【摘要】：研究背景：支氣管哮喘（哮喘）是由多種炎癥細胞，，包括嗜酸性粒細胞、肥大細胞、T淋巴細胞和上皮細胞及其細胞組分參與的氣道慢性炎癥。臨床上表現(xiàn)為反復(fù)發(fā)作性喘息、呼吸困難、胸悶和咳嗽等癥狀。哮喘是全球范圍內(nèi)嚴重威脅公眾健康的一種慢性疾病，不論是發(fā)達國家還是發(fā)展中國家，哮喘已成為嚴重威脅人類健康的一大疾病。支氣管哮喘是兒童時期最常見的慢性呼吸道疾病，患病率亦呈上升趨勢，我國兒科哮喘協(xié)作組曾對2000年及1990年全國兒童哮喘患病率進行調(diào)查，結(jié)果顯示：我國兒童哮喘患病率從1990年的0.91%上升到2000年的1.5%,上升了64.84%,且2000年調(diào)查顯示90.33%哮喘兒童首次喘息發(fā)生在5歲及以前，69.26%在3歲以下，29.74%在1歲以下。可見，5歲以下兒童哮喘占了兒童哮喘的極高的比例，大多數(shù)持續(xù)哮喘患者的發(fā)病始于學(xué)齡前。在5歲以下兒童，除了哮喘癥狀為非特異性這個普遍特點外，哮喘癥狀的多變性在這個年齡段更為突出。另外，在這年齡段因不能配合肺功能檢查或肺功能檢查僅作參考，難以客觀評價氣流受限和氣道炎癥，故目前尚無低齡兒童哮喘診斷的金標(biāo)準(zhǔn)。在以往，年幼兒哮喘的定義反復(fù)修改數(shù)次，但迄今為止仍無適于所有患兒的確切定義，此點也反映出年幼兒哮喘致病因素的復(fù)雜性，盡管人們對哮喘的病因進行了大量的研究，但至今仍未能明確闡明。2009年5月全球哮喘防治創(chuàng)議組織（GINA）發(fā)布了“5歲及5歲以下兒童哮喘診斷和管理的全球策略”，這是GINA首次針對5歲以下兒童而專有的哮喘管理指南。既往哮喘兒童的危險因素流行病學(xué)調(diào)查主要針對5歲以上兒童，且國內(nèi)資料多以單因素分析為主。而對于5歲以下哮喘兒童危險因素的調(diào)查資料并不是太完善，大部分僅是調(diào)查問卷，如調(diào)查對象對過敏原依據(jù)的判斷僅來源于既往醫(yī)師的診斷或家人提供的病史而非患兒的實驗室檢查依據(jù)；且低齡兒童發(fā)生喘息相對大齡兒童可能更多與病毒感染，過敏原裸露、遺傳等有關(guān)。因此，從不同角度研究年幼兒哮喘的危險因素，可有針對性地為有效預(yù)防與控制哮喘的發(fā)生、發(fā)展提供理論依據(jù)。 目的：通過病例對照研究方法，對5歲以下兒童哮喘危險因素進行單因素、多因素綜合分析，以探討本地區(qū)年幼兒哮喘兒童的危險因素所在，為有針對性地為有效預(yù)防與控制年幼兒哮喘患兒喘息持續(xù)發(fā)展提供理論依據(jù)，以預(yù)防哮喘發(fā)展為持續(xù)性喘息。 方法：本研究采用病例對照研究方法。研究對象：選擇2010年1月至2011年6月在廣州醫(yī)學(xué)院第一附屬醫(yī)院兒科住院及門診診斷哮喘的5歲及以下哮喘患兒共224例為哮喘組，其中男141例，女83例，年齡為2.0±1.46歲。選擇同年齡段健康兒童共151例為對照組，其中男71例，女80例，年齡為2.5±0.3歲。通過問卷調(diào)查方式對兩組進行病例對照研究，調(diào)查與年幼兒哮喘有關(guān)的因素。年幼兒哮喘診斷標(biāo)準(zhǔn)參照2008年全國兒童哮喘協(xié)作組制定的統(tǒng)一標(biāo)準(zhǔn)。并對所有對象抽取靜脈血4ml,分離血清，通過酶聯(lián)免疫分析法檢測血清TIgE和常見16種血清過敏原的SIgE。此外抽取靜脈血1ml，進行外周血常規(guī)檢查。所以哮喘組患兒均另抽取靜脈血及留取唾液標(biāo)本進行病毒咽拭子PCR DNA檢測、血清9種呼吸道病原學(xué)血清抗體檢測。將回收的問卷進行核對檢查，剔除失訪、不配合調(diào)查、不合格問卷，哮喘組實際取得完整、合格資料171份問卷，合格率為76.34%，其中男127例，女44例，平均年齡為2.67±1.64歲。健康對照組中剔除不配合調(diào)查、不合格問卷共24份，實際取得完整、合格資料共127份問卷，合格率為84.11%，其中男62例，女65例平均年齡為2.94±1.38歲。兩組在年齡、體重、身高上無明顯差異。將調(diào)查結(jié)果錄入計算機，利用SPSS17.0統(tǒng)計軟件建立數(shù)據(jù)庫并進行統(tǒng)計分析。首先將各變量賦值后帶入單因Logistic回歸分析中，再將單因素分析中有統(tǒng)計學(xué)意義的變量引入多因素非條Logistic回歸分析中擬合主效應(yīng)模型，求出最優(yōu)效應(yīng)方程估計各種危險因素對兒童哮喘發(fā)病的綜合相對危險度，進一步考察各因素的作用。 結(jié)果：1、單因素分析結(jié)果如下所示：①出生史與哮喘的關(guān)系：男性（OR＝3.026）；早產(chǎn)或出生體重＜2.53彛∣R＝2.547）；出生時吸氧（OR＝3.603）；新生兒期訴有反復(fù)痰鳴（OR＝24.671）是哮喘發(fā)病的危險因素（P均＜0.05），陰式分娩是哮喘的保護性因素（OR＝0.363, P＜0.01）。②喂養(yǎng)史與哮喘的關(guān)系：母乳喂養(yǎng)持續(xù)時間≥6個月（OR＝0.288）；添加益生菌持續(xù)時間≥6個月、添加維生素D、鈣劑持續(xù)時間≥1年是哮喘的保護因素（OR＝0.273和OR＝0.450,P＜0.05）③家居環(huán)境及附近外界環(huán)境與哮喘關(guān)系：生后第1年吸煙暴露（OR＝1.752）；潮濕（OR＝5.573）；花草多（OR＝4.828）；布藝沙發(fā)或家居鋪地毯多（OR＝3.874）；蟑螂（OR＝6.495）；毛絨玩具多（OR＝10.624）；居住地在城市（OR＝2.642）；附近有工廠（OR＝1.969）；家居靠近馬路（OR＝1.901）；家內(nèi)及周圍環(huán)境灰塵大（OR＝4.543）是哮喘發(fā)病的危險因素（P均＜0.05）。