR=0.2, 95% CI=（0.1, 0.4）】和增加【OR=5.4, 95% CI=（1.5, 19.2）】。在CAMP，低风险和高风险组一年随访其哮喘发作的风险比分别是0.6 【95% CI=（0.5,0.7）】和1.9 【95% CI=（1.4, 2.4）】,第2年的结果与其类似。
结论：所推荐的哮喘发作临床评分使用简单,并能有效的识别哮喘发作的高风险和低风险儿童。该评分工具在基层医院易于使用。
(王刚 四川大学华西医院中西医结合科呼吸组 610041 摘译)
(Chest; 2010; 138(5):1156–1165)
Risk Factors and Predictive Clinical Scores for Asthma Exacerbations in Childhood
Forno E, Fuhlbrigge A, Soto-Quirós ME, Avila L, Raby BA, Brehm J, Sylvia JM, Weiss ST, Celedón JC.
CHEST ;2010; 138(5):1156–1165
Background: Asthma is a major public health problem that affects millions of children worldwide, and exacerbations account for most of its morbidity and costs. Primary-care providers lack efficient tools to identify children at high risk for exacerbations. We aimed to construct a clinical score to help providers to identify such children.
Methods: Our main outcome was severe asthma exacerbation, which was defined as any hospitalization, urgent visit, or systemic steroid course for asthma in the previous year, in children. A clinical score, consisting of a checklist questionnaire made up of 17 yes-no questions regarding asthma symptoms, use of medications and health-care services, and history, was built and validated in a cross-sectional study of Costa Rican children with asthma. It was then evaluated using data from the Childhood Asthma Management Program (CAMP), a longitudinal trial cohort of North American children.
Results: Compared with children at average risk for an exacerbation in the Costa Rican validation set, the odds of an exacerbation among children in the low-risk (OR, 0.2; 95% CI, 0.1-0.4) and high-risk (OR, 5.4; 95% CI, 1.5-19.2) score categories were significantly reduced and increased, respectively. In CAMP, the hazard ratios for an exacerbation after 1-year follow-up in the low-risk and high-risk groups were 0.6 (95% CI, 0.5-0.7) and 1.9 (95% CI, 1.4-2.4), respectively, with similar results at 2 years.
Conclusions: The proposed Asthma Exacerbation Clinical Score is simple to use and effective at identifying children at high and low risk for asthma exacerbations. The tool can easily be used in primary-care settings.
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学龄前城市儿童哮喘远期发病预测
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儿童哮喘控制和个体控制标准的治疗反应的组成部分：对PEACE研究的分析
