Just Jocelyne, Belfar Samira, Wanin Stéphanie, Pribil Céline, Grimfeld Alain, Duru Gérard
Centre de l'Asthme et des Allergies, Groupe Hospitalier Trousseau-La Roche Guyon, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie-Paris 6, Paris, France.
J Asthma. 2010 May;47(4):412-6. doi: 10.3109/02770900903584035.
Persistent asthma in adults starts often early in childhood and is associated with alterations in respiratory function that occur early in life.
The aim of this study was to evaluate the importance of innate and environmental factors associated with occurrence of asthma during childhood in a population of recurrent wheezing infants followed prospectively.
A cohort of infants less than 30 months old with recurrent wheezing was established in order to assess severity of respiratory symptoms and to look for the presence of atopy and environmental risk factors. At the age of 6 years, they were reevaluated with respect to remission or persistence of wheezing over the previous 12-month period.
Data were available for 219 subjects aged 15 +/- 5 months. In 27% of the infants with recurrent wheeze, wheezing persisted until the age of 6 years. In multivariate analysis, stepwise logit analysis showed that the risk factors for persistent wheezing are eosinophilia >or=470/mm(3), allergenic sensitization, and a father with asthma. Environmental factors present during the first year of life that protect from persistence of wheezing are ( 1 ) breastfeeding for longer than 3 months, ( 2 ) pets at home, and ( 3 ) >or=3 siblings. The detection rate for persistent wheezing in this model is 72%. The persistence score showed good specificity 91% but low sensitivity 35%.
This study confirms the role of atopic host factors on wheezing persistence during childhood and detected protective environmental factors.
成人持续性哮喘通常始于儿童早期，并与生命早期出现的呼吸功能改变有关。
本研究的目的是评估在一组前瞻性随访的反复喘息婴儿群体中，与儿童期哮喘发生相关的先天因素和环境因素的重要性。
建立了一个年龄小于30个月、反复喘息的婴儿队列，以评估呼吸道症状的严重程度，并寻找特应性和环境危险因素的存在情况。在6岁时，对他们在过去12个月内喘息的缓解或持续情况进行重新评估。
有219名年龄为15±5个月的受试者的数据。在27%的反复喘息婴儿中，喘息持续到6岁。在多变量分析中，逐步逻辑回归分析显示，持续性喘息的危险因素为嗜酸性粒细胞增多≥470/mm³、变应原致敏以及父亲患有哮喘。生命第一年中存在的可防止喘息持续的环境因素为：（1）母乳喂养超过3个月；（2）家中有宠物；（3）≥3个兄弟姐妹。该模型中持续性喘息的检出率为72%。持续性评分显示出良好的特异性（91%）但敏感性较低（35%）。
本研究证实了特应性宿主因素在儿童期喘息持续中的作用，并发现了具有保护作用的环境因素。