房屋對流通風(fēng)好（OR＝0.118）；定期清理濾過網(wǎng)（OR＝0.472）；衛(wèi)生清潔周期≥3次/周（OR＝0.049）是哮喘的保護因素（P均＜0.05）。哮喘組的人居居住面積為23.25±11.24m~2，對照組為33.92±17.86m~2，人均居住面積大是哮喘的保護性因素（OR＝0.250，P＜0.001）。④患兒營養(yǎng)性疾病與哮喘關(guān)系：佝僂病、患有其它營養(yǎng)性疾�。òI養(yǎng)不良、貧血、缺鋅等）是哮喘的危險因素（OR＝10.702和12.524，P均＜0.01）；⑤遺傳過敏史與哮喘關(guān)系：患兒過敏史（OR＝128.348）；父母過敏史(指父母其中一方有過敏史者)（OR＝21.888）；母親過敏史（OR＝16.109）；父親過敏史（OR＝7.687）；其他1、2級親屬過敏史（OR＝34.791）是哮喘發(fā)病的危險因素（P均＜0.01）。⑥咳嗽癥狀與哮喘關(guān)系：第1次下呼吸道感染年齡＜6月（OR＝2.926）；1年中下呼吸道感染（支氣管炎或支氣管肺炎）的次數(shù)（OR＝6.250）；咳嗽持續(xù)時間≥2周（OR＝5.889）；咳嗽發(fā)作時間規(guī)律性（常在清晨或夜間咳嗽發(fā)作）（OR＝8.830）；冬春季節(jié)咳嗽多（OR＝2.871）；干咳癥狀為主（OR＝7.950）；（活動、吃奶、哭鬧后）咳嗽氣喘加劇（OR＝6.103）；突然出現(xiàn)的劇烈咳嗽（OR＝37.539）；咳嗽常伴隨有鼻炎（OR＝5.887）；皮膚癢或眼癢的癥狀（OR_(伴隨皮膚癢)＝38.473，OR_(伴隨眼癢)＝17.567）；經(jīng)常使用抗生素≥1次/月（OR＝9.389）；因呼吸道感染住院次數(shù)（OR＝120.780）是哮喘的危險因素（P均＜0.05）。⑦血清過敏原、血嗜酸粒細胞與哮喘關(guān)系：哮喘組中TIgE陽性率、SIgE陽性率均較對照組升高，是哮喘的危險因素（OR_(TIgE≥1級陽性率)＝2.888和OR_(SIgE≥1級陽性率)＝4.034， P均＜0.01）。哮喘組吸入性過敏原以螨類、屋塵過敏為主，食物性過敏原以牛奶過敏為主，其次是全蛋過敏。⑧兩組其它輔助檢查比較分析：哮喘患兒病毒感染陽性率、支原體感染陽性率均較健康兒童高，是哮喘的危險因素（OR＝14.974，和OR＝7.944，P均＜0.01）。 2、多因素分析結(jié)果顯示：性別（OR＝6.554）、花草多（OR＝6.155）、家內(nèi)及周圍環(huán)境灰塵大（OR＝7.389）、父母過敏史（OR＝75.048）、清晨或夜間咳嗽發(fā)作（OR＝20.172）、多在冬春季咳嗽（OR＝6.495）、干咳為主（OR＝25.413）、螨類≥1級陽性率（OR＝18.704）、TIgE≥2倍陽性率（OR＝10.201）與對照組相比有統(tǒng)計學(xué)意義，是5歲以下兒童哮喘發(fā)病的重要危險因素（P均＜0.05）。添加維生素D、鈣劑持續(xù)時間≥1年、添加益生菌持續(xù)時間≥6個月是哮喘的保護性因素（OR＝0.189和OR＝0.192，P均＜0.05）。 結(jié)論：通過病例對照分析，可見過敏原、病毒、家居環(huán)境、咳嗽癥狀及規(guī)律等因素是年幼兒哮喘的重要危險因素，病毒可能是導(dǎo)致年幼兒哮喘癥狀反復(fù)或加重的危險因素之一。早期預(yù)防及診治年幼兒哮喘對預(yù)防哮喘持續(xù)發(fā)展意義重大。本文通過研究和分析5歲以下哮喘患兒的危險因素，以便明確哮喘的發(fā)病機制，并對早期發(fā)現(xiàn)哮喘、早期診治哮喘，避免年幼兒哮喘發(fā)展并持續(xù)至成人期有一定意義。
[Abstract]:Background: bronchial asthma (asthma) is a chronic airway inflammation involving a variety of inflammatory cells, including eosinophils, mast cells, T lymphocytes and epithelial cells and their cell components. The clinical manifestations are recurrent wheezing, dyspnea, chest tightness, cough and other symptoms. Asthma is a serious threat to the public worldwide. Asthma, a chronic disease in the developed and developing countries, has become a major threat to human health. Bronchial asthma is the most common chronic respiratory disease in childhood, and the prevalence rate is on the rise. The prevalence rate of childhood asthma in 2000 and 1990 