昆明市儿童哮喘流行病学调查分析

Epidemiological survey of childhood asthma in Kunming City, China

摘要:

目的 了解昆明市儿童哮喘的流行现状、分布特征、诱发因素及治疗情况，为进一步规范哮喘患儿诊治提供依据。方法 采用随机整群抽样的方法，通过自填式问卷调查与集中调查相结合的方式进行调查。对于初筛问卷中的可疑哮喘患儿按哮喘诊断标准进行诊断，对确诊的哮喘患儿填写哮喘儿童调查表。结果 昆明市 0~14 岁儿童哮喘患病率为 1.40%，男性患病率明显高于女性（P<0.05）。6 岁以前儿童哮喘患病率明显高于 6 岁以后（P<0.05）。哮喘患儿中既往诊断为哮喘及咳嗽变异性哮喘的占 51.3%。哮喘急性发作在 12~2 月份最多，占 26.0%，午夜及清晨最易发作，占 54.0%。87.3% 的哮喘发作诱因为呼吸道感染。使用抗生素治疗的有80.0%，使用支气管舒张剂治疗的有 66.0%，吸入糖皮质激素治疗有 64.0%。5 岁以上哮喘患儿风流速仪使用率为 17%。结论 昆明市 0~14 岁儿童哮喘的患病与年龄、性别有关。哮喘急性发作多发生在冬季、午夜及清晨，最常见的发作诱因为呼吸道感染。哮喘既往诊断与调查时最后诊断的符合率较低。糖皮质激素及支气管舒张剂吸入治疗的比例较低，而使用抗生素治疗的患儿比例则较高，需进一步规范哮喘患儿诊治方法。

Abstract:

Objective To investigate the prevalence of childhood asthma, and to find the distribution characteristics, precipitating factors, diagnosis and treatment status, and to provide scientific data for improving the prevention and management of asthma in children in Kunming City, China.Methods Children were selected by random cluster sampling. A standardized preliminary questionnaire was used for screening out possible patients in the survey. Diagnosis of asthma was confirmed by diagnostic criteria in suspected asthmatic children. Asthmatic children were further asked for past diagnosis and treatment with the questionnaire of asthma in children. Results The total asthma incidence rate was 1.40%. The prevalence of asthma in male and female children was 1.89% and 0.88% respectively（P<0.05). Children aged 0-5 years old had a higher prevalence of asthma（1.69%) than that of school-age children（6-14 years old, 1.21%). In all asthmatic children, 51.3% were previously diagnosed with classical asthma or cough variant asthma, 26.0% were suffered attacks from December to February, and 54.0% were suffered attacks at midnight or dawn. Respiratory tract infection（87.3%) was the most common triggers of asthma exacerbation. Antibiotics were used in 80.0%, bronchodilators in 66.0%, inhaled corticosteroid in 64.0%. A peak flow meter for monitoring lung function was used in 17% of asthmatic children over 5 years old. Conclusion The prevalence of asthma is associated with age and gender in children aged 0-14 years old in Kunming City. Acute asthma attack occurs mostly in winter and at midnight or dawn. Respiratory tract infection is the most common trigger of asthma exacerbation. Nearly a half of patients with asthma had not been diagnosed with asthma in the early stage. Most asthmatic children use antibiotics and only two-thirds use bronchodilators or inhaled corticosteroid in the treatment. The treatment and management of asthma in children awaits improvement as well.