学龄前城市儿童哮喘远期发病预测
2011/10/12
摘要
背景和目的：城市儿童特别容易受到哮喘的困扰。我们虽然已发现不少因素会影响城市儿童的短期转归，但是这些因素并不能指导临床医生预测今后几年内哮喘发病情况，特别是学龄前儿童的哮喘。本研究旨在明确能对远期控制效果较差的城市学龄前儿童哮喘进行预测的临床和环境因素。
材料与方法：我们选定了几个基线状态特点作为哮喘严重程度的备选预测因子：人口统计学数据、哮喘症状、药物使用、卫生资源使用、早期病史、家族史、过敏原暴露和过敏性疾病以及污染物暴露。通过双变量和多变量分析，检测2年内哮喘严重程度预测因子与卫生资源使用间的相关性。
结果：在基线状态入选儿童150例，2年的随访率为83%，进入最终分析的儿童共计124例。参与者的基线状态平均年龄为4.4岁，以非洲裔美国人为主（90%）。大部分儿童为特应性哮喘，32.5%的儿童采用皮质激素吸入治疗。夜间因哮喘觉醒和肺炎病史是预示哮喘远期控制效果较差的预测因子。
结论：有夜间因哮喘觉醒或肺炎病史的学龄前儿童，应该密切观察，预防后期哮喘发病。
(苏楠 审校)
J Asthma. 2011 Aug 23. [Epub ahead of print]
J Asthma. 2011 Aug 23. [Epub ahead of print]
Hansel NN, Matsui EC, Rusher R, McCormack MC, Curtin-Brosnan J, Peng RD, Mazique D, Breysse PN, Diette GB.
Source
Department of Medicine, School of Medicine, Johns Hopkins University , Baltimore, MD , USA.
Abstract
BACKGROUND AND AIMS: Children living in the inner city are particularly vulnerable to asthma. While we know much about factors that affect near-term outcomes in inner-city children, there is little evidence to guide clinicians on what to expect in the coming years, especially in preschool children. The purpose of our study was to determine which clinical and environmental factors are predictive of poor long-term asthma control in preschool inner-city children.
MATERIALS AND METHODS: Baseline characteristics determined to be potential predictors of asthma severity were examined: demographics, asthma symptoms, medication use, healthcare utilization, early life medical history, family history, allergen exposure and allergic disease, and pollutant exposure. Bivariate and multivariate analyses were performed using logistic regression to examine the association of predictors of asthma severity with healthcare utilization at 2 years.
RESULTS: Of the 150 children at baseline, the follow-up rate was 83% at 2 years; therefore, 124 children were included in final analyses. At baseline, the mean age was 4.4 years and participants were predominantly African-American (90%). Most of the children were atopic and 32.5% reported using inhaled corticosteroids. Nighttime awakening from asthma and a history of pneumonia were predictive of future poor control.
CONCLUSION: Preschool children with nighttime awakening from asthma and a history of pneumonia may deserve closer monitoring to prevent future asthma morbidity.
MATERIALS AND METHODS: Baseline characteristics determined to be potential predictors of asthma severity were examined: demographics, asthma symptoms, medication use, healthcare utilization, early life medical history, family history, allergen exposure and allergic disease, and pollutant exposure. Bivariate and multivariate analyses were performed using logistic regression to examine the association of predictors of asthma severity with healthcare utilization at 2 years.
RESULTS: Of the 150 children at baseline, the follow-up rate was 83% at 2 years; therefore, 124 children were included in final analyses. At baseline, the mean age was 4.4 years and participants were predominantly African-American (90%). Most of the children were atopic and 32.5% reported using inhaled corticosteroids. Nighttime awakening from asthma and a history of pneumonia were predictive of future poor control.
CONCLUSION: Preschool children with nighttime awakening from asthma and a history of pneumonia may deserve closer monitoring to prevent future asthma morbidity.
J Asthma. 2011 Aug 23. [Epub ahead of print]
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儿童哮喘症状的季节性差异
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儿童哮喘发作的危险因素和可预测的临床评分工具
