儿童重症支气管哮喘的流行病学特征及危险因素：一项单中心前瞻性队列研究

doi:10.3969/j.issn.1674-8115.2023.06.002

上海交通大学学报（医学版） ›› 2023, Vol. 43 ›› Issue (6): 665-672.doi: 10.3969/j.issn.1674-8115.2023.06.002

• 儿童哮喘专题 • 上一篇

儿童重症支气管哮喘的流行病学特征及危险因素：一项单中心前瞻性队列研究

王颖雯¹(), 李小玲²(), 代佳佳², 刘芳¹, 黄剑峰², 王立波², 张晓波²(), 冯瑞³()

^1.复旦大学附属儿科医院护理部，上海 201102
^2.复旦大学附属儿科医院呼吸科，上海 201102
^3.复旦大学计算机科学技术学院，上海 200433

收稿日期:2023-02-26 接受日期:2023-05-17 出版日期:2023-06-28 发布日期:2023-06-28
通讯作者: 张晓波,冯瑞 E-mail:yingwenwong@163.com;18211240037@fudan.edu.cn;zhangxiaobo0307@163.com;fengrui@fudan.edu.cn
作者简介:王颖雯（1982—），女，副主任护师，硕士；电子信箱：yingwenwong@163.com
李小玲（1994—），女，住院医师，硕士；电子信箱：18211240037@fudan.edu.cn第一联系人：*为共同第一作者。
#为共同通信作者。
基金资助:
上海市科学技术委员会重点课题(22511106001)

Epidemiological characteristics and risk factors of severe asthma in children: a single-center prospective cohort study

WANG Yingwen¹(), LI Xiaoling²(), DAI Jiajia², LIU Fang¹, HUANG Jianfeng², WANG Libo², ZHANG Xiaobo²(), FENG Rui³()

^1.Nursing Department of Children's Hospital of Fudan University, Shanghai 201102, China
^2.Respiratory Department of Children's Hospital of Fudan University, Shanghai 201102, China
^3.School of Computer Science, Fudan University, Shanghai 200433, China

Received:2023-02-26 Accepted:2023-05-17 Online:2023-06-28 Published:2023-06-28
Contact: ZHANG Xiaobo,FENG Rui E-mail:yingwenwong@163.com;18211240037@fudan.edu.cn;zhangxiaobo0307@163.com;fengrui@fudan.edu.cn
Supported by:
Project of Science and Technology Commission of Shanghai Municipality(22511106001)

摘要/Abstract

摘要：

目的·探讨儿童重症支气管哮喘（简称哮喘）的流行病学特征并分析其危险因素。方法·采用单中心前瞻性队列研究，纳入2021年1月1日—12月31日就诊于复旦大学附属儿科医院的难治性哮喘患儿674例，建立动态队列。收集队列成员的基本信息（包括患儿性别、年龄、出生胎龄、出生体质量等）和共存疾病情况，评估其哮喘控制情况、药物吸入技术水平、药物依从性，以及肺功能指标［1秒用力呼气容积（forced expiratory volume in one second，FEV₁）占预计值百分比（FEV₁%预计值），FEV₁/用力肺活量（forced vital capacity，FVC）和用力呼出50%肺活量的呼气流量（forced expiratory flow at 50% of FVC exhaled，FEF₅₀）、FEF₇₅、FEF_25-75占预计值百分比］、气道炎症指标［呼出气一氧化氮（fraction exhaled nitric oxide，FeNO）检测值］和过敏状态指标［外周血嗜酸性粒细胞（eosinophil，EOS）计数和总血清免疫球蛋白E（immunoglobulin E，IgE）浓度］。所有队列成员分别在其进入队列的第3、6、9和12个月至该院哮喘专病门诊接受再次评估。结果·至队列终点时，有52例（7.7%）患儿被诊断为重症哮喘。处于二手烟暴露环境、家中常年使用空调、共存疾病为鼻炎/鼻窦炎、FEV₁%预计值<80%、FEV₁/FVC<80%、小气道功能障碍、EOS>300/μL、IgE>200国际单位（international unit，IU）/L、FeNO>20/25 ppb［FeNO>20 ppb（≤12岁），>25 ppb（>12岁），1 ppb=1×10^-9 mol/L］在重症哮喘患儿中占比较高，母乳喂养至6月龄及以上、药物依从性好在非重症患儿中占比较高，差异有统计学意义（均P<0.05）。6~11岁重症哮喘患儿中男性占比更多，12~17岁重症哮喘患儿中女性占比更多，差异有统计学意义（均P<0.05）。多因素Logistic回归分析显示，小气道功能障碍是发生重症哮喘的独立危险因素［OR=5.158（95%CI 2.516~10.572）］。结论·难治性哮喘患儿在规范管理1年后，重症哮喘患儿占比有显著下降趋势；小气道功能障碍是其进展为重症哮喘的独立危险因素。

