婴儿发生喘息20年后的哮喘和肺功能:一项前瞻性随访研究

作     者：Piippo-Savolainen E. Remes S. Kannisto S. M. Korppi 郭战宏 

作者机构：Department of Pediatrics Kuopio University Hospital FIN-70210 Kuopio Finland Dr. 

出 版 物：《世界核心医学期刊文摘（儿科学分册）》 (Dkgest of the World Latest Medical Information)

年 卷 期：2005年第1卷第9期

页      面：8-9页

学科分类：1002[医学-临床医学] 100202[医学-儿科学] 10[医学] 

主　　题：随访研究 细支气管炎 吸入性变应原 乙酰甲胆碱 过敏症 年龄中位数 吸入激发 住院治疗 前瞻性队列研究 独立危险因子 

摘      要：Objective: To determine the outcome until adulthood after wheezing in infancy Design: An 18-to-20-year prospective cohort study. Setting: Pediatric department at a university hospital, providing primary hospital care for a defined population. Patients: Fifty-four children hospitalized for bronchiolitis and 34 for pneumonia at younger than 2 years, and 45 controls with no early-life wheezing or hospitalization, were studied at median age 19 years. Main Outcome Measures: A questionnaire on asthma symptoms and medication, physical examination, flow volume spirometry (FVS), methacholine inhalation challenge (MIC), home peak expiratory flow (PEF) monitoring, and skin prick testing (SPT) to common inhalant allergens. The 2 asthma definitions were physician-diagnosed asthma and previously diagnosed asthma with recent asthmatic symptoms (physiciandiagnosed asthma included). Results: By the 2 definitions, asthma was present in 30% (odds ratio OR , 3.37; 95% confi-dence interval CI , 1.12-10.10) and in 41% (OR 1.38; 95% CI, 0.37-5.21) in the bronchiolitis group, in 15% (OR, 5.50; 95% CI, 1.87-16.14) and in 24% (OR, 2.07; 95% CI, 0.59-7.22) in the pneumonia group, and in 11% in the control group. After bronchiolitis, the FVS values were forced vital capacity (FVC), 108% (SD, 13% ) of predicted; forced expiratory volume in 1 second, 98% (SD, 12% ); forced expiratory volume in 1 second divided by FVC, 91% (SD, 7.6% ); midexpiratory flow at 50% of the FVC, 74% (SD, 19% ); and midexpiratory flow at 25% of the FVC, 74% (SD, 22% ). Bronchial reactivity by MIC was present in 25 (48% ) of 52 subjects in the bronchiolitis group, in 13 (42% ) of 31 in the pneumonia group, and in 14 (32% ) of 44 in the control group. The prevalence of atopy (positive SPTs) was 48% to 63% in the 3 groups. In a logistic regression adjusted for atopy and smoking, infantile bronchiolitis was an independent risk factor for asthma by both definitions. Conclusion: The increased risk for asthma persists until ad