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儿童哮喘控制水平的影响因素和评估指标分析
Influencing factors and evaluation indicators for asthma control level in children
目的 分析儿童哮喘控制水平的影响因素，评价哮喘评估指标的实用性。方法 选取185例哮喘患儿，采用问卷及肺功能检测的方法，分析儿童哮喘控制水平及影响因素，以及评估指标与哮喘控制水平的相关性。结果 185例患儿中，完全控制的139例 （75.1%），部分控制的36例 （19.5%），未控制10例 （5.4%）。是否规范吸入糖皮质激素和嗜酸性粒细胞计数水平对哮喘控制的影响有统计学意义 （P < 0.05）。第1秒用力呼气容积占预计值的百分比 （FEV1%）、呼出气一氧化氮 （FeNO）以及儿童哮喘控制测试问卷 （C-ACT）、儿科哮喘生命质量调查问卷 （PAQLQ）得分等哮喘检测指标在控制组、部分控制组和未控制组之间的差异有统计学意义 （P < 0.05）。哮喘患儿FEV1%与C-ACT、PAQLQ呈正相关性 （r = 0.214、0.312，P < 0.05），而与FeNO水平没有显著的相关性 （r = -0.18，P > 0.05）。结论 吸入糖皮质激素治疗的依从性和嗜酸性粒细胞计数水平是儿童哮喘控制的影响因素。联合FEV1%、FeNO水平以及C-ACT、PAQLQ评分等多个指标评估哮喘控制水平，更有利于儿童哮喘的临床诊疗。
Objective To investigate the influencing factors for asthma control level in children and the practicability of evaluation indicators for asthma. Methods A total of 185 children with asthma were enrolled. Questionnaires and pulmonary function test were used to evaluate the asthma control level and the factors influencing the control level. The correlation between evaluation indicators and asthma control level was analyzed. Results Among the 185 children with asthma, 139 (75.1%) achieved full control, 36 (19.5%) achieved partial control, and 10 (5.4%) had uncontrolled asthma. Application of inhaled corticosteroids and eosinophil count showed significant effects on asthma control level (P < 0.05). There were significant differences in the percentage of forced expiratory volume in 1 second (FEV1%), fractional exhaled nitric oxide (FeNO), childhood asthma control test (C-ACT) questionnaire score, and pediatric asthma quality of life questionnaire (PAQLQ) score between the full control, partial control, and uncontrolled groups (P < 0.05). In the children with asthma, FEV1% was positively correlated with C-ACT and PAQLQ scores (P < 0.05), while there was no significant correlation between FEV1% and FeNO (P=0.214). Conclusions Application of inhaled corticosteroids and eosinophil count are factors influencing asthma control in children. A combination of FEV1%, FeNO, C-ACT score, and PAQLQ score helps with the evaluation of asthma control level.
哮喘 / 控制水平 / 呼出气一氧化氮 / 第1秒用力呼气容积占预计值的百分比 / 儿童哮喘控制测试问卷 / 儿童
Asthma / Control level / Fractional exhaled nitric oxide / Percentage of forced expiratory volume in 1 second / Childhood asthma control test questionnaire / Child
[1] 全国儿科哮喘协作组, 中国疾病预防控制中心环境与健康相关产品安全所. 第三次中国城市儿童哮喘流行病学调查[J]. 中华儿科杂志, 2013, 51(10):729-735.
[2] Global Initiative for Asthma. New tool to track and reduce asthma hospitalization[DB/OL]. (2015-05-06). http://www. ginasthma.org.
[3] 中华医学会儿科分会呼吸学组, 《中华儿科杂志》编辑委员会. 儿童支气管哮喘诊断与防治指南(2008年修订)[J]. 中华儿科杂志, 2008, 46(10):745-753.
[4] 骆学勤, 刘恩梅, 符州, 等. 呼出气一氧化氮与儿童哮喘控制测试和支气管激发试验指标相关性研究[J]. 中国实用儿科杂志, 2013, 28(7):533-536.
[5] Pedersen S. From asthma severity to control:a shift in clinical practice[J]. Prim Care Respir J, 2010, 19(1):3-9.
[6] 顾希茜, 段红梅, 向莉. 儿童哮喘控制测试在门诊定期随访管理中的应用价值[J]. 中华护理杂志, 2014, 49(5):625-628.
[7] 吴谨准, 张健民, 盛锦云, 等. 应用儿科哮喘生命质量调查问卷评估儿童哮喘吸入疗法[J]. 中华儿科杂志, 2004, 42(4):301-302.
[8] Pinnock H, Fletcher M, Holmes S, et al. Setting the standard for routine asthma consultations:a discussion of the aims, process and outcomes of reviewing people with asthma in primary care[J]. Prim Care Respir J, 2010, 19(1):75-83.
[9] Tesse R, Pandey RC, Kabesch M. Genetic variations in toll-like receptor pathway genes influent asthma and atopy[J]. Allergy, 2011, 66(3):307-316.
[10] Tischer CG, Hohmann C, Thiering E, et al. Meta-analysis of mould and dampness exposure on asthma and allergy in eight European birth cohorts:an ENRIECO initiative[J]. Allergy, 2011, 66(12):1570-1579.
[11] van de Griendt EJ, Verkleij M, Douwes JM, et al. Problematic severs asthma in children treated at high altitude:tapering the dose while improving control[J]. J Asthma, 2014, 51(3):315-319.
[12] Wadsworth SJ, Sin D, Dorscheid D. Clinical update on the use of biomarkers of airway inflammation in the management of asthma[J]. J Asthma Allergy, 2011, 4:77-86.
[13] Dodig S, Richter D, Zrinski-Topi? R. Inflammatory markers in childhood asthma[J]. Clin Chem Lab Med, 2011, 49(4):587-599.
[14] Louis R, Lau LC, Bron AO, et al. The relationship between airways inflammation and asthma severity[J]. Am J Respir Crit Care Med, 2000, 161(1):9-16.
[15] Waibel V, Ulmer H, Horak E. Assessing asthma control:symptom scores, GINA levels of asthma control, lung function, and exhaled nitric oxide[J]. Pediatr Pulmonol, 2012, 47(2):113-118.
[16] Malby Schoos AM, Chawes BL, Bønnelykke K, et al. Fraction of exhaled nitric oxide and bronchial responsiveness are associated and continuous traits in young children independent of asthma[J]. Chest, 2012, 142(6):1562-1568.