关键词: 儿童, 哮喘, 重症, 诊断, 治疗

Abstract:

Objective ·To explore the epidemiological characteristics of severe asthma in children and analyze the risk factors. Methods ·A single-center prospective cohort study was conducted. Six hundred and seventy four children with difficult-to-treat asthma who visited the Children′s Hospital of Fudan University from January 1 to December 31, 2021 were included to establish a dynamic cohort. Basic information (including gender, age, gestational age at birth, birth weight, etc.) and comorbidity of the cohort members were collected. The asthma control status, drug inhalation technique level, medication compliance, pulmonary function parameters [forced expiratory volume in one second (FEV₁) as a percent-age of the predicted value (FEV₁%pred), FEV₁/ forced vital capacity (FVC), and the rate of estimated values of forced expiratory flow at 50% of FVC exhaled (FEF₅₀), FEF₇₅, and FEF_25-75 in percent-predicted value, respectively], airway inflammation index [fraction exhaled nitric oxide (FeNO)], and allergy status parameters [eosinophil (EOS) and immunoglobulin E (IgE)] of all cohort members were evaluated. All cohort members underwent re-evaluation respectively at the specialist asthma clinic of the hospital at 3, 6, 9, and 12 months. Results ·At the endpoint of the cohort, 52 children were diagnosed with severe asthma, accounting for 7.7%. A high proportion of severe asthma was found in children who were exposed to secondhand smoke, used air conditioning at home all year round, or had coexisting rhinitis/nasosinusitis, FEV₁%pred<80%, FEV₁/FVC<80%, small airway dysfunction, EOS>300/μL, IgE>200 IU/L, or FeNO>20/25 ppb [FeNO>20 ppb (≤12 years old) or >25 ppb (>12 years old), 1 ppb=1×10^-9 mol/L]. A high proportion of non-severe asthma was found in children who were breastfed for 6 months or longer, or had good medication compliance. The differences were statistically significant (all P<0.05). There were more males in children with severe asthma aged 6?11 years, and more females in children with severe asthma aged 12?17 years, with statistical significance (both P<0.05). Multiple-factor Logistic regression analysis showed that only small airway dysfunction was an independent risk factor for severe asthma [OR=5.158 (95%CI 2.516?10.572)]. Conclusion ·The proportion of children with severe asthma has a significantly decrease after one year of standardized management in children with difficult-to-treat asthma. Small airway dysfunction is an independent risk factor for the progression to severe asthma.

Key words: child, asthma, severe, diagnosis, treatment

中图分类号:

R725.6

王颖雯, 李小玲, 代佳佳, 刘芳, 黄剑峰, 王立波, 张晓波, 冯瑞. 儿童重症支气管哮喘的流行病学特征及危险因素：一项单中心前瞻性队列研究[J]. 上海交通大学学报（医学版）, 2023, 43(6): 665-672.

WANG Yingwen, LI Xiaoling, DAI Jiajia, LIU Fang, HUANG Jianfeng, WANG Libo, ZHANG Xiaobo, FENG Rui. Epidemiological characteristics and risk factors of severe asthma in children: a single-center prospective cohort study[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(6): 665-672.