in China's pediatric asthma cooperation group has been carried out in China. The results showed that the incidence of asthma in children in China rose from 0.91% in 1990 to 1.5% in 2000, up 64.84%. In 2000, a survey showed that 90.33% asthma children were first wheezing for the first time at 5 years of age, 69.26% under 3 years of age and 29.74% under 1 years of age. The onset of persistent asthma begins before school age. In children under 5 years of age, in addition to the general characteristics of asthma symptoms, the variability of asthma symptoms is more prominent at this age. In addition, it is difficult to objectively evaluate airflow limitation and airway inflammation due to the lack of reference to pulmonary function examination or pulmonary function examination in this age group. So far, there is no gold standard for diagnosis of asthma in young children. In the past, the definition of childhood asthma has been revised several times, but so far there is still no exact definition for all children. This point also reflects the complexity of the pathogenic factors of asthma in young children. Although a lot of studies have been made on the cause of asthma in young children, it is still not clear to date. The global strategy for asthma prevention and management under the age of 5 and 5 years of age was published in May,.2009, the global strategy for asthma diagnosis and management for children under the age of 5 and under the age of 5. This is the first guide to asthma management for children under 5 years of age. The epidemiological investigation of risk factors for children with asthma is mainly aimed at children over 5 years of age, with more domestic data. The data of the risk factors for children under 5 years of age were not too perfect. Most of them were only questionnaires, such as the diagnosis of the allergen based on a previous physician's diagnosis or family history rather than the laboratory examination of the children; and the asthmatic phase of the younger children. The older children may be more related to the virus infection, the allergen exposure and the heredity. Therefore, the study of the risk factors of childhood asthma from different angles can provide a theoretical basis for the effective prevention and control of the occurrence of asthma.
