儿童哮喘急性加重的季节性变化及其与哮喘表型的关联。
Seasonal variation of pediatric asthma exacerbations and its association with asthma phenotypes.
作者信息
Makrufardi Firdian, Rusmawatiningtyas Desy, Murni Indah Kartika, Arguni Eggi, Lin Yuan-Chien, Ho Kin-Fai, Chung Kian Fan, Lin Sheng-Chieh, Chuang Hsiao-Chi
机构信息
International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Department of Child Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada - Dr. Sardjito Hospital, Yogyakarta, Indonesia.
出版信息
Pediatr Res. 2025 May 7. doi: 10.1038/s41390-025-04073-2.
BACKGROUND
The objective of this study was to examine the associations of blood inflammatory phenotypes with acute pediatric asthma exacerbations during different seasons and the COVID-19 pandemic.
METHODS
A retrospective study was conducted involving 32,160 pediatric asthma patients from January 2008 to December 2021. Asthma blood inflammatory phenotypes were categorized based on low (L) and high (H) eosinophils (E) and neutrophils (N) (LBE/HBE: ≥ 0.25 × 10/L and LBN/HBN: ≥ 5 × 10/L, respectively) and logistic regression was used to examine the odds ratio (OR) of outcome variables.
RESULTS
A 10/L increase of neutrophils and eosinophils was associated with a 1.015-fold (95% CI: 1.009-1.021) and a 1.057-fold increase in the OR (95% CI: 1.026-1.088) for asthma exacerbations of hospitalized pediatric asthma patients. An increase in HBE/LBN phenotype was associated with a respective 1.232-fold (95% CI: 1.081-1.404) and 1.248-fold (95% CI: 1.101-1.414) increase in the OR for asthma exacerbations of hospitalized pediatric asthma patients before the COVID-19 pandemic in the winter and autumn seasons. However, an increase of LBE/LBN phenotype was associated with a respective 0.873-fold (95% CI: 0.769-0.991), 0.872-fold (95% CI: 0.771-0.986), and 0.813-fold (95% CI: 0.709-0.932) decrease in the OR for asthma exacerbations in the winter, spring and summer seasons.
CONCLUSIONS
HBE/LBN phenotype had a higher risk of asthma exacerbations among hospitalized pediatric asthma patients in the winter and autumn, while LBE/LBN phenotype had a lower risk in the winter, spring, and summer.
IMPACT
Blood eosinophils and neutrophils have been indicated to have a potential influence on pediatric asthma development and severity. HBE/LBN phenotype was associated with increased asthma exacerbations among hospitalized pediatric asthma patients during winter and autumn. Eosinophil and neutrophil predominance exhibited a higher influence on pediatric asthma exacerbations.
背景
本研究的目的是探讨血液炎症表型与不同季节及新冠疫情期间儿童急性哮喘发作之间的关联。
方法
进行了一项回顾性研究，纳入了2008年1月至2021年12月期间的32160例儿童哮喘患者。根据低（L）和高（H）嗜酸性粒细胞（E）及中性粒细胞（N）对哮喘血液炎症表型进行分类（LBE/HBE：分别≥0.25×10/L和LBN/HBN：≥5×10/L），并使用逻辑回归分析来检验结局变量的比值比（OR）。
结果
住院儿童哮喘患者哮喘发作的OR值中，中性粒细胞和嗜酸性粒细胞每增加10/L，分别增加1.015倍（95%CI：1.009 - 1.021）和1.057倍（95%CI：1.026 - 1.088）。在新冠疫情之前的冬季和秋季，住院儿童哮喘患者哮喘发作的OR值中，HBE/LBN表型增加分别与增加1.232倍（95%CI：1.081 - 1.404）和1.248倍（95%CI：1.101 - 1.414）相关。然而，在冬季、春季和夏季，LBE/LBN表型增加与住院儿童哮喘患者哮喘发作的OR值分别降低0.873倍（95%CI：0.769 - 0.991）、0.872倍（95%CI：0.771 - 0.986）和0.813倍（95%CI：0.709 - 0.932）相关。
结论
在冬季和秋季，住院儿童哮喘患者中HBE/LBN表型哮喘发作风险较高，而在冬季、春季和夏季，LBE/LBN表型风险较低。
影响
血液嗜酸性粒细胞和中性粒细胞已被表明对儿童哮喘的发生发展及严重程度有潜在影响。在冬季和秋季，住院儿童哮喘患者中HBE/LBN表型与哮喘发作增加相关。嗜酸性粒细胞和中性粒细胞优势对儿童哮喘发作有更高影响。
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