摘要目的 了解儿童支气管哮喘(哮喘)6年后转归情况.方法 以2010 年北京市城区0~14岁儿童哮喘流行病学调查临床确诊哮喘患儿为调查对象,2016年(6年后)现场随访,获得其哮喘发作、疾病控制情况、用药、伴发变应性疾病等有关信息,并进行变应原皮肤点刺、肺功能、呼出气一氧化氮检查.结果 完成现场调查64例,年龄7~19岁[(13. 59 ± 3. 48)岁].2年内仍有发作(临床未缓解)的哮喘患儿占35. 9%(23/64例),2年及以上无发作(临床缓解)的哮喘患儿占64. 1%(41/64例).临床未缓解患儿病程(9. 0年)较缓解患儿(5. 5年)明显延长,差异有统计学意义(z＝ -3. 775,P<0. 001).临床未缓解患儿中,近1个月未控制患儿占13. 0%(3/23例),部分控制占17. 4%(4/23例),控制患儿占69. 6%(16/23例).临床未缓解患儿以间断控制用药居多[43. 5%(10/23例)比12. 2%(5/41例),χ2 ＝8. 036,P<0. 01].临床未缓解患儿体育活动完全不受影响者占47. 8%(11/23例),临床缓解患儿体育活动完全不受影响者占92. 7%(38/41例),二者比较差异有统计学意义(χ2 ＝14. 117,P<0. 001).临床未缓解患儿湿疹及特应性皮炎持续至>6岁占56. 5%(13/23例),明显高于临床缓解患儿[29. 3%(12/41例)],差异有统计学意义(χ2 ＝4. 598,P<0. 05).2010年及2016年均有变应原结果患儿46例,与2010年比较,2016年动物皮毛及花粉过敏比例升高[19. 6%(9/46例)比52. 2%(24/46例),36. 9%(17/46例)比67. 4%(31/46例)],差异均有统计学意义(χ2 ＝10. 632、8. 538,均P<0. 01).2016年现场变应原分析发现,临床未缓解组总变应原数目及程度高于临床缓解组,进一步分析提示临床未缓解组香烟阳性较高(21. 7%比2. 5%,χ2 ＝4. 239,P<0. 05).临床未缓解组与临床缓解组肺功能及呼出气一氧化氮值无明显差异.结论 哮喘儿童6年后,动物皮毛及花粉过敏比例升高.临床未缓解患儿以间断用药居多,>6岁仍有持续湿疹及特应性皮炎居多,变应原检测香烟过敏比例较高.

abstractsObjective To investigate six yearsˊ outcome of children with asthma. Methods Children with asthma diagnosed in the epidemiological survey of childhood asthma in urban area of Beijing in 2010 were selected in this study. The field follow-up was conducted in 2016(6 years later)to obtain information about asthma attack,di-sease control,medication usage,and comorbidities of allergic diseases. The skin prick test,lung function and exhaled ni-tric oxide were performed during field follow - up stage. Results Sixty - four children,aged 7 - 19 years old [(13. 59 ± 3. 48)years old],completed the field follow-up survey. Among 35. 9%(23/64 cases)children,the asth-ma symptoms still persisted within 2 years(without remission),while 64. 1%(41/64 cases)children had no symp-toms within 2 years and above(remission). The course of children without remission(9. 0 years)was significantly lon-ger than that of children with remission(5. 5 years),and there was statistical significance(z＝ -3. 775,P<0. 001). Among the children without remission,the number of uncontrolled children in the last month accounted for 13. 0%(3/23 cases),partially controlled for 17. 4%(4/23 cases),and under controlled for 69. 6%(16/23 cases). The majority of unrelieved children were treated with intermittent control drug[43. 5%(10/23 cases)υs. 12. 2%(5/41 cases), χ2 ＝8. 036,P<0. 01]. A total of 47. 8%(11/23 cases)of children without remission were completely unaffected by physical activity,while 92. 7%(38/41 cases)of children with clinical remission were completely unaffected by physi-cal activity(χ2 ＝14. 117,P<0. 001). The proportion of children without remission with eczema and atopic dermatitis lasting longer than 6 years old was 56. 5%(13/23 cases),which was significantly higher than that of children with re-mission[29. 3%(12/41 cases),χ2 ＝4. 598,P<0. 05]. In 2010 and 2016,there were 46 children with allergen re-sults. Compared with 2010,the proportion of animal fur and pollen allergy increased in 2016[19. 6%(9/46 cases)υs. 52. 2%(24/46 cases),36. 9%(17/46 cases)υs. 67. 4%(31/46 cases)],and there were statistical significances (χ2 ＝10. 632,8. 538,all P<0. 01). In 2016,the number and degree of total allergens in the clinical unrelieved chil-dren were higher than that in the relieved children. Further analysis showed that the unrelieved children had higher cigarette allergy positivity(21. 7% υs. 2. 5%,χ2 ＝4. 239,P<0. 05). There was no significant difference in lung func-tion and exhaling nitric oxide between the clinical unrelieved children and the relieved children. Conclusions Six years later,the proportion of animal fur and pollen allergy increased in children with asthma. Compared with children with remission,the children without remission had more treatment with intermittent control drug,with higher proportion of eczema and atopic dermatitis over six years old,and higher percentage of cigarette allergy positivity.