Objective: To investigate the risk factors of asthma in children under 5 years of age through a case-control study to explore the risk factors of childhood asthma in young children in this area, and to provide a theoretical basis for the prevention and control of asthma in children. For persistent wheezing.
Methods: a case-control study was used in this study. Objective: to select 224 asthmatic children aged 5 and below in the First Affiliated Hospital of Guangzhou Medical College from January 2010 to June 2011 to diagnose asthma, including 141 males and 83 females with age of 2 1.46 years. A total of 151 children in the same age group were selected. In the control group, there were 71 males and 80 females, aged 2.5 0.3 years old. The two groups were investigated by questionnaires to investigate the factors associated with childhood asthma. The standard of childhood asthma diagnosis was referred to the unified standard established by the National Children Asthma cooperation group in 2008. The venous blood 4ml was extracted from all the subjects and the serum was separated. Serum TIgE and 16 common serum allergens were detected by enzyme linked immunosorbent assay (SIgE.) and venous blood 1ml was extracted to perform peripheral blood routine examination. Therefore, the children of the asthma group were extracted from the venous blood and the saliva specimens for the PCR DNA of the virus swabs and the serum antibody test of the sera of the serum. A total of 171 questionnaires were completed and the qualified rate was 76.34%, including 127 men and 44 women, with an average age of 2.67 1.64 years. The health control group was excluded from the investigation, the unmatched questionnaire was 24, the actual data were complete and the qualified data were 127 questionnaires, The qualified rate was 84.11%, of which 62 were male and 65 for women, the average age was 2.94 + 1.38. The two groups had no obvious difference in age, weight and height. The results of the investigation were recorded in the computer, and the database was established and analyzed by SPSS17.0 software. First, the variables were assigned to the single factor Logistic regression analysis, and then the single factor analysis was used. The variables of statistical significance were used to fit the main effect model in multi factor non stripe Logistic regression analysis. The optimal effect equation was used to estimate the comprehensive relative risk of various risk factors to children's asthma, and the effect of various factors was further investigated.
