儿童和成人季节性变应性鼻炎的危险因素和哮喘表型。
Risk factors and asthma phenotypes in children and adults with seasonal allergic rhinitis.
机构信息
Transylvania University, Brasov, Romania.
出版信息
Phys Sportsmed. 2010 Dec;38(4):81-6. doi: 10.3810/psm.2010.12.1829.
BACKGROUND
There are few data on asthma risk factors and phenotypes in patients with seasonal allergic rhinitis (SAR).
METHODS
Thirty-three children (mean age, 8.27 ± 1.77 years) and 82 adults (mean age, 34.12 ± 10.59 years) with SAR were evaluated for asthma (history, reversibility of bronchial obstruction, increased inhaled nitric oxide). The following asthma risk factors were considered in the multiple regression analysis: male sex, family history of asthma, breastfeeding < 2 months, passive/active smoking, obesity, pets/molds exposure, high total serum immunoglobulin E (IgE), polysensitization (sensitized to 3 seasonal pollens with different structure), mixed sensitization (seasonal and perennial allergens), severe rhinitis (according to the Allergic Rhinitis and its Impact on Asthma guidelines), and lack of allergen-specific immunotherapy (SIT) for rhinitis preceding asthma diagnosis. Asthma phenotypes were characterized using the k-means clustering (silhouette method for cluster validation).
RESULTS
Asthma was diagnosed in 22 (66.7%) children and in 57 (69.5%) adults with SAR. Independent risk factors for asthma were lack of SIT preceding asthma diagnosis, both for children (P = 0.008132) and adults (P = 0.000017), and mixed sensitization for children (P = 0.035694). Asthma phenotypes identified in children according to the associated risk factors were: breastfeeding < 2 months and severe rhinitis in 16 (63.6%) patients; male, polysensitized, and severe rhinitis in 8 (36.4%) patients. Asthma phenotypes in adults were: polysensitization and severe rhinitis in 30 (52.6%) patients; male, exposure to pets, and severe rhinitis in 11 (19.3%) patients; and high total serum IgE and polysensitization in 16 (28.1%) patients.
CONCLUSION
Lack of SIT is an independent risk factor for asthma both in children and adults with SAR, whereas polysensitization is a risk factor only for children. The dominant asthma phenotype in children with SAR is breastfeeding < 2 months and severe rhinitis. In adults with SAR, the dominant asthma phenotype is polysensitization and severe rhinitis.
背景
季节性过敏性鼻炎（SAR）患者的哮喘危险因素和表型数据较少。
方法
评估了 33 名儿童（平均年龄 8.27 ± 1.77 岁）和 82 名成年人（平均年龄 34.12 ± 10.59 岁）的哮喘（病史、支气管阻塞的可逆性、吸入性一氧化氮增加）。在多元回归分析中考虑了以下哮喘危险因素：男性、哮喘家族史、母乳喂养<2 个月、被动/主动吸烟、肥胖、宠物/霉菌暴露、总血清免疫球蛋白 E（IgE）高、多敏化（对 3 种结构不同的季节性花粉过敏）、混合敏化（季节性和常年过敏原）、重度鼻炎（根据过敏性鼻炎及其对哮喘的影响指南）和缺乏针对哮喘前鼻炎的过敏原特异性免疫疗法（SIT）。使用 K 均值聚类（聚类验证的轮廓法）对哮喘表型进行了特征描述。
结果
SAR 患儿中诊断出哮喘 22 例（66.7%），成人中诊断出哮喘 57 例（69.5%）。缺乏针对哮喘前鼻炎的 SIT 是儿童（P = 0.008132）和成人（P = 0.000017）发生哮喘的独立危险因素，而儿童混合敏化（P = 0.035694）也是哮喘的危险因素。根据相关危险因素，儿童哮喘表型为：母乳喂养<2 个月和重度鼻炎 16 例（63.6%）；男性、多敏化和重度鼻炎 8 例（36.4%）。成人哮喘表型为：多敏化和重度鼻炎 30 例（52.6%）；男性、接触宠物和重度鼻炎 11 例（19.3%）；总血清 IgE 高和多敏化 16 例（28.1%）。
结论
缺乏针对 SAR 患儿和成人的 SIT 是哮喘的独立危险因素，而多敏化仅为儿童的危险因素。SAR 儿童中占主导地位的哮喘表型是母乳喂养<2 个月和重度鼻炎。在 SAR 成人中，占主导地位的哮喘表型是多敏化和重度鼻炎。
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