Sex-specific effects of asthma on pulmonary function in children
Sex-specific effects of asthma on pulmonary function in children
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DOI：
10.1164/ajrccm.162.5.2001116
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发表时间：
2000-11-01
影响因子：
24.7
通讯作者：
Peters, JM
中科院分区：
文献类型：
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作者：
Berhane, K;McConnell, R;Peters, JM
为了评估哮喘对肺功能的影响，自诊断哮喘以来的时间，以及诊断哮喘时的年龄，我们在4年的随访期内对2，277名四年级和七年级学生的队列进行了至少两次检查。通过混合效应模型拟合每种肺功能的性别特异性模型，该模型使用回归样条并捕获哮喘对肺功能影响的年龄依赖性趋势。在男性中，哮喘史与最大呼气中段流量（MMEF）（-4.89%）和75%呼气FVC时用力呼气流量（FEF75）（-6.62%）的巨大且具有统计学显著性的缺陷相关，而在女性中，这些缺陷较小（分别为-1.93%和-2.45%）且无统计学显著性。然而，自诊断以来时间较长的男性和女性中均观察到较大的缺损。与确诊后3年内的儿童相比，确诊后6年以上的男性患者FEV1、MMEF、FEF75和PEFR均明显下降，分别为-3.91%、-7.39%、-8.12%和-4.65%。诊断后超过6年的女性较少，但FEV1（-2.52%）、MMEF（-9.26%）和FEF75（-14.28%）的缺陷与男性相似。据报道，在3岁以前被诊断为哮喘的男性和女性中，观察到大气道和小气道的流速都有很大的不足。几乎没有证据表明哮喘儿童的肺部生长在年龄较大时“赶上”。因此，由于恒定的肺功能缺陷百分比意味着肺较大的大龄儿童的绝对缺陷越来越大，这些结果与先前的证据一致，即哮喘儿童的肺功能缺陷持续到成年。我们还认为，在儿童中，通常观察到的哮喘对肺功能影响的性别差异可能反映了男性和女性哮喘发作的持续时间和年龄的差异。
To evaluate the effects on lung function of asthma, time since diagnosis of asthma, and age at diagnosis of asthma, we examined school children in a cohort of 2,277 fourth- and seventh-graders at least twice during a 4-yr follow-up period. Sex-specific models for each lung function were fitted through mixed-effects models that used regression splines and captured age-dependent trends in the effect of asthma on lung function. In males, a history of asthma was associated with large and statistically significant deficits in maximum midexpiratory flow (MMEF) (-4.89%) and forced expiratory flow at 75% of expired FVC (FEF75) (-6.62%), whereas in females these deficits were smaller (-1.93% and -2.45%, respectively) and were not statistically significant. However, larger deficits were seen in both males and females with longer time since diagnosis. In males with more than 6 yr since diagnosis, there were significant deficits in FEV1 (-3.91%), MMEF (-7.39%), FEF75 (-8.12%), and peak expiratory flow rate (PEFR) (-4.65%) as compared with children with less than 3 yr since diagnosis. There were fewer females with more than 6 yr since diagnosis, but deficits were similar to those of males for FEV1 (-2.52%), MMEF (-9.26%), and FEF75 (-14.28%). Large deficits in flow rates in both large and small airways were observed in males and females for whom asthma was reported to have been diagnosed before age 3 yr. There was little evidence that lung growth in children with asthma "catches up" at older ages. Therefore, because a constant percent deficit in lung function implies an increasingly large absolute deficit in older children with larger lungs, these results are consistent with prior evidence that lung function deficits in children with asthma persist into adulthood. We also suggest that in children, commonly observed differences between sexes in the impact of asthma on lung function may reflect differences in the duration and age of onset of asthma in males and females.