Martinez F D, Wright A L, Taussig L M, Holberg C J, Halonen M, Morgan W J
Respiratory Sciences Center, University of Arizona College of Medicine, Tucson.
N Engl J Med. 1995 Jan 19;332(3):133-8. doi: 10.1056/NEJM199501193320301.
Many young children wheeze during viral respiratory infections, but the pathogenesis of these episodes and their relation to the development of asthma later in life are not well understood.
In a prospective study, we investigated the factors affecting wheezing before the age of three years and their relation to wheezing at six years of age. Of 1246 newborns in the Tucson, Arizona, area enrolled between May 1980 and October 1984, follow-up data at both three and six years of age was available for 826. For these children, assessments in infancy included measurement of cord-serum IgE levels (measured in 750 children), pulmonary-function testing before any lower respiratory illness had occurred (125), measurement of serum IgE levels at nine months of age (672), and questionnaires completed by the children's parents when the children were one year old (800). Assessments at six years of age included measurement of serum IgE levels (in 460), pulmonary-function testing (526), and skin allergy testing (629).
At the age of six years, 425 children (51.5 percent) had never wheezed, 164 (19.9 percent) had had at least one lower respiratory illness with wheezing during the first three years of life but had no wheezing at six years of age, 124 (15.0 percent) had no wheezing before the age of three years but had wheezing at the age of six years, and 113 (13.7 percent) had wheezing both before three years of age and at six years of age. The children who had wheezing before three years of age but not at the age of six had diminished airway function (length-adjusted maximal expiratory flow at functional residual capacity [Vmax FRC]) both before the age of one year and at the age of six years, were more likely than the other children to have mothers who smoked but not mothers with asthma, and did not have elevated serum IgE levels or skin-test reactivity. Children who started wheezing in early life and continued to wheeze at the age of six were more likely than the children who never wheezed to have mothers with a history of asthma (P < 0.001), to have elevated serum IgE levels (P < 0.01), to have normal lung function in the first year of life, and to have elevated serum IgE levels (P < 0.001) and diminished values for VmaxFRC (P < 0.01) at six years of age.
The majority of infants with wheezing have transient conditions associated with diminished airway function at birth and do not have increased risks of asthma or allergies later in life. In a substantial minority of infants, however, wheezing episodes are probably related to a predisposition to asthma.
许多幼儿在病毒性呼吸道感染期间会出现喘息，但这些发作的发病机制及其与日后哮喘发展的关系尚未完全明确。
在一项前瞻性研究中，我们调查了影响三岁前喘息的因素及其与六岁时喘息的关系。在1980年5月至1984年10月期间登记的亚利桑那州图森市的1246名新生儿中，826名儿童有三岁和六岁时的随访数据。对于这些儿童，婴儿期的评估包括脐血IgE水平测定（750名儿童）、在发生任何下呼吸道疾病之前的肺功能测试（125名）、九个月大时血清IgE水平测定（672名）以及儿童一岁时其父母填写的问卷（800名）。六岁时的评估包括血清IgE水平测定（460名）、肺功能测试（526名）和皮肤过敏测试（629名）。
六岁时，425名儿童（51.5%）从未喘息过，164名（19.9%）在生命的前三年至少有一次下呼吸道疾病伴喘息但六岁时无喘息，124名（15.0%）三岁前无喘息但六岁时有喘息，113名（13.7%）三岁前和六岁时均有喘息。三岁前有喘息但六岁时没有喘息的儿童在一岁前和六岁时气道功能（功能残气量时的长度校正最大呼气流量[Vmax FRC]）均降低，比其他儿童更有可能有吸烟的母亲但没有患哮喘的母亲，且血清IgE水平或皮肤试验反应性未升高。早年开始喘息并在六岁时仍继续喘息的儿童比从未喘息过的儿童更有可能有哮喘病史的母亲（P<0.001）、血清IgE水平升高（P<0.01）、一岁时肺功能正常、六岁时血清IgE水平升高（P<0.001）且VmaxFRC值降低（P<0.01）。
大多数喘息婴儿有与出生时气道功能降低相关的短暂情况，日后患哮喘或过敏的风险并未增加。然而，在相当少数的婴儿中，喘息发作可能与哮喘易感性有关。
