3岁儿童的比气道阻力：一项前瞻性队列研究。

Specific airway resistance in 3-year-old children: a prospective cohort study.

作者信息

Lowe Lesley, Murray Clare S, Custovic Adnan, Simpson Bridget M, Kissen Patricia M, Woodcock Ashley

机构信息

North West Lung Centre, Wythenshawe Hospital, Manchester, UK.

出版信息

Lancet. 2002 Jun 1;359(9321):1904-8. doi: 10.1016/S0140-6736(02)08781-0.

DOI:10.1016/S0140-6736(02)08781-0

PMID:12057553

Abstract

BACKGROUND

The development of a method to assess lung function in young children may provide new insight into asthma development. Plethysmographic measurement of specific airway resistance (sR(aw)) is feasible in this age group. We aimed to identify risk factors associated with low lung function in early childhood in a prospective birth cohort.

METHODS

Children were prenatally assigned to risk group according to parental atopic status (high risk, both parents atopic; medium risk, one parent atopic; low risk, neither parent atopic) and followed prospectively until age 3 years. We measured sR(aw) in 503 symptom-free children using whole-body plethysmography during tidal breathing.

FINDINGS

803 of 868 children attended the clinic, of whom 503 obtained satisfactory sR(aw) readings. 200 who wheezed at least once during first 3 years of life had significantly higher sR(aw) than the 303 who had never wheezed (mean difference 5.8%, 95% CI 2.2-9.3, p=0.002). For children who had never wheezed there were significant differences in sR(aw) between risk groups (p<0.001). Children at high risk (n=87) had a higher sR(aw) (geometric mean 1.17 kPa/s, 1.12-1.22) than children at medium risk (n=162; 1.02 kPa/s, 1.00-1.05) and at low risk (54; 1.04 kPa/s, 0.99-1.11). Atopic children (n=62) had significantly higher sR(aw) (1.15 kPa/s, 1.09-1.21) than those who were not atopic (232; 1.05 kPa/s, 1.02-1.07, p=0.002). For non-atopic children, those at high risk (58) had higher sR(aw) (1.13kPa/s, 1.07-1.18) than those at medium risk (125, 1.01kPa/s, 0.98-1.05) or at low risk (49, 1.04 kPa/s, 0.97-1.10, p=0.003). We showed a significant interaction between history of maternal asthma and child's atopic status (p=0.006).

INTERPRETATION

Even in the absence of respiratory symptoms, children of atopic parents and those with personal atopy have impaired lung function in early life.

摘要

背景

开发一种评估幼儿肺功能的方法可能为哮喘的发展提供新的见解。在这个年龄组中，通过体积描记法测量比气道阻力（sR(aw)）是可行的。我们旨在确定一个前瞻性出生队列中与幼儿肺功能低下相关的风险因素。

方法

根据父母的特应性状态（高风险，父母双方均为特应性；中等风险，父母一方为特应性；低风险，父母双方均非特应性），在产前将儿童分配到风险组，并进行前瞻性随访至3岁。我们在503名无症状儿童潮气呼吸期间使用全身体积描记法测量了sR(aw)。

结果

868名儿童中有803名到诊所就诊，其中503名获得了满意的sR(aw)读数。在生命的前3年中至少喘息一次的200名儿童的sR(aw)明显高于从未喘息过的303名儿童（平均差异5.8%，95%CI 2.2 - 9.3，p = 0.002）。对于从未喘息过的儿童，风险组之间的sR(aw)存在显著差异（p < 0.001）。高风险组儿童（n = 87）的sR(aw)（几何平均值1.17 kPa/s，1.12 - 1.22）高于中等风险组儿童（n = 162；1.02 kPa/s，1.00 - 1.05）和低风险组儿童（54；1.04 kPa/s，0.99 - 1.11）。特应性儿童（n = 62）的sR(aw)（1.15 kPa/s，1.09 - 1.21）明显高于非特应性儿童（232；1.05 kPa/s，1.02 - 1.07，p = 0.002）。对于非特应性儿童，高风险组（58名）的sR(aw)（1.13kPa/s，1.07 - 1.18）高于中等风险组（125名，1.01kPa/s，0.98 - 1.05）或低风险组（49名，1.04 kPa/s，0.97 - 1.10，p = 0.003）。我们发现母亲哮喘病史与儿童特应性状态之间存在显著交互作用（p = 0.006）。