目的 分析上海浦江地区婴幼儿(＜3岁)反复喘息(发作次数≥3次)的相关危险因素.方法 采用病例对照研究的方法,选择2014年1月至12月因喘息在上海交通大学医学院附属仁济医院南院儿科进行诊治的婴幼儿作为研究对象,共262例.根据喘息发作次数分为反复喘息组(≥3次)75例及偶发喘息组(1、2次)110例,并选择同期来院就诊的既往无喘息患儿77例作为对照组.采用面对面问卷方式询问相关危险因素,采用被动凝集法检测肺炎支原体免疫球蛋白M(IgM)抗体,采用间接免疫荧光法进行呼吸道病原体检测,采用免疫印记法检测血清20项变应原.得到的结果进行单因素分析及逐步前进法Logistic回归多因素分析.结果 单因素分析结果显示:男童(OR=4.030,95％CI:1.937 ～8.388)、个人特应质(OR=13.125,95％CI:5.951 ～ 28.946)、变应性皮炎(OR=9.833,95％CI:4.663～20.737)、变应性鼻炎(OR=40.327,95％ CI:5.300～306.842)、喜揉眼鼻(OR=6.487,95％CI:3.190 ～ 13.191)、食物过敏史(OR=6.689,95％CI:1.860～24.051)、早产(OR=3.795,95％CI:1.001 ～ 14.385)、低出生体质量(OR=9.075,95％CI:1.106～ 74.450)、父母特应质(OR=10.667,95％ CI:4.824 ～ 23.587)、父母变应性鼻炎(OR=6.524,95％CI:2.920～ 14.577)、父母变应性皮炎(OR=8.072,95％ CI:2.634 ～24.734)、父母结膜炎(OR=1.087,95％ CI:1.017 ～1.162)、父母支气管哮喘史(OR=1.119,95％CI:1.035 ～1.210)、感冒＞6次(OR=9.111,95％CI:3.970 ～ 20.909)、肺炎史(OR=7.554,95％CI:3.588～ 15.903)、首次使用抗生素时年龄＜6个月(OR=2.388,95％ CI:1.129～5.052)、烟草暴露(OR=1.922,95％CI:1.004～3.681)、母孕期被动吸烟(OR=2.508,95％ CI:1.298～4.848)、靠近木柴燃烧(OR=3.342,95％ CI:1.427 ～7.827)、吸人性变应原阳性(OR=1.821,95％ CI:1.420 ～2.336)与反复喘息有关.养猫为保护因素(OR =0.922,95％ CI:0.864～0.984).多因素Logistic分析结果显示下列因素为婴幼儿反复喘息的独立危险因素:个人特应质(OR=10.278,95％ CI:2.503～42.202)、喜揉眼鼻(OR=10.316,95％CI:2.722 ～39.101)、食物过敏史(OR=10.370,95％CI:1.248 ～ 86.145)、父母特应质(OR=5.402,95％ CI:1.340 ～21.778)、肺炎史(OR=7.876,95％ CI:2.040～30.407)、感冒＞6次(OR=7.048,95％ CI:1.688 ～29.423)、母孕期被动吸烟(OR =3.696,95％ CI:1.013 ～ 13.494).结论 婴幼儿反复喘息的独立危险因素为个人特应质、喜揉眼鼻、食物过敏史、父母特应质、感冒＞6次、肺炎史、母孕时被动吸烟.%Objective To analyze the relevant risk factors of recurrent wheezing(≥3 attacks) in the first 3 years of life in Shanghai Pujiang.Methods A case-control study was conducted.Two hundred and sixty-two research children were chosen for clinical visits (＜ 3 years old) with wheezing at the Pediatric Department of Shanghai Renji Hospital (South Campus),School of Medicine,Shanghai Jiaotong University,from January to December 2014.According to the frequency of wheezing,the subjects were divided into 75 cases of recurrent wheezing group (≥ 3 attacks),110 cases of occasional wheezing group(1-2 attacks) and 77 cases of no wheezing group.Probable risk factors were inquired by using face-to-face questionnaire.The passive agglutination method was used to detect the Mycoplasma pneumoniae antibody immunoglobulin M (IgM).The indirect immunofluorescence was used to detect the respiratory pathogens.The Western blot was used to detect 20 items of serum allergen.Chi-square test was firstly used for univariate analysis,and then the multivariate stepwise Logistic regression was used to analyze the independent risk factors associated with infant recurrent wheezing.Results A total of 20 factors were found relevant to infant recurrent wheezing by univariate analysis,which included boys (OR =4.030,95％ CI:1.937-8.388),personal atopy (OR =13.125,95％ CI:5.951-28.946),allergic dermatitis (OR =9.833,95％ CI:4.663-20.737),allergic rhinitis (OR =40.327,95％ CI:5.300-306.842),like rubbing eyes or nose(OR =6.487,95％ CI:3.190-13.191),food allergy (OR =6.689,95 ％ CI:1.860-24.051),premature birth (OR =3.795,95 ％ CI:1.001-14.385),low birth weight (OR =9.075,95％ CI:1.106-74.450),parental atopy (OR =10.667,95％ CI:4.824-23.587),parental allergic dermatitis (OR =8.072,95 ％ CI:2.634-24.734),parental allergic rhinitis (OR =6.524,95 ％ CI:2.920-14.577),parental allergic conjunctivitis (OR =1.087,95％ CI:1.017-1.162),parental asthma history (OR =1.119,95％ CI:1.035-1.210),colds ＞ 6 times (OR =9.111,95％ CI:3.970-20.909),history of bronchopneumonia(OR =7.554,95％ CI:3.588-15.903),age at first time use of antibiotics less than 6 months (OR =2.388,95％ CI:1.129-5.052),exposure to cigarette smoking (OR =1.922,95 ％ CI:1.004-3.681),maternal passive smoking during pregnancy (OR =2.508,95 ％ CI:1.298-4.848),living close to wood stove (OR =3.342,95 ％ CI:1.427-7.827) and positive results of inhaled allergens (OR =1.821,95 ％ CI:1.420-2.336).Keeping cats was the protective factor(OR =0.922,95％ CI:0.864-0.984).The forward Logistic regression analysis showed that personal atopy (OR =10.278,95 ％ CI:2.503-42.202),like rubbing eyes or nose (OR =1 0.316,95 ％ CI:2.722-39.101),food allergy (OR =10.370,95％ CI:1.248-86.145),parental atopy (OR =5.402,95％ CI:1.340-21.778),colds ＞ 6 times (OR =7.048,95 ％ CI:1.688-29.423),history of bronchopneumonia (OR =7.876,95 ％ CI:2.040-30.407) and maternaal passive smoking (OR =3.696,95 ％ CI:1.013-13.494) during pregnancy were the independent risk factors of infants recurrent wheezing.Conclusion Personal atopy,like rubbing eyes or nose,food allergy,parental atopy,colds ＞ 6 times,history of bronchopneumonia,maternal passive smoking are the independent risk factors of recurrent wheezing in infants less than 3 years old.
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