上海交通大学学报（医学版）

上海交通大学学报（医学版） >

2022 , Vol. 42 >Issue 10: 1435 - 1440

DOI: https://doi.org/10.3969/j.issn.1674-8115.2022.10.009

论著 · 临床研究

学龄前儿童反复喘息的相关危险因素分析

  • 李爱求 ,
  • 张潇潇 ,
  • 姜允丽 ,
  • 肖艳赏 ,
  • 丁国栋 ,
  • 吴蓓蓉 ,
  • 董晓艳
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  • 1.上海市儿童医院，上海交通大学医学院附属儿童医院护理部，上海 200040
    2.上海市儿童医院，上海交通大学医学院附属儿童医院呼吸科，上海 200040
李爱求（1966—），女，主任护师，学士；电子信箱：liaiqiu817@hotmail.com。
董晓艳，电子信箱：dong_x_y0305@126.com。

收稿日期: 2022-06-18

  录用日期: 2022-09-18

  网络出版日期: 2022-12-02

基金资助

上海申康医院发展中心临床科技创新项目(SHDC12016215)

收起

Risk factors of recurrent wheezing in preschool children

  • Aiqiu LI ,
  • Xiaoxiao ZHANG ,
  • Yunli JIANG ,
  • Yanshang XIAO ,
  • Guodong DING ,
  • Beirong WU ,
  • Xiaoyan DONG
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  • 1.Nursing Department, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200040, China
    2.Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200040, China
DONG Xiaoyan, E-mail: dong_x_y0305@126.com.

Received date: 2022-06-18

  Accepted date: 2022-09-18

  Online published: 2022-12-02

Supported by

Clinical Science and Technology Innovation Project of Shanghai Hospital Development Center(SHDC12016215)

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摘要

目的·探讨学龄前儿童反复喘息的相关危险因素。方法·选取2019年12月—2020年12月因喘息在上海市某儿童专科医院呼吸科住院诊治的学龄前儿童（年龄3~6岁）作为研究对象，随访12个月。根据喘息发作次数分偶发喘息组（1~2次/年）和反复喘息组（≥3次/年）。采用面对面问卷形式向患儿父母询问患儿基本情况、相关病史及潜在的危险因素，包括儿童的年龄、性别、胎龄、低出生体质量史、湿疹史、变应性鼻炎史、食物过敏史、吸入花粉过敏史、毛细支气管炎病史、母亲生产年龄、生产方式、喂养方式、父母哮喘病史、生活区域（城市/农村）、被动吸烟史、宠物接触史、季节因素等。单因素分析比较2组学龄前儿童喘息发作的相关因素，Logistic回归分析反复喘息的独立危险因素。结果·共纳入370例，其中偶发喘息组204例（55.14%），反复喘息组166例（44.86%）。与反复喘息显著相关的危险因素包括年龄（χ2=36.608，P=0.000）、性别（χ2=4.290，P=0.038）、湿疹史（χ2=6.250，P=0.012）、变应性鼻炎史（χ2=10.787，P=0.001）、吸入花粉过敏史（χ2=8.868，P=0.003）、毛细支气管炎病史（χ2=27.898，P=0.000）、胎龄（χ2=5.141，P=0.023）、喂养方式（χ2=4.316，P=0.038）、父母哮喘病史（χ2=5.050，P=0.025）和生活区域（χ2=31.013，P=0.000）。Logistic回归分析结果显示：变应性鼻炎史（OR=4.759，95%CI 1.665~13.603）、毛细支气管炎史（OR=12.113，95%CI 5.686~25.802）、早产（OR=3.092，95%CI 1.120~8.539）和居住在城市（OR=2.395，95%CI 1.326~4.324）是反复喘息的独立危险因素。结论·学龄前儿童反复喘息的独立危险因素包括变应性鼻炎史、毛细支气管炎史、早产和居住于城市。

