BMJ：学龄前哮鸣儿童发生哮喘可预测
英国曼彻斯特Wythenshawe医院Frank等报告，使用2个简单的预测因素，即父母报告的运动诱发性哮鸣和特应性疾病史，可估计学龄前哮鸣儿童将来发生哮喘的可能性。如果哮鸣儿童不存在运动诱发性哮鸣和特应性疾病史，其以后发生哮喘的可能性为同时具有上述因素儿童的五分之一，相关论文发表于《英国医学杂志》。
在1993~2004年期间，研究者采用国际儿童哮喘和变态反应研究问卷调查表对英国曼彻斯特南部2个全科医疗人群进行了5次纵向邮寄问卷调查。在6~11年期间，研究者对父母报告有或无哮鸣的一组学龄前儿童进行了随访，以确定哮鸣儿童的预后及发生哮喘的重要预测因素。
这些儿童纳入时年龄<5岁，共有628名儿童至少接受了6年随访。主要转归指标为父母填写的关于呼吸系症状和相关特点的问卷调查数据。
结果显示，在纳入研究的628名儿童中，201名(32%)在第一次观察(基线)时父母报告存在哮鸣，其中27%的儿童在第2次观察时亦报告有症状(持久哮喘)。持久哮喘唯一重要的基线预测因素为，运动诱发性哮鸣(比值比为3.94)与特应性疾病史(比值比为4.44)。
如果儿童存在上述2个预测因素，发生哮喘的可能性为53.2%。如只存在1个预测因素，则发生哮喘的可能性降至17.2%。如果2个预测因素都不存在，则发生哮喘的可能性为10.9%。而哮喘家族史未能预测学龄前哮鸣儿童将来是否发生持久哮喘。（生物谷Bioon.com）
生物谷推荐原始出处：
BMJ，2008;336:1423-1426 (21 June), doi:10.1136/bmj.39568.623750.BE，Peter I Frank, Timothy L Frank
Long term prognosis in preschool children with wheeze: longitudinal postal questionnaire study 1993-2004
Peter I Frank, director1, Julie A Morris, head of medical statistics2, Michelle L Hazell, senior research associate1, Mary F Linehan, senior research associate1, Timothy L Frank, director1
1 General Practice Research Unit, North West Lung Research Centre, Wythenshawe Hospital, Manchester M23 9LT, 2 Department of Medical Statistics, University Hospital of South Manchester NHS Foundation Trust, Manchester
Correspondence to: M L Hazell michelle.hazell@manchester.ac.uk
Objectives To follow a population of preschool children with and without parent reported wheeze over a period of 6-11 years to determine prognosis and its important predictive factors.
Design Longitudinal series of five postal surveys based on the international study of asthma and allergies in childhood questionnaire carried out between 1993 and 2004.
Setting Two general practice populations, south Manchester.
Participants 628 children aged less than 5 years at recruitment and those with at least six years’ follow-up data.
Main outcome measures Parent completed questionnaire data for respiratory symptoms and associated features.
Results Of 628 children included in the study, 201 (32%) had parent reported wheeze at the first observation (baseline), of whom 27% also reported the symptom on the second occasion (persistent asthma). The only important baseline predictors of persistent asthma were exercise induced wheeze (odds ratio 3.94, 95% confidence interval 1.72 to 9.00) and a history of atopic disorders (4.44, 1.94 to 10.13). The presence of both predictors indicated a likelihood of 53.2% of developing asthma; if only one feature was present this decreased to 17.2%, whereas if neither was present the likelihood was 10.9%. Family history of asthma was not predictive of persistent asthma among children with preschool wheeze.
Conclusion Using two simple predictive factors (baseline parent reported exercise induced wheeze and a history of atopic disorders), it is possible to estimate the likelihood of future asthma in children presenting with preschool wheeze. The absence of baseline exercise induced wheeze and a history of atopic disorders reduces the likelihood of subsequent asthma by a factor of five.
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