郑州市城区儿童哮喘的流行病学调查及发病相关因素分析

Epidemiological survey and risk factor analysis of asthma in children in urban districts of Zhengzhou, China

摘要:

目的 了解郑州市儿童哮喘的流行病学特征、诊治情况及发病的危险因素.方法 以多阶段分层抽样的方法发放初筛问卷.疑似哮喘者二次问卷调查、体检及查阅既往病历、辅助检查,明确诊断;同时根据年龄、性别匹配的原则随机抽取非哮喘患儿调查作为对照.结果 共收集有效调查问卷10 616份,其中男5 444人,女5 172人.哮喘确诊308人,患病率为2.90%.男童患病率高于女童(3.38% vs 2.40%);3岁以下儿童哮喘患病率为10.24%,高于其他年龄组儿童.哮喘儿童发作的前3位诱因包括呼吸道感染(94.2%)、天气变化(89.0%)和运动(35.1%).哮喘患儿发作强度多为中度发作(71.8%),其次为轻度(22.7%).94.8%(292例)吸入糖皮质激素治疗,74.7%(230例)全身使用糖皮质激素治疗,90.9%(280例)使用抗生素治疗.多因素logistic回归分析显示下列因素是哮喘发病的主要危险因素:过敏性鼻炎史(OR=150.285,95%CI:31.934~707.264)、湿疹史(OR=10.600,95%CI:1.054~106.624)、特应性皮炎史(OR=31.368,95%CI:3.339~294.683)、食物过敏史(OR=27.373,95%CI:2.670~280.621)、出生方式(OR=2.853,95%CI:1.311~6.208)、使用抗生素的年龄(OR=0.384,95%CI: 0.172~0.857)、1岁内使用抗生素的次数(OR=9.940,95%CI:6.246~15.820)、家装修墙面材料(OR=2.108,95%CI:1.464~3.036)、冬天是否采暖(OR=6.046,95%CI:1.034~35.362).结论 郑州市儿童哮喘患病率与年龄、性别有关;发作程度以中度为主;哮喘最主要诱因为呼吸道感染.哮喘的治疗较规范,但仍有待提高.过敏性鼻炎史、湿疹史、特应性皮炎史、食物过敏史及剖腹产出生、1岁内使用抗生素的次数多、家墙面使用装修材料、冬天采暖会增加儿童哮喘发病的危险,而使用抗生素时间较晚者哮喘发病的危险性较低.

Abstract:

Objective To study the epidemiological features, treatment status, and risk factors for asthma in children in Zhengzhou, China. Methods Questionnaires for primary screening were issued using the method of multi-stage stratified sampling. Suspected asthmatic children were given a second questionnaire, physical examination, medical history review, and auxiliary examination to confirm the diagnosis. Age-and sex-matched non-asthmatic children were randomly recruited to the control group. Results The number of valid questionnaires was 10 616 (5 444 males and 5 172 females). There were 308 confirmed asthma cases and the overall prevalence was 2.90%. The prevalence in boys was higher than that in girls (3.4% vs 2.4%). The prevalence in children under 3 years of age was 10.2%, which was higher than that in other age groups. The top three triggers for asthma attack in children were respiratory infection (94.2%), weather changes (89.0%), and exercise (35.1%). The most common asthma attack was moderate (71.8%), followed by mild (22.7%). Inhaled corticosteroids, systemic corticosteroids, and antibiotics were applied to 94.8% (292 cases), 74.7% (230 cases), and 90.9% (280 cases) of all patients, respectively. Multivariate logistic regression analysis indicated the following major risk factors for asthma: history of allergic rhinitis (OR=150.285, 95% CI: 31.934-707.264), history of eczema (OR=10.600, 95% CI: 1.054-106.624), history of atopic dermatitis (OR=31.368, 95% CI: 3.339-294.683), food allergies (OR=27.373, 95% CI: 2.670-280.621), method of birth (OR=2.853, 95% CI: 1.311-6.208), age of first antibiotic use (OR=0.384, 95% CI: 0.172-0.857), frequency of antibiotic use within 1 year of age (OR=9.940, 95% CI: 6.246-15.820), use of wall decorating materials (OR=2.108, 95% CI: 1.464-3.036), and use of heat supply in winter (OR=6.046, 95% CI: 1.034-35.362). Conclusions The prevalence of childhood asthma is associated with age and gender in Zhengzhou. Most asthma attacks are moderate, often triggered by respiratory infection. Treatment of asthma has been standardized, but still needs further improvement. History of allergic rhinitis, eczema, atopic dermatitis and food allergies, cesarean delivery, frequent use of antibiotics within 1 year of age, use of decorating materials on the wall, and use of heating in winter may increase risk for asthma, and use of antibiotics in older age is a protective factor against asthma in children.