关键词： 喘息; 反复; 危险因素; 学龄前儿童

本文引用格式

李爱求 , 张潇潇 , 姜允丽 , 肖艳赏 , 丁国栋 , 吴蓓蓉 , 董晓艳 . 学龄前儿童反复喘息的相关危险因素分析[J]. 上海交通大学学报（医学版）, 2022 , 42(10) : 1435 -1440 . DOI: 10.3969/j.issn.1674-8115.2022.10.009

Abstract

Objective ·To investigate the potential risk factors of recurrent wheezing in preschool children. Methods ·A case-control study was conducted in 370 children with wheezing admitted to the Department of Respiratory Medicine in a specialized hospital for children in Shanghai from December 2019 to December 2020. The children were preschool children aged 3?6 years. According to the frequency of wheezing, pediatric patients were divided into occasional wheezing group (1?2 attacks per year) and recurrent wheezing group (≥3 attacks per year). The face-to-face questionnaire was performed to the parents responding for basic information and recurrent wheezing risk factors including the children age, gender, gestational age, birth weight, history of eczema, history of allergic rhinitis, history of food allergy, history of inhalational pollen allergy, history of bronchiolitis, maternal age, production mode, feeding pattern, history of parental asthma, resident area (city/village), passive smoking, history of pet contact, seasonal factors, etc. Univariate analysis was used to compare risk factors of recurrent wheezing between the two groups. Logistic regression analysis was used to analyze the independent risk factors associated with recurrent wheezing. Results ·Three hundred and seventy cases were enrolled, including 204 cases (55.14%) in the occasional wheezing group and 166 cases (44.86%) in the recurrent wheezing group. A total of 10 risk factors were determined for recurrent wheezing, which included children's age (χ2=36.608, P=0.000), gender (χ2=4.290, P=0.038), eczema (χ2=6.250, P=0.012), allergic rhinitis (χ2=10.787, P=0.001), inhaling pollen (χ2=8.868, P=0.003), history of bronchiolitis (χ2=27.898, P=0.000), gestational age (χ2=5.141, P=0.023), feeding pattern (χ2=4.316, P=0.038), parental asthma history (χ2=5.050, P=0.025) and resident area (χ2=31.013, P=0.000). The Logistic regression showed that allergic rhinitis (OR=4.759, 95%CI 1.665?13.603), bronchiolitis (OR=12.113, 95%CI 5.686?25.802), premature birth (OR=3.092, 95%CI 1.120?8.539) and living in city (OR=2.395, 95%CI 1.326?4.324) were the independent risk factors of recurrent wheezing. Conclusion ·The independent risk factors for recurrent wheezing in preschoolers include allergic rhinitis, bronchiolitis, premature birth and living in city.

