Asthma, lung function and allergy in 12-year-old children with very low birth weight:: A prospective study
Asthma, lung function and allergy in 12-year-old children with very low birth weight:: A prospective study
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DOI：
10.1034/j.1399-3038.2003.00045.x
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发表时间：
2003-06-01
影响因子：
4.4
通讯作者：
Leijon, I
中科院分区：
文献类型：
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作者：
Mai, XM;Gäddlin, PO;Leijon, I
我们评估了极低出生体重(VLBW)(小于或等于1500克)与哮喘、肺功能和特应性的关系。研究组包括全部86名极低出生体重儿中的74名(86%)和所有86名匹配的足月儿中的(74%)，他们前瞻性地随访了12年。对12岁儿童进行哮喘和过敏症状问卷调查，并进行皮肤点刺试验、肺活量测定和高渗盐水激发试验。本文分析了28例极低出生体重儿和23例足月新生儿外周血白细胞培养中细胞因子的分泌情况。与12岁时足月出生的儿童相比，极低出生体重儿的哮喘史更为常见(22%对9%，p=0.046)。单因素分析显示，在极低出生体重儿中，早产(胎龄25~29周)(RR 2.5，95%CI 1.1~5.8)、新生儿机械通气(RR 2.8，95%CI 1.2~6.4)和新生儿补氧(RR 4.3，95%CI 1.3~14.0)与12岁以前的哮喘史显著相关。在多因素Logistic回归分析中，新生儿补氧大于或等于9天是哮喘病史的唯一显著危险因素(调整后的OR6.7，95%可信区间1.0-44)。在新生儿期需要机械呼吸机的极低出生体重儿比那些不需要机械呼吸机的极低出生体重儿更有可能出现支气管高反应性(60%比28%，p=0.050)。12岁时极低出生体重儿和足月儿的肺活量值相似。极低出生体重与过敏性鼻结膜炎、湿疹或皮肤点刺试验阳性没有显著关系。此外，极低出生体重儿和足月儿刺激细胞培养中IL-4、IL-5和干扰素-γ的水平相似。12岁以前有哮喘史的极低出生体重儿是足月儿童的两倍，新生儿补充氧气似乎与增加风险有关。此外，新生儿期的机械通气与12岁时的支气管高反应性有关。然而，极低出生体重本身与特应性无关。
We assessed the relationship between very low birth weight (VLBW) (less than or equal to1500 g) and the development of asthma, lung function and atopy. The study groups comprised 74 of all 86 (86%) VLBW and 64 of all 86 (74%) matched term children who were prospectively followed for 12 years. A questionnaire on asthmatic and allergic symptoms was completed and skin prick tests, spirometry and hypertonic saline provocation tests were performed at 12 years of age. Cytokine secretion was analysed in stimulated blood leukocyte cultures in 28 VLBW and 23 term children. A history of asthma was more frequent among the VLBW children, as compared with the term children at age 12 (22% vs. 9%, p = 0.046). Among the VLBW children, very preterm birth (gestational age: week 25 to 29) (RR 2.5, 95%CI 1.1-5.8), neonatal mechanical ventilation (RR 2.8, 95%CI 1.2-6.4) and neonatal oxygen supplementation (RR 4.3, 95%CI 1.3-14.0) were significantly associated with a history of asthma by the age of 12 years in univariate analyses. In multivariate logistic regression, neonatal oxygen supplementation greater than or equal to 9 days was the only remaining significant risk factor for a history of asthma (adjusted OR 6.7, 95%CI 1.0-44). The VLBW children who required mechanical ventilation during the neonatal period were more likely to have bronchial hyperresponsiveness than those not requiring mechanical ventilation (60% vs. 28%, p = 0.050). The spirometric values were similar among the VLBW and the term children at 12 years. Very low birth weight was not significantly related to allergic rhinoconjunctivitis, eczema or positive skin prick tests. Furthermore, the levels of IL-4, IL-5 and IFN-gamma in stimulated cell cultures were similar in the VLBW and the term children. A history of asthma by 12 years of age was twice as common among the VLBW as the term children, and neonatal oxygen supplementation seemed to be associated with the increased risk. Furthermore, mechanical ventilation during the neonatal period was associated with bronchial hyperresponsiveness at age 12. Very low birth weight per se was not, however, related to atopy.