图/表 3

参考文献 33

1	HUANG K, YANG T, XU J, et al. Prevalence, risk factors, and management of asthma in China: a national cross-sectional study[J]. Lancet, 2019, 394(10196): 407-418.
2	中华儿科杂志编辑委员会, 中华医学会儿科学分会呼吸学组, 中国医师协会儿科医师分会儿童呼吸专业委员会. 儿童支气管哮喘规范化诊治建议(2020年版)[J]. 中华儿科杂志, 2020, 58(9): 708-717.
	The Editorial Board, Chinese Journal of Pediatrics, the Subspecialty Group of Respiratory Diseases, the Society of Pediatrics, Chinese Medical Association, the Children′s Respiratory Professional Committee, the Society of Pediatrics of Chinese Medical Doctor Association. Recommendations for diagnosis and management of bronchial asthma in children (2020)[J].Chinese Journal of Pediatrics, 2020, 58(9): 708-717.
3	XIANG L, ZHAO J, ZHENG Y J, et al. Uncontrolled asthma and its risk factors in Chinese children: a cross-sectional observational study[J]. J Asthma, 2016, 53(7): 699-706.
4	ROBINSON D S, CAMPBELL D A, DURHAM S R, et al. Systematic assessment of difficult-to-treat asthma[J]. Eur Respir J, 2003, 22(3): 478-483.
5	GUILBERT T W, BACHARIER L B, FITZPATRICK A M. Severe asthma in children[J]. J Allergy Clin Immunol Pract, 2014, 2(5): 489-500.
6	洪建国. 重视儿童难治/重症哮喘的诊治[J]. 中华临床免疫和变态反应杂志, 2019, 13(4): 267-270.
	HONG J G. Pay attention to the diagnosis and treatment of difficult-to-treat asthma / severe asthma in children[J]. Chinese Journal of Allergy & Clinical Immunology, 2019, 13(4): 267-270.
7	Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2022[EB/OL]. [2022-12-09]. https://ginasthma.org/wp-content/uploads/2022/07/GINA-Main-Report-2022- FINAL-22-07-01-WMS.pdf.
8	刘芳, 张玉蓉, 李小玲, 等. 儿童哮喘专病库的构建与应用研究[J]. 护理学杂志, 2022, 37(19): 25-28.
	LIU F, ZHANG Y R, Li X L, et al. Construction and application of an asthma: specific database for children[J]. Journal of Nursing Science, 2022, 37(19): 25-28.
9	LOTT T F, BLAZEY M E, WEST M G. Patient participation in health care: an underused resource[J]. Nurs Clin North Am, 1992, 27(1): 61-76.
10	LIU A H, ZEIGER R, SORKNESS C, et al. Development and cross-sectional validation of the Childhood Asthma Control Test[J]. J Allergy Clin Immunol, 2007, 119(4): 817-825.
11	NATHAN R A, SORKNESS C A, KOSINSKI M, et al. Development of the asthma control test: a survey for assessing asthma control[J]. J Allergy Clin Immunol, 2004, 113(1): 59-65.
12	THOMAS M, KAY S, PIKE J, et al. The Asthma Control Test (ACT) as a predictor of GINA guideline-defined asthma control: analysis of a multinational cross-sectional survey[J]. Prim Care Respir J, 2009, 18(1): 41-49.
13	COHEN J L, MANN D M, WISNIVESKY J P, et al. Assessing the validity of self-reported medication adherence among inner-city asthmatic adults: the Medication Adherence Report Scale for Asthma[J]. Ann Allergy Asthma Immunol, 2009, 103(4): 325-331.
14	傅唯佳, 汤梁峰, 叶成杰, 等. 运用人工智能技术进行肺功能数据库构建并辅助诊断实践[J]. 中国医疗器械信息, 2022, 28(14): 147-150.
	FU W J, TANG L F, YE C J, et al. Implementation of an artificial intelligence based clinical decision support system on historical pulmonary function reports[J]. China Medical Device Information, 2022, 28(14): 147-150.
15	中华医学会儿科学分会呼吸学组肺功能协作组, «中华实用儿科临床杂志»编辑委员会.儿童肺功能系列指南(二): 肺容积和通气功能[J]. 中华实用儿科临床杂志, 2016, 31(10): 744-750.
	Pulmonary Function Group, Respiratory Branch of Chinese Pediatric Society of Chinese Medical Association, Editorial Board of Chinese Journal of Applied Clinical Pediatrics. Series guidelines for pediatric pulmonary function (part Ⅱ): lung volume and spirometry[J]. Chinese Journal of Applied Clinical Pediatrics, 2016, 31(10): 744-750.
