摘要目的 了解北京市城区哮喘患儿的6年转归及其影响因素.方法 采用问卷调查的方法,以2010年北京市城区0～14岁儿童哮喘流行病学调查(从中心城区随机抽取)临床确诊的497例哮喘患儿为调查对象,2016年(6年后)进行电话随访,获得其哮喘发作、急诊就诊、住院、用药及疾病控制情况、最近12个月伴发过敏性疾病等有关信息.不同组间率的比较采用x2检验,计量资料采用秩和检验,多因素Logistic回归分析相关因素与哮喘发作的关系.COX回归及Kaplan-Meier生存分析了解相关因素与病程的关系.结果 完成随访问卷366份,男66.7％(244/366),女33.3％(122/366).哮喘患儿近12个月发作率、急诊就诊率较6年前均显著下降[19.1％(70/366)比57.1％(284/497)、3.0％(11/366)比19.7％ (98/497),x2=125.910、53.352,P均＜0.01],伴发过敏性鼻炎率、特应性皮炎率较6年前差异均无统计学意义(P均＞0.05).2年及以上无发作(临床缓解)患儿占75.4％(276/366),2年以内有发作(临床未缓解)患儿占24.6％ (90/366).临床未缓解患儿中年龄≤12岁的男孩比例明显高于临床缓解患儿[52.4％ (33/63)比30.9％(56/181),x2=9.273,P＜0.01];近12个月伴发过敏性鼻炎、特应性皮炎、一级亲属哮喘史比例均高于临床缓解患儿[67.8％(61/90)比51.8％(143/276)、30.0％(27/90)比17.0％(47/276)、68.9％(62/90)比54.7％(151/276),x2=7.013、7.079、5.608,P均＜0.05];曾使用控制药物比例明显高于临床缓解患儿[33.3％(30/90)比7.2％ (20/276),x2=39.158,P＜0.01].对哮喘发作情况多因素Logistic回归发现,男性和起病年龄大是哮喘未缓解的危险因素[比值比(OR)=2.402(1.611～3.580)和4.339(＞3～6岁比0～3岁),2.630(＞6岁比0～3岁),x2=18.512、31.371、6.510,P均＜0.05].对发作情况和病程进行COX回归分析发现使用控制药物的患儿病程短[风险比(HR) =0.705 (0.515～0.964),x2=4.795,P＜0.05].结论 2010年北京市城区0～14岁哮喘患儿6年后随访,近12个月哮喘发作、急诊就诊显著减少.男性、起病年龄大、未使用控制药物是哮喘未缓解的危险因素,使用控制药物可缩短病程.

abstractsObjective To understand the outcome of asthma in children from urban area of Beijing and the factors associated with the outcome.Methods A total of 497 children with asthma diagnosed in the epidemiological survey of childhood asthma in urban area of Beijing in 2010 were selected in this study.Telephone follow-up was conducted in 2016 to obtain information about asthma attack,emergency visit,hospitalization,medication and disease control,and data of comorbidities of allergic diseases from 1 year earlier.Enumeration data were compared using chi-square test,measurement data were compared by rank sum test.The multi-factor logistic regression analysis was employed for the relationship between the related factors and asthma,Kaplan-Meier survival analysis and COX regression was employed to understand the relationship between the related factors and the course of the disease.Results Questionnaires were conducted in 366 children,of whom 66.7％ (244/366) were male,and 33.3％ (122/366) were female.Compared with 2010,the rate of asthma attack and emergency room visits in children in last 12 months were significantly lower (19.1％(70/366) vs.57.1％(284/497),and 3.0％ (11/366) vs.19.7％ (98/497),x2=125.910 and 53.352,both P＜0.01).There was no significant change in the proportion of allergic rhinitis and atopic dermatitis in last 12 months compared with that 6 years ago (both P＞0.05).The number of children with clinical remission (2 years and above) was 75.4％ (276/366).The number of children without remission within 2 years was 24.6％ (90/366).The majority of children without remission were less than 12 years old boys (52.4％ (33/63) vs.30.9％ (56/181),x2=9.273,P＜0.01).The proportion of children without remission associated with allergic rhinitis (67.8％(61/90)),atopic dermatitis (30.0％(27/90)),first-degree relatives with asthma (68.9％ (62/90)) was higher than that of children with remission (51.8％(143/276),17.0％(47/276),and 54.7％ (151/276),respectively,x2=7.013,7.079,5.608,respectively,all P＜0.05).The proportion of children without remission who used control drugs was (33.3％ (30/90)),which was higher than that in children with remission (7.2％ (20/276),x2=39.158,P＜0.01).Multiple logistic regression showed that boy (OR=2.402 (1.611-3.580),P＜0.05),later onset (OR=4.339 (＞3-6 years old vs.0-3 years old),OR=2.630(＞6 years old vs.0-3 years old),x2=18.512,31.371,6.510,all P＜0.05) were independent risk factors for asthma remission.COX regression analysis showed that the use of control drugs (HR=0.705 (0.515-0.964),x2=4.795,P＜0.05) was the relevant factor in the course of the disease.Conclusions With the increase of age,the incidence of asthma in children in Beijing city in recent 12 months reduced.Male and late onsets were independent risk factors for asthma remission.The use of control drugs was the relevant factor in the course of the disease.