出生时肺功能降低与10岁时患哮喘的风险。

Reduced lung function at birth and the risk of asthma at 10 years of age.

作者信息

Håland Geir, Carlsen Karin C Lødrup, Sandvik Leiv, Devulapalli Chandra Sekhar, Munthe-Kaas Monica Cheng, Pettersen Morten, Carlsen Kai-Håkon

机构信息

Department of Pediatrics, Division of Woman and Child, Ullevål University Hospital, Oslo.

出版信息

N Engl J Med. 2006 Oct 19;355(16):1682-9. doi: 10.1056/NEJMoa052885.

DOI:10.1056/NEJMoa052885

PMID:17050892

Abstract

BACKGROUND

Reduced lung function in early infancy has been associated with later obstructive airway diseases. We assessed whether reduced lung function shortly after birth predicts asthma 10 years later.

METHODS

We conducted a prospective birth cohort study of healthy infants in which we measured lung function shortly after birth with the use of tidal breathing flow-volume loops (the fraction of expiratory time to peak tidal expiratory flow to total expiratory time [t(PTEF)/t(E)]) in 802 infants and passive respiratory mechanics, including respiratory-system compliance, in 664 infants. At 10 years of age, 616 children (77%) were reassessed by measuring lung function, exercise-induced bronchoconstriction, and bronchial hyperresponsiveness (by means of a methacholine challenge) and by conducting a structured interview to determine whether there was a history of asthma or current asthma.

RESULTS

As compared with children whose t(PTEF)/t(E) shortly after birth was above the median, children whose t(PTEF)/t(E) was at or below the median were more likely at 10 years of age to have a history of asthma (24.3% vs. 16.2%, P=0.01), to have current asthma (14.6% vs. 7.5%, P=0.005), and to have severe bronchial hyperresponsiveness, defined as a methacholine dose of less than 1.0 micromol causing a 20% fall in the forced expiratory volume in 1 second (FEV1) (9.1% vs. 4.9%, P=0.05). As compared with children whose respiratory-system compliance was above the median, children with respiratory compliance at or below the median more often had a history of asthma (27.4% vs. 14.8%; P=0.001) and current asthma (15.0% vs. 7.7%, P=0.009), although this measure was not associated with later measurements of lung function. At 10 years of age, t(PTEF)/t(E) at birth correlated weakly with the maximal midexpiratory flow rate (r=0.10, P=0.01) but not with FEV1 or forced vital capacity.

CONCLUSIONS

Reduced lung function at birth is associated with an increased risk of asthma by 10 years of age.

摘要

背景

婴儿早期肺功能降低与后期阻塞性气道疾病相关。我们评估了出生后不久肺功能降低是否能预测10年后的哮喘。

方法

我们对健康婴儿进行了一项前瞻性出生队列研究，在802名婴儿中使用潮气呼吸流速容量环（呼气时间分数至潮气呼气峰值流速与总呼气时间之比[t(PTEF)/t(E)]）在出生后不久测量肺功能，并在664名婴儿中测量被动呼吸力学，包括呼吸系统顺应性。在10岁时，通过测量肺功能、运动诱发性支气管收缩和支气管高反应性（通过乙酰甲胆碱激发试验）以及进行结构化访谈以确定是否有哮喘病史或当前哮喘，对616名儿童（77%）进行了重新评估。

结果

与出生后不久t(PTEF)/t(E)高于中位数的儿童相比，t(PTEF)/t(E)处于或低于中位数的儿童在10岁时更有可能有哮喘病史（24.3%对16.2%，P = 0.01）、当前患有哮喘（14.6%对7.5%，P = 0.005）以及有严重支气管高反应性，定义为乙酰甲胆碱剂量小于1.0微摩尔导致1秒用力呼气量（FEV1）下降20%（9.1%对4.9%，P = 0.05）。与呼吸系统顺应性高于中位数的儿童相比，呼吸系统顺应性处于或低于中位数的儿童更常有哮喘病史（27.4%对14.8%；P = 0.001）和当前哮喘（15.0%对7.7%，P = 0.009），尽管该指标与后期肺功能测量无关。在10岁时，出生时的t(PTEF)/t(E)与最大呼气中期流速弱相关（r = 0.10，P = 0.01），但与FEV1或用力肺活量无关。