16	CULVER B H, GRAHAM B L, COATES A L, et al. Recommendations for a standardized pulmonary function report. An official American thoracic society technical statement[J]. Am J Respir Crit Care Med, 2017, 196(11): 1463-1472.
17	中华医学会儿科学分会呼吸学组哮喘协作组. 儿童呼出气一氧化氮检测及临床应用专家共识(2021版)[J]. 中华实用儿科临床杂志, 2021, 36(6): 417-423.
	Collaboration Group of Asthma, the Subspecialty Group of Respiratory Diseases, the Society of Pediatrics, Chinese Medical Association. Expert consensus on detection and clinical application of exhaled nitric oxide in children (2021 edition) [J]. Chinese Journal of Applied Clinical Pediatrics, 2021, 36(6): 417-423.
18	ROSS K R, GUPTA R, DEBOER M D, et al. Severe asthma during childhood and adolescence: a longitudinal study[J]. J Allergy Clin Immunol, 2020, 145(1): 140-146.e9.
19	LEYNAERT B, SUNYER J, GARCIA-ESTEBAN R, et al. Gender differences in prevalence, diagnosis and incidence of allergic and non-allergic asthma: a population-based cohort[J]. Thorax, 2012, 67(7): 625-631.
20	CHIPPS B E, HASELKORN T, PAKNIS B, et al. More than a decade follow-up in patients with severe or difficult-to-treat asthma: The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) Ⅱ[J]. J Allergy Clin Immunol, 2018, 141(5): 1590-1597.e9.
21	DEBOER M D, PHILLIPS B R, MAUGER D T, et al. Effects of endogenous sex hormones on lung function and symptom control in adolescents with asthma[J]. BMC Pulm Med, 2018, 18(1): 58.
22	TAI A, TRAN H, ROBERTS M, et al. The association between childhood asthma and adult chronic obstructive pulmonary disease[J]. Thorax, 2014, 69(9): 805-810.
23	MUKHERJEE M, STODDART A, GUPTA R P, et al. The epidemiology, healthcare and societal burden and costs of asthma in the UK and its member nations: analyses of standalone and linked national databases[J]. BMC Med, 2016, 14(1): 113.
24	FITZPATRICK A M. Severe asthma in children: lessons learned and future directions[J]. J Allergy Clin Immunol Pract, 2016, 4(1): 11-19.
25	HEDLIN G, BUSH A, LØDRUP CARLSEN K, et al. Problematic severe asthma in children, not one problem but many: a GA²LEN initiative[J]. Eur Respir J, 2010, 36(1): 196-201.
26	DE ANDRADE W C, LASMAR L M, RICCI C D E A, et al. Phenotypes of severe asthma among children and adolescents in Brazil: a prospective study[J]. BMC Pulm Med, 2015, 15: 36.
27	JARJOUR N N, ERZURUM S C, BLEECKER E R, et al. Severe asthma: lessons learned from the National Heart, Lung, and Blood Institute Severe Asthma Research Program[J]. Am J Respir Crit Care Med, 2012, 185(4): 356-362.
28	李芮, 董晓艳, 蒋鲲, 等. 口鼻呼出气一氧化氮检测在儿童支气管哮喘控制评估及过敏性鼻炎诊断中的应用[J]. 中国当代儿科杂志, 2022, 24(1): 90-95.
	LI R, DONG X Y, JIANG K, et al. Application of fractional exhaled nitric oxide and nasal nitric oxide in control evaluation of bronchial asthma and diagnosis of allergic rhinitis in children[J]. Chinese Journal of Contemporary Pediatrics, 2022, 24(1) :90-95.
29	SCOTNEY E, BURCHETT S, GODDARD T, et al. Pediatric problematic severe asthma: recent advances in management[J]. Pediatr Allergy Immunol, 2021, 32(7): 1405-1415.
30	COTTINI M, LOMBARDI C, BERTI A, et al. Small-airway dysfunction in paediatric asthma[J]. Curr Opin Allergy Clin Immunol, 2021, 21(2): 128-134.
31	KOULOUMENTA V, HATZIEFTHIMIOU A, PARASKEVA E, et al. Non-genomic effect of testosterone on airway smooth muscle[J]. Br J Pharmacol, 2006, 149(8): 1083-1091.
32	FUSEINI H, YUNG J A, CEPHUS J Y, et al. Testosterone decreases house dust mite-induced type 2 and IL-17A-mediated airway inflammation[J]. J Immunol, 2018, 201(7): 1843-1854.
33	FUSEINI H, NEWCOMB D C. Mechanisms driving gender differences in asthma[J]. Curr Allergy Asthma Rep, 2017, 17(3): 19.

