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呼吸道合胞病毒细支气管炎后的复发性喘息和哮喘

Recurrent Wheezing and Asthma After Respiratory Syncytial Virus Bronchiolitis.

作者信息

Zhou Yunlian, Tong Lin, Li Mengyao, Wang Yingshuo, Li Lanxin, Yang Dehua, Zhang Yuanyuan, Chen Zhimin

机构信息

Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.

出版信息

Front Pediatr. 2021 Jun 4;9:649003. doi: 10.3389/fped.2021.649003. eCollection 2021.

Abstract

Respiratory syncytial virus (RSV) is the most common pathogen of acute bronchiolitis in children, which sometimes triggers the development of recurrent wheezing and increases the risk of childhood asthma. We enrolled 425 children who were diagnosed with RSV-infected bronchiolitis at the department of pulmonology, Children's Hospital Zhejiang University School of Medicine in 2011. Long-term follow-up was performed to explore the consequence of bronchiolitis on subsequent recurrent wheezing and asthma. Of 425 patients, 266 cases completed the entire follow-up, the mean age of onset was 4.9 (3.3) months, and the male-to-female ratio was 2.5. The mean birth weight of all patients was 3.22 (0.63) kg, and the number of patients who had a history of cesarean section was 148. According to the outcome of follow-up, 36 were in the recurrent wheezing (RW) group, 65 were in the asthma (AS) group, and the remaining 165 were in the completely recovered (CR) group. The age of onset was older and the birth weights were higher in the AS group than those in the CR group ( < 0.05). And the higher proportion of cesarean sections was higher in the RW group than that in the CR group ( < 0.05). Furthermore, we found a remarkable increasing of serum IgE in the AS groups than that in the CR group ( < 0.01). Multiple logistic regression analysis showed that the cesarean section was the risk factor for the development of recurrent wheezing and the higher birth weight was the risk factor for the development of asthma. RSV bronchiolitis might increase the incidence of recurrent wheezing and asthma. Allergic constitution was an important prerequisite for the occurrence of asthma, and related risk factor such as cesarean section can only increase recurrent wheezing to a certain extent within a certain period of time. And we also find higher birth weight and older onset age for those who develop asthma, which should be verified in the future.

摘要

呼吸道合胞病毒(RSV)是儿童急性细支气管炎最常见的病原体,有时会引发反复喘息,并增加儿童患哮喘的风险。2011年,我们纳入了425名在浙江大学医学院附属儿童医院呼吸内科被诊断为RSV感染性细支气管炎的儿童。进行长期随访以探讨细支气管炎对随后反复喘息和哮喘的影响。425例患者中,266例完成了全部随访,发病的平均年龄为4.9(3.)个月,男女比例为2.5。所有患者的平均出生体重为3.22(0.63)kg,有剖宫产史的患者为148例。根据随访结果,36例属于反复喘息(RW)组,65例属于哮喘(AS)组,其余165例属于完全康复(CR)组。AS组的发病年龄比CR组大,出生体重也更高(<0.05)。RW组剖宫产的比例高于CR组(<0.05)。此外,我们发现AS组血清IgE显著高于CR组(<0.01)。多因素logistic回归分析显示,剖宫产是反复喘息发生的危险因素,较高的出生体重是哮喘发生的危险因素。RSV细支气管炎可能会增加反复喘息和哮喘的发生率。过敏体质是哮喘发生的重要前提,剖宫产等相关危险因素只能在一定时期内一定程度上增加反复喘息。并且我们还发现患哮喘者出生体重较高且发病年龄较大,这一点有待未来进一步验证。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7e7d/8211724/9985bea0f3f3/fped-09-649003-g0001.jpg

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