ASTHMA AND WHEEZING IN THE FIRST 6 YEARS OF LIFE
ASTHMA AND WHEEZING IN THE FIRST 6 YEARS OF LIFE
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DOI：
10.1056/nejm199501193320301
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发表时间：
1995-01-19
影响因子：
158.5
通讯作者：
MCLELLAN, M
中科院分区：
文献类型：
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作者：
MARTINEZ, FD;WRIGHT, AL;MCLELLAN, M
背景许多幼儿在病毒性呼吸道感染时会出现喘息，但这些发作的发病机制及其与日后哮喘发展的关系尚不清楚。在一项前瞻性研究中，我们调查了三岁以前影响喘息的因素及其与六岁时喘息的关系。1246名新生儿在图森，亚利桑那州，1980年5月和1984年10月之间登记的地区，在3岁和6岁的随访数据可用于826。对于这些儿童，婴儿期的评估包括测量脐带血清IgE水平（在750名儿童中进行测量），在任何下呼吸道疾病发生之前进行肺功能测试（125），在9个月大时测量血清IgE水平（672），以及在儿童一岁时由儿童父母完成的问卷调查（800），6岁时的评估包括血清IgE水平测量（460例）、肺功能试验（526例）和皮肤过敏试验（629例）。在六岁的时候，425个孩子（51.5%）从来没有喘鸣，164（19.9%）在生命的前三年至少有一次下呼吸道疾病伴喘息，但在六岁时没有喘息，124（15.0%）在3岁之前没有喘息，但在6岁时有喘息，113（13.7%）在3岁之前和6岁时都有喘息。在3岁以前有喘息而在6岁时没有喘息的儿童在1岁以前和6岁时都有气道功能下降（长度调整的功能残气量最大呼气流量[V（max）FRC]），与其他儿童相比，母亲吸烟而母亲没有哮喘的可能性更大，血清IgE水平或皮肤试验反应性也没有升高。在生命早期开始喘息并在6岁时持续喘息的儿童比从未喘息的儿童更有可能有哮喘史的母亲（P
Background. Many young children wheeze during viral respiratory infections, but the pathogenesis of these episodes and their relation to the development of asthma later in life are not well understood.Methods. In a prospective study, we investigated the factors affecting wheezing before the age of three years and their relation to wheezing at six years of age. Of 1246 newborns in the Tucson, Arizona, area enrolled between May 1980 and October 1984, follow-up data at both three and six years of age were available for 826. For these children, assessments in infancy included measurement of cord-serum IgE levels (measured in 750 children), pulmonary-function testing before any lower respiratory tract illness had occurred (125), measurement of serum IgE levels at nine months of age (672), and questionnaires completed by the children's parents when the children were one year old (800), Assessments at six years of age included measurement of serum IgE levels (in 460), pulmonary-function testing (526), and skin allergy testing (629).Results. At the age of six years, 425 children (51.5 percent) had never wheezed, 164 (19.9 percent) had had at least one lower respiratory tract illness with wheezing during the first three years of life but had no wheezing at six years of age, 124 (15.0 percent) had no wheezing before the age of three years but had wheezing at the age of six years, and 113 (13.7 percent) had wheezing both before three years of age and at six years of age. The children who had wheezing before three years of age but not at the age of six had diminished airway function (length-adjusted maximal expiratory flow at functional residual capacity [V(max)FRC]) both before the age of one year and at the age of six years, were more likely than the other children to have mothers who smoked but not mothers with asthma, and did not have elevated serum IgE levels or skin-test reactivity. Children who started wheezing in early life and continued to wheeze at the age of six were more likely than the children who never wheezed to have mothers with a history of asthma (P