Results: 1, the results of the single factor analysis were as follows: (1) the relationship between birth history and asthma: male (OR = 3.026); premature birth or birth weight < 2.53 R = 2.547); birth oxygen inhalation (OR = 3.603); recurrent phlegm (OR = 24.671) during neonatal period (P < 0.05); vaginal delivery was the protection of asthma Factors (OR = 0.363, P < 0.01). The relationship between feeding history and asthma: breast feeding duration more than 6 months (OR = 0.288); addition of probiotics for more than 6 months, vitamin D, calcium duration for more than 1 years is a protective factor for asthma (OR = 0.273 and OR = 0.450, P < 0.05) (P < 0.05) (P < 0.05); the home environment and the surrounding environment and asthma customs Department: first years after birth (OR = 1.752); humid (OR = 5.573); flowers and plants (OR = 4.828); cloth sofa or home carpets (OR = 3.874); cockroaches (OR = 6.495); plush toys (OR = 10.624); residence in city (OR = 2.642); close to a factory (OR = 1.969); home near the street (OR = 1.901); home and week; home and week Environmental dust (OR = 4.543) was a risk factor for asthma (P < 0.05). Convective ventilation in houses (OR = 0.118); regular cleaning of filter network (OR = 0.472); sanitary cleaning cycle more than 3 times / week (OR = 0.049) was a protective factor for asthma (P < 0.05). The living area of the asthma group was 23.25 + 11.24m~2, and the control group was 33.92 + 17.86m. ~2, a large per capita living area is a protective factor for asthma (OR = 0.250, P < 0.001). (4) the relationship between nutritional diseases and asthma in children: rickets, other nutritional diseases (including malnutrition, anemia, zinc deficiency, etc.) is a risk factor for asthma (OR = 10.702 and 12.524, P < 0.01); (5) the relationship between allergic history and asthma: allergy to children: allergy to children History (OR = 128.348); parents' allergy history (OR = 21.888); mother's allergic history (OR = 16.109); father's allergic history (OR = 7.687); other 1,2 level kinship allergies (OR = 34.791) is a risk factor for asthma (P < 0.01). (6) the relationship between cough and asthma: first times of lower respiratory infection age. June (OR = 2.926); 1 years of lower respiratory tract infection (bronchitis or bronchopneumonia) times (OR = 6.250); coughing duration more than 2 weeks (OR = 5.889); coughing time regularity (often in the morning or night coughing attack) (OR = 8.830); winter and Spring Festival coughing (OR = 2.871); dry cough symptoms (OR = 7.950); (activity, = 7.950); Cough and asthma exacerbated (OR = 6.103); sudden severe cough (OR = 37.539); cough often accompanied by rhinitis (OR = 5.887); skin itching or itching (OR_ (with skin itching) = 38.473, OR_ (accompanied by itching) = 17.567); frequent use of antibiotics more than 1 times / month (OR = 9.389); respiratory infection hospitalization (O); O R = 120.780) was a risk factor for asthma (P < 0.05). Serum allergen, blood eosinophil and asthma: TIgE positive rate and SIgE positive rate in asthma group were higher than those of control group (OR_ (TIgE > 1 positive rate) = 2.888 and OR_ (SIgE > 1 positive rate) = 4.034, P < 0.01). Asthma group inhalation allergy The former was mainly acaroid, house dust allergy, food allergen was mainly milk allergy, followed by whole egg allergy. Two other auxiliary examinations were compared and analyzed: the positive rate of virus infection in children with asthma and the positive rate of mycoplasma infection were higher than those of healthy children. It was the risk factor of asthma (OR = 14.974, and OR = 7.944, P < 0.01).
2, the results of multiple factors analysis showed that sex (OR = 6.554), flowers and grass more (OR = 6.155), home and surrounding environment dust (OR = 7.389), parents' allergic history (OR = 75.048), early morning or night coughing (OR = 20.172), more in winter and spring (OR = 6.495), dry cough (OR = 25.413), positive rate of mites > 1 (OR = 18.704), TIgE more than 2 times positive The rate (OR = 10.201) was statistically significant compared with the control group. It was an important risk factor for asthma in children under 5 years of age (P < 0.05). Vitamin D was added, calcium duration was more than 1 years, and the duration of probiotics longer than 6 months was a protective factor for asthma (OR = 0.189, OR = 0.192, P < 0.05).
Conclusion: by case-control analysis, it can be seen that the factors such as allergen, virus, home environment, cough symptoms and regularity are important risk factors for young children's asthma. The virus may be one of the risk factors that cause recurrent or aggravated asthma symptoms in young children. Early prevention and treatment of childhood asthma is of great significance in preventing the continuous development of asthma. This paper studies and analyzes the risk factors of asthma in children under 5 years of age, in order to clarify the pathogenesis of asthma, and it is of certain significance for early detection of asthma, early diagnosis and treatment of asthma, avoiding the development of childhood asthma and continuing to adult stage.
【學(xué)位授予單位】：廣州醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R725.6

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