Chan Johnny Y C, Stern Debra A, Guerra Stefano, Wright Anne L, Morgan Wayne J, Martinez Fernando D
Department of Pediatrics, Kwong Wah Hospital, Hospital Authority, Kowloon, Hong Kong; and Arizona Respiratory Center, University of Arizona, Tucson, Arizona.
Arizona Respiratory Center, University of Arizona, Tucson, Arizona.
Pediatrics. 2015 Apr;135(4):607-16. doi: 10.1542/peds.2014-3060. Epub 2015 Mar 2.
Diminished lung function and increased prevalence of asthma have been reported in children with a history of early lower respiratory illnesses (LRIs), including pneumonia. Whether these associations persist up to adulthood has not been established.
As part of the prospective Tucson Children's Respiratory Study, LRIs during the first 3 years of life were ascertained by pediatricians. Spirometry was performed at ages 11, 16, 22, and 26 years. The occurrence of asthma/wheeze during the previous year was ascertained at ages 11, 13, 16, 18, 22, 24, 26, and 29 years. Longitudinal random effects models and generalized estimating equations were used to assess the relation of LRIs to lung function and asthma.
Compared with participants without early-life LRIs, those with pneumonia had the most severe subsequent lung function impairment, with mean ± SE deficits of -3.9% ± 0.9% (P < .001) and -2.5% ± 0.8% (P = .001) for pre- and post-bronchodilator FEV1:FVC ratio from age 11 to 26 years, respectively. Pneumonia was associated with increased risk for asthma (odds ratio [OR]: 1.95; 95% confidence interval [CI]: 1.11-3.44) and wheeze (OR: 1.94; 95% CI: 1.28-2.95) over the same age range. Early non-pneumonia LRIs were associated with mildly impaired pre-bronchodilator FEV1 (-62.8 ± 27.9 mL, P = .024) and FEV1:FVC ratio (-1.1 ± 0.5%, P = .018), and wheeze (OR: 1.37; 95% CI: 1.09-1.72).
Early pneumonia is associated with asthma and impaired airway function, which is partially reversible with bronchodilators and persists into adulthood. Early pneumonia may be a major risk factor for adult chronic obstructive pulmonary disease.
据报道，有早期下呼吸道疾病（LRI）病史的儿童，包括肺炎患儿，其肺功能会下降，哮喘患病率会增加。这些关联在成年后是否持续尚未确定。
作为图森儿童呼吸研究前瞻性研究的一部分，由儿科医生确定1岁前3年的下呼吸道感染情况。在11岁、16岁、22岁和26岁时进行肺活量测定。在11岁、13岁、16岁、18岁、22岁、24岁、26岁和29岁时确定上一年哮喘/喘息的发生情况。采用纵向随机效应模型和广义估计方程来评估下呼吸道感染与肺功能和哮喘之间的关系。
与无早期下呼吸道感染的参与者相比，肺炎患儿随后的肺功能损害最为严重，11岁至26岁期间，支气管扩张剂使用前和使用后FEV1:FVC比值的平均±标准误下降分别为-3.9%±0.9%（P<.001）和-2.5%±0.8%（P=.001）。在相同年龄范围内，肺炎与哮喘风险增加（比值比[OR]：1.95；95%置信区间[CI]：1.11-3.44）和喘息风险增加（OR：1.94；95%CI：1.28-2.95）相关。早期非肺炎性下呼吸道感染与支气管扩张剂使用前FEV1轻度受损（-62.8±27.9 mL，P=.024）、FEV1:FVC比值轻度受损（-1.1±0.5%，P=.018）以及喘息（OR：1.37；95%CI：1.09-1.72）相关。
早期肺炎与哮喘和气道功能受损相关，支气管扩张剂可部分逆转这种损害，且这种损害会持续到成年期。早期肺炎可能是成人慢性阻塞性肺疾病的主要危险因素。
