Siltanen Mirjami, Savilahti Erkki, Pohjavuori Maija, Kajosaari Merja
Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland.
Pediatr Pulmonol. 2004 Jan;37(1):43-9. doi: 10.1002/ppul.10402.
Respiratory morbidity is a major health problem among children. The aim of this study was to compare the background of respiratory problems of children born preterm with that of children born full-term, with special reference to atopy. The study comprised two cohorts of 10-year-old children: a group of 72 children born preterm with birth weights of less than 1,501 g, and a group of 65 children born full-term with birth weights of over 2,500 g. Histories of respiratory and atopic symptoms, and of risk factors for atopy, were collected with a questionnaire. Predisposition to atopy was verified by skin-prick testing and by measuring serum total and antigen-specific IgEs. Lung function was evaluated by spirometry testing. Children born preterm had significantly more wheezing. In them, the lifetime prevalence of wheezing was 43%, vs. 17% in children born full-term (P = 0.001; odds ratio, 3.71; 95% confidence interval, 1.67-8.25). In the full-term group, wheezing was associated with atopy: 64% of wheezers were atopic; in the preterm group, 23% of wheezers were atopic (difference between groups, P = 0.024). Children born preterm expired significantly lower spirometry values of forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV1), FEV1/FVC ratio, forced expiratory flow after 50% of vital capacity has been exhaled (FEF50), and forced expiratory flow during middle half of FVC (FEF25-75). In the preterm group, wheezing, asthma, and low gestational age, but not atopy, were significantly associated with lower lung function values. Wheezers of the preterm group who still wheezed at age 10 were significantly more often atopic than those who no longer wheezed (62% vs. 9%, P = 0.006). In conclusion, we demonstrated a significant difference between groups in the association of atopy with respiratory problems. However, although atopy was not associated with a lifetime prevalence of respiratory symptoms in prematurely born children, an atopic predisposition in them was found to associate with persistence of wheezing.
呼吸道疾病是儿童中的一个主要健康问题。本研究的目的是比较早产儿童与足月出生儿童的呼吸道问题背景，特别关注特应性。该研究包括两组10岁儿童：一组72名出生时体重小于1501克的早产儿童，以及一组65名出生时体重超过2500克的足月出生儿童。通过问卷调查收集呼吸道和特应性症状的病史以及特应性的危险因素。通过皮肤点刺试验和测量血清总IgE及抗原特异性IgE来验证特应性易感性。通过肺量计测试评估肺功能。早产儿童的喘息明显更多。在他们当中，喘息的终生患病率为43%，而足月出生儿童为17%（P = 0.001；比值比，3.71；95%置信区间，1.67 - 8.25）。在足月组中，喘息与特应性相关：64%的喘息儿童患有特应性；在早产组中，23%的喘息儿童患有特应性（两组之间的差异，P = 0.024）。早产儿童的肺活量（FVC）、第1秒用力呼气量（FEV1）、FEV1/FVC比值、呼出肺活量50%后的用力呼气流量（FEF50）以及FVC中间一半的用力呼气流量（FEF25 - 75）的肺量计值明显更低。在早产组中，喘息、哮喘和低胎龄，但不是特应性，与较低的肺功能值显著相关。早产组中10岁时仍喘息的喘息儿童比特应性的特应性显著高于不再喘息的儿童（62%对9%，P = 0.006）。总之，我们证明了两组在特应性与呼吸道问题的关联方面存在显著差异。然而，尽管特应性与早产儿童呼吸道症状的终生患病率无关，但发现他们的特应性易感性与喘息的持续存在有关。