Key words： wheezing; recurrent; risk factor; preschool child

参考文献

1 STOKES J R, BACHARIER L B. Prevention and treatment of recurrent viral-induced wheezing in the preschool child[J]. Ann Allergy Asthma Immunol, 2020, 125(2): 156-162.
2 唐铭钰, 李锦, 赵瑞柯, 等. 6岁以下儿童急性喘息性疾病病原学与临床特点分析[J]. 中国感染与化疗杂志, 2018, 18(4): 365-371.
2 TANG M Y, LI J, ZHAO R K, et al. Analysis of the pathogens and clinical characteristics of acute wheezing disorders in children under 6 years old[J]. Chin J Infect Chemother, 2018, 18(4): 365-371.
3 杨阳, 李敬娴, 相琼. 儿童喘息发展为哮喘的危险因素分析[J]. 中国临床医生杂志, 2021, 49(6): 737-739.
3 YANG Y, LI J X, XIANG Q. Risk factors of wheezing development to asthma in children[J]. Chin J Clin, 2021, 49(6): 737-739.
4 李志鹏, 韩冰, 李志刚, 等. 大气PM2.5及高脂饮食对哮喘发病影响的研究进展[J]. 环境科学研究, 2020, 33(9): 2169-2174.
4 LI Z P,HAN B,LI Z G,et al. Research progress on the effects of atmospheric PM2.5 and high-fat diet on the incidence of asthma[J]. Res Environm Sci, 2020, 33(9): 2169-2174.
5 中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会. 儿童支气管哮喘诊断与防治指南(2016年版)[J].中华儿科杂志,2016, 54(3): 167-181.
5 Respiratory Group, Pediatrics Society of Chinese Medical Association,Editorial Board of Chinese Journal of Pediatrics. Guidelines for diagnosis and prevention of bronchial asthma in children (2016 edition)[J]. Chin J Pediatr, 2016, 54(3): 167-181.
6 沙莉, 刘传合, 邵明军, 等. 中国城市儿童哮喘诊治状况十年对比[J]. 中华儿科杂志, 2016, 54(3): 182-186.
6 SHA L, LIU C H, SHAO M J, et al.Ten years comparison of diagnosis and treatment of asthma in urban children in China[J]. Chin J Pediatr, 2016, 54 (3): 182-186.
7 BURBANK A J, SZEFLER S J. Current and future management of the young child with early onset wheezing[J]. Curr Opin Allergy Clin Immunol, 2017, 17(2): 146-152.
8 RODRíGUEZ-MARTíNEZ C E, SOSSA-BRICE?O M P, CASTRO-RODRIGUEZ J A. Factors predicting persistence of early wheezing through childhood and adolescence: a systematic review of the literature[J]. J Asthma Allergy, 2017, 10: 83-98.
9 江载芳, 申昆玲, 沈颖. 诸福棠实用儿科学[M]. 8版. 北京: 人民卫生出版社, 2015: 1231-1349.
9 JIANG Z F, SHEN K L, SHEN Y. Zhu Futang practical pediatrics[M]. 8ed. Beijing: People's Medical Publishing House, 2015: 1231-1349.
10 单文婕, 卢燕鸣, 李亚琴, 等. 上海浦江地区婴幼儿反复喘息危险因素的病例对照研究及Logistic分析[J]. 中华实用儿科临床杂志, 2017, 32(4): 292-295.
10 SHAN W J, LU Y M, LI Y Q, et al. Case-control study and Logistic analysis of the risk factors of infants with recurrent wheezing in Shanghai Pujiang area[J]. Chin J Appl Clin Pediatr, 2017, 32(4): 292-295.
11 向莉. 全球哮喘防治创议(GINA)2018更新版要点导读与解析[J]. 中华实用儿科临床杂志, 2018, 33(11): 807-811.
11 XIANG L. Global Initiative for Asthma (GINA) 2018 updated version of the guide reading and analysis[J]. Chin J Appl Clin Pediatr, 2018, 33(11): 807-811.
12 全国儿科哮喘协作组, 中国疾病预防控制中心环境与健康相关产品安全所. 第三次中国城市儿童哮喘流行病学调查[J]. 中华儿科杂志, 2013, 51(10): 729-735.
12 National Cooperative Group on Childhood Asthma, Institute of Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention. Third nationwide survey of childhood asthma in urban areas of China[J]. Chin J Pediatr, 2013, 51(10): 729-735.
13 刘琪, 李嘉琛, 杜怀东, 等. 中国10个地区30~79岁成年人被动吸烟行为特征分析[J]. 中华流行病学杂志, 2020, 41(10): 1668-1673.