Item	Non-severe asthma (n=622)	Severe asthma (n=52)	Z/χ² value	P value
Male/n(%)	419 (67.4)	37 (71.2)	0.166	0.684
Age/year	9.0 (6.0, 13.0)	9.0 (6.8, 12.2)	0.228	0.820
Age groups/n(%)			0.003	0.957
6‒11 years old	338 (54.3)	29 (55.8)
12‒17 years old	284 (45.7)	23 (44.2)
Gestational age<37 weeks/n(%)	33 (5.3)	5 (9.6)	0.963	0.326
Birth weight<2 500 g/n(%)	59 (9.5)	6 (11.5)	0.056	0.812
Taking vitamin D supplements regularly until 3-year-old/n(%)	277 (44.5)	27 (51.9)	0.781	0.377
Taking vitamin D supplements regularly during pregnancy/n(%)	298 (47.9)	31 (59.6)	2.184	0.139
Mother′s age at delivery/year	29.0 (26.0, 32.0)	29.0 (27.0, 31.2)	-0.242	0.809
Breastfeeding≥6 months/n(%)	333 (53.5)	10 (19.2)	21.247	0.000
Reside in city/n(%)	539 (86.7)	46 (88.5)	0.024	0.876
Expose to second-hand smoking at home/n(%)	95 (15.3)	15 (28.8)	5.518	0.019
Long-term use of air conditioning/n(%)	501 (80.5)	52 (100.0)	11.044	0.001
Annual household income/n(%)			0.349	0.840
<100 000 CNY	101 (16.2)	8 (15.4)
≥100 000 and <200 000 CNY	307 (49.4)	24 (46.2)
≥200 000 CNY	214 (34.4)	20 (38.5)
Educational level of the main household/n(%)			0.067	0.796
Senior high school or lower	116 (18.6)	11 (21.2)
College and above	506 (81.4)	41 (78.8)
Comorbidity/n(%)
Obesity	137 (22.0)	17 (32.7)	2.522	0.112
Obstructive sleep apnea	59 (9.5)	8 (15.4)	1.265	0.261
Rhinitis/sinusitis	317 (51.0)	38 (73.1)	8.546	0.003
MARS-A≥4.5/n(%)	301 (48.4)	17 (32.7)	4.137	0.042
Correct inhaler technique/n(%)	140 (22.5)	17 (32.7)	2.245	0.134
Pulmonary function/n(%)
FEV₁%pred<80%	2 (0.3)	17 (32.7)	171.928	0.000
FEV₁/FVC<80%	0 (0)	7 (13.5)	72.019	0.000
Small airway dysfunction^①	32 (5.1)	40 (76.9)	251.658	0.000
EOS>300 μL^-1/n(%)	329 (52.9)	46 (88.5)	23.176	0.000
IgE>200 (IU·L^-1)/n(%)	260 (41.8)	47 (90.4)	43.733	0.000
FeNO>20 or 25 ppb^②/n(%)	390 (62.7)	52 (100.0)	27.947	0.000
C-AST or ACT<20/n(%)	51 (8.2)	52 (100.0)	305.321	0.000

