背景支气管哮喘（BA）和阻塞性睡眠呼吸暂停低通气综合征（OSAHS）是困扰儿童健康的两大慢性疾病，合并OSAHS可能使BA病情加重、难以控制，BA又可通过多种机制导致OSAHS的发生或进展，两者关系日益受到关注。目的 探讨儿童BA合并OSAHS的临床特征及影响因素。方法 选取2021年9月至2022年8月在甘肃省妇幼保健院儿童哮喘中心就诊的BA患儿109例为研究对象，根据是否合并OSAHS，分为BA合并OSAHS组（n=49）和单纯BA组（n=60），收集患儿的一般临床资料、肺功能检查、血清炎性细胞因子、25-（OH）D及CRP检测结果，分析BA合并OSAHS患儿的临床特征，并采用多因素Logistic回归分析探讨BA合并OSAHS患儿的影响因素。结果多因素Logistic回归分析结果显示肥胖[OR=4.803,95%CI（1.011,2.822）]、颈围增大[OR=1.318,95%CI（1.003,1.732）]、合并胃食管反流病（GERD）[OR=7.756,95%CI（1.398,43.045）]是BA合并OSAHS患儿的独立危险因素（P＜0.05）;25-（OH）D水平升高[OR=0.830,95%CI（0.757,0.910）]是BA合并OSAHS患儿的保护因素（P＜0.05）。结论 BA合并OSAHS患儿的肺功能指标低于单纯BA患儿，肥胖、颈围、合并GERD、25-（OH）D水平是BA合并OSAHS患儿的影响因素。
儿童哮喘患病率逐年上升,除遗传因素外,室外环境因素也扮演着重要角色.儿童人群肺部尚未完全发育,日益复杂多变的室外空气污染物可通过各种特定机制增加患儿哮喘症状、门急诊次数,引发免疫学紊乱,降低治疗的敏感度.因此,本文对室外空气污染对儿童哮喘的影响及其机制的研究进展进行综述,并对儿童哮喘管理措施进行了总结.
Asthma is a complex multifactorial disease with different clinical presentations in different patients; therefore, the simple concept of asthma as a single disease characterized by chronic airway inflammation, bronchial hyperresponsiveness, airway obstruction, and airway remodeling is outdated.Based on the latest progress in the pathophysiological classification of asthma, the main phenotypes and endotypes of asthma are discussed.
Antibiotic exposure in early life significantly increases the risk of childhood asthma, which is closely related to the dysbiosis and decreased diversity of intestinal and airway microbial flora caused by antibiotics. During birth and early life, the normal microbiota in the body plays an important role in the regulation of immune homeostasis and tolerance in children. Early antibiotic exposure can severely damage the gut and lung microbiota, resulting in dysbiosis and reduced microbial diversity, causing respiratory hyperresponsiveness, leading to high incidence of asthma in children. In recent years, the irrational use of antibiotics has become prominent. This article reviews the effect of early life antibiotics on the development of asthma in children, hoping that pediatricians will apply antibiotics more carefully and rationally to avoid the risk of developing asthma in children due to early exposure.
