哮喘联盟

   摘要
   背景：哮喘是妊娠妇女最常见的慢性疾病之一。妊娠期哮喘急性加重对妊娠预后有不良影响。本综述概述了目前关于妊娠期哮喘急性加重的发生率、发病机制以及危险因素的资料。
   方法：本综述为叙述性评述，所有数据来源于Pubmed数据库。
   结果：妊娠期间，多达6%哮喘女性因哮喘急性加重住院。妊娠期间母体免疫系统以Th2/Th1比值显著增高为特征，从而为胎儿存活提供必要环境，但可能加重哮喘。妊娠期固有免疫系统细胞（如单核细胞和中性粒细胞）同样增加，也可加重母体哮喘。严重或难治性哮喘是妊娠期哮喘发作的主要危险因素，但研究提示患者对控制医疗方案不依从和病毒感染也是妊娠期哮喘发作的重要触发因素。目前，关于胎儿性别对妊娠期哮喘发作影响的研究报道结果尚不一致。妊娠期哮喘急性加重的其它危险因素包括肥胖、种族和反流，但是遗传性过敏症并非危险因素。
   结论：妊娠期哮喘急性加重的发生率非常高。对严重哮喘（或称为难治性哮喘）控制方案不依从性、病毒感染、肥胖和种族是妊娠期哮喘急性加重的重要危险因素，而关于胎儿性别是否对其有影响，目前尚无统一结论。

 

（苏楠 审校）
J Asthma Allergy. 2013 May 6;6:53-60. doi: 10.2147/JAA.S43183. Print 2013.

Incidence and risk factors for exacerbations of asthma during pregnancy.
 

Ali Z, Ulrik CS.

Abstract
BACKGROUND: Asthma is one of the most common chronic diseases among pregnant women. Acute exacerbations of asthma during pregnancy have an unfavorable impact on pregnancy outcome. This review provides an overview of current knowledge of incidence, mechanisms, and risk factors for acute exacerbations of asthma during pregnancy.
METHODS: A narrative literature review was carried out using the PubMed database.
RESULTS: During pregnancy, up to 6% of women with asthma are hospitalized for an acute exacerbation. The maternal immune system is characterized by a very high T-helper-2:T-helper-1 cytokine ratio during pregnancy and thereby provides an environment essential for fetal survival but one that may aggravate asthma. Cells of the innate immune system such as monocytes and neutrophils are also increased during pregnancy, and this too can exacerbate maternal asthma. Severe or difficult-to-control asthma appears to be the major risk factor for exacerbations during pregnancy, but studies also suggest that nonadherence with controller medication and viral infections are important triggers of exacerbations during pregnancy. So far, inconsistent findings have been reported regarding the effect of fetal sex on exacerbations during pregnancy. Other risk factors for exacerbation during pregnancy include obesity, ethnicity, and reflux, whereas atopy does not appear to be a risk factor.
DISCUSSION: The incidence of asthma exacerbations during pregnancy is disturbingly high. Severe asthma - better described as difficult-to-control asthma - nonadherence with controller therapy, viral infections, obesity, and ethnicity are likely to be important risk factors for exacerbations of asthma during pregnancy, whereas inconsistent findings have been reported with regard to the importance of sex of the fetus.
 

J Asthma Allergy. 2013 May 6;6:53-60. doi: 10.2147/JAA.S43183. Print 2013.