13 LIU Q, LI J C, DU H D, et al. Regional and demographic differences on passive smoking among non-smokers aged 30-79 years in 10 regions of China[J]. Chin J Epidemiol, 2020, 41(10): 1668-1673.
14 MA H, LI Y, TANG L, et al. Impact of childhood wheezing on lung function in adulthood: a meta-analysis[J]. PLoS One, 2018, 13(2): e0192390.
15 王慧敏, 刘传合. 年幼儿童反复喘息发作的远期预后及影响因素[J]. 中华实用儿科临床杂志, 2019, 34(12): 957-959.
15 WANG H M, LIU C H. Long-term prognosis and impact factors of recurrent wheezing in young children[J]. Chin J Appl Clin Pediatr, 2019, 34 (12): 957-959.
16 顾菁, 郭岚峰. 护理干预对儿童支气管哮喘的影响: 10年随访研究[J]. 中华现代护理杂志, 2018, 24(4): 373-377.
16 GU J, GUO L F. Effects of nursing intervention on bronchial asthma in children: a 10-year follow-up study[J]. Chin J Mod Nurs, 2018, 24(4): 373-377.
17 王艳艳, 安淑华, 李权恒, 等. 石家庄地区年幼喘息患儿转归的随访研究[J]. 中华实用儿科临床杂志, 2020, 35(11): 868-870.
17 WANG Y Y, AN S H, LI Q H, et al. Follow-up study on outcome of young wheeze children in Shijiazhuang area[J]. Chin J Appl Clin Pediatr, 2020, 35(11): 868-870.
18 JACKSON D J, GERN J E, LEMANSKE R F. Lessons learned from birth cohort studies conducted in diverse environments[J]. J Allergy Clin Immunol, 2017, 139(2): 379-386.
19 RUBNER F J, JACKSON D J, EVANS M D, et al. Early life rhinovirus wheezing, allergic sensitization, and asthma risk at adolescence[J]. J Allergy Clin Immunol, 2017, 139(2): 501-507.
20 宣爱丽, 孙谦, 沈怀云, 等. 婴幼儿毛细支气管炎后反复喘息现状及影响因素分析[J]. 蚌埠医学院学报, 2020, 45(9): 1232-1235, 1239.
20 XUAN A L, SUN Q, SHEN H Y, et al. Analysis on the status and influencing factors of repeated wheezing after bronchiolitis in infant[J]. J Bengbu Med Coll, 2020, 45(9): 1232-1235, 1239.
21 LEPS C, CARSON C, QUIGLEY M A. Gestational age at birth and wheezing trajectories at 3-11 years[J]. Arch Dis Child, 2018, 103(12): 1138-1144.
22 DEN DEKKER H T, SONNENSCHEIN-VAN DER VOORT A M M, DE JONGSTE J C, et al. Early growth characteristics and the risk of reduced lung function and asthma: a meta-analysis of 25, 000 children[J]. J Allergy Clin Immunol, 2016, 137(4): 1026-1035.
23 KOTECHA S J, WATKINS W J, LOWE J, et al. Effect of early-term birth on respiratory symptoms and lung function in childhood and adolescence[J]. Pediatr Pulmonol, 2016, 51(11): 1212-1221.
24 WHYAND T, HURST J R, BECKLES M, et al. Pollution and respiratory disease: can diet or supplements help? A review[J]. Respir Res, 2018, 19(1): 79.
25 蔡丽容, 王明义, 刘郴州, 等. 江门地区婴幼儿喘息发作的相关危险因素的Logistic回归分析[J]. 齐齐哈尔医学院学报, 2017, 38(12): 1411-1414.
25 CAI L R, WANG M Y, LIU C Z, et al. Analysis of related risk factors of infant wheezing in Jiangmen area[J]. J Qiqihar Med Univ, 2017, 38(12): 1411-1414.
26 黄东明, 肖晓雄, 付四毛, 等. 中山地区乡镇和城区3~14岁儿童喘息和慢性咳嗽问卷调查分析[J]. 中国当代儿科杂志, 2014, 16(7): 734-739.
26 HUANG D M, XIAO X X, FU S M, et al. Incidence of wheezing and chronic cough in children aged 3-14 years in rural and urban areas of Zhongshan, China: a questionnaire survey[J]. Chin J Contemp Pediatri, 2014, 16(7): 734-739.
27 SILVERWOOD R J, RUTTER C E, MITCHELL E A, et al. Are environmental risk factors for current wheeze in the International Study of Asthma and Allergies in Childhood (ISAAC) phase three due to reverse causation?[J]. Clin Exp Allergy, 2019, 49(4): 430-441.
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