Item	Non-severe asthma (n=622)	Severe asthma (n=52)	Z/χ² value	P value
Male/n(%)	419 (67.4)	37 (71.2)	0.166	0.684
Age/year	9.0 (6.0, 13.0)	9.0 (6.8, 12.2)	0.228	0.820
Age groups/n(%)			0.003	0.957
6‒11 years old	338 (54.3)	29 (55.8)
12‒17 years old	284 (45.7)	23 (44.2)
Gestational age<37 weeks/n(%)	33 (5.3)	5 (9.6)	0.963	0.326
Birth weight<2 500 g/n(%)	59 (9.5)	6 (11.5)	0.056	0.812
Taking vitamin D supplements regularly until 3-year-old/n(%)	277 (44.5)	27 (51.9)	0.781	0.377
Taking vitamin D supplements regularly during pregnancy/n(%)	298 (47.9)	31 (59.6)	2.184	0.139
Mother′s age at delivery/year	29.0 (26.0, 32.0)	29.0 (27.0, 31.2)	-0.242	0.809
Breastfeeding≥6 months/n(%)	333 (53.5)	10 (19.2)	21.247	0.000
Reside in city/n(%)	539 (86.7)	46 (88.5)	0.024	0.876
Expose to second-hand smoking at home/n(%)	95 (15.3)	15 (28.8)	5.518	0.019
Long-term use of air conditioning/n(%)	501 (80.5)	52 (100.0)	11.044	0.001
Annual household income/n(%)			0.349	0.840
<100 000 CNY	101 (16.2)	8 (15.4)
≥100 000 and <200 000 CNY	307 (49.4)	24 (46.2)
≥200 000 CNY	214 (34.4)	20 (38.5)
Educational level of the main household/n(%)			0.067	0.796
Senior high school or lower	116 (18.6)	11 (21.2)
College and above	506 (81.4)	41 (78.8)
Comorbidity/n(%)
Obesity	137 (22.0)	17 (32.7)	2.522	0.112
Obstructive sleep apnea	59 (9.5)	8 (15.4)	1.265	0.261
Rhinitis/sinusitis	317 (51.0)	38 (73.1)	8.546	0.003
MARS-A≥4.5/n(%)	301 (48.4)	17 (32.7)	4.137	0.042
Correct inhaler technique/n(%)	140 (22.5)	17 (32.7)	2.245	0.134
Pulmonary function/n(%)
FEV₁%pred<80%	2 (0.3)	17 (32.7)	171.928	0.000
FEV₁/FVC<80%	0 (0)	7 (13.5)	72.019	0.000
Small airway dysfunction^①	32 (5.1)	40 (76.9)	251.658	0.000
EOS>300 μL^-1/n(%)	329 (52.9)	46 (88.5)	23.176	0.000
IgE>200 (IU·L^-1)/n(%)	260 (41.8)	47 (90.4)	43.733	0.000
FeNO>20 or 25 ppb^②/n(%)	390 (62.7)	52 (100.0)	27.947	0.000
C-AST or ACT<20/n(%)	51 (8.2)	52 (100.0)	305.321	0.000

Category	Severe asthma	Non-severe asthma	χ² value	P value
6‒11 years old/n(%)			4.634	0.031
Male (n=256)	27 (10.5)	229 (89.5)
Female (n=111)	2 (1.8)	109 (98.2)
12‒17 years old/n(%)			9.105	0.003
Male (n=200)	10 (5.0)	190 (95.0)
Female (n=107)	13 (12.1)	94 (87.9)

Category	Severe asthma	Non-severe asthma	χ² value	P value
6‒11 years old/n(%)			4.634	0.031
Male (n=256)	27 (10.5)	229 (89.5)
Female (n=111)	2 (1.8)	109 (98.2)
12‒17 years old/n(%)			9.105	0.003
Male (n=200)	10 (5.0)	190 (95.0)
Female (n=107)	13 (12.1)	94 (87.9)

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儿童重症支气管哮喘的流行病学特征及危险因素：一项单中心前瞻性队列研究

Epidemiological characteristics and risk factors of severe asthma in children: a single-center prospective cohort study

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