Castro-Rodríguez J A, Holberg C J, Morgan W J, Wright A L, Halonen M, Taussig L M, Martinez F D
Respiratory Sciences Center, University of Arizona, College of Medicine, Tucson, Arizona, USA.
Pediatrics. 2001 Mar;107(3):512-8. doi: 10.1542/peds.107.3.512.
Some retrospective evidence suggests that children with a history of croup may be at increased risk of subsequently developing asthma, atopy, and diminished pulmonary function. The objective of this study was to determine the long-term outcome of croup (as diagnosed by a physician) in early life.
Lower respiratory illnesses (LRIs) in the first 3 years of life were assessed in 884 children who were enrolled in a large longitudinal study of airway diseases at birth. Pulmonary function tests, markers of atopy, and wheezing episodes were studied at different ages between birth and 13 years.
Ten percent of children had croup with wheeze (Croup/Wheeze), 5% had croup without wheeze (Croup/No Wheeze), 36% had another LRI (Other LRI), and 48% had no LRI. Respiratory syncytial virus was more frequently isolated in children with Croup/Wheeze and Other LRI than in those with Croup/No Wheeze. There was no association between croup in early life and markers of atopy measured during the school years. Only children with Croup/Wheeze and with Other LRI had a significant risk of subsequent persistent wheeze later in life. Significantly lower levels of indices of intrapulmonary airway function were observed at ages <1 (before any LRI), 6, and 11 years in children with Croup/Wheeze and Other LRI compared with children with No LRI. Conversely, inspiratory resistance before any LRI episode was significantly higher in infants who later developed Croup/No Wheeze than in the other 3 groups.
We distinguish 2 manifestations of croup with and without wheezing. Children who present with croup may or may not be at increased risk of subsequent recurrent lower airway obstruction, depending on the initial lower airway involvement, and preillness and postillness abnormalities in lung function associated with this condition.
一些回顾性证据表明，有哮吼病史的儿童随后患哮喘、特应性疾病及肺功能降低的风险可能会增加。本研究的目的是确定生命早期哮吼（由医生诊断）的长期转归。
对884名出生时参加大型气道疾病纵向研究的儿童在生命的前3年中的下呼吸道疾病（LRI）进行评估。在出生至13岁的不同年龄段研究肺功能测试、特应性标志物及喘息发作情况。
10%的儿童有哮吼伴喘息（哮吼/喘息），5%的儿童有哮吼但无喘息（哮吼/无喘息），36%的儿童有其他下呼吸道疾病（其他LRI），48%的儿童无下呼吸道疾病。呼吸道合胞病毒在哮吼/喘息和其他LRI儿童中比在哮吼/无喘息儿童中更常分离到。生命早期的哮吼与学龄期测量的特应性标志物之间无关联。只有哮吼/喘息和其他LRI儿童在生命后期有随后持续性喘息的显著风险。与无下呼吸道疾病的儿童相比，哮吼/喘息和其他LRI儿童在<1岁（在任何下呼吸道疾病之前）、6岁和11岁时肺内气道功能指标水平显著较低。相反，后来发生哮吼/无喘息的婴儿在任何下呼吸道疾病发作之前的吸气阻力显著高于其他3组。
我们区分了有喘息和无喘息的两种哮吼表现形式。患哮吼的儿童随后发生复发性下气道阻塞的风险可能增加，也可能不增加，这取决于最初的下气道受累情况以及与此疾病相关的发病前和发病后肺功能异常。
