【摘要】 目的·探讨儿童重症支气管哮喘（简称哮喘）的流行病学特征并分析其危险因素。方法·采用单中心前瞻性队列研究，纳入2021年1月1日—12月31日就诊于复旦大学附属儿科医院的难治性哮喘患儿674例，建立动态队列。收集队列成员的基本信息（包括患儿性别、年龄、出生胎龄、出生体质量等）和共存疾病情况，评估其哮喘控制情况、药物吸入技术水平、药物依从性，以及肺功能指标[1秒用力呼气容积（forced expiratory volume in one second,FEV₁）占预计值百分比（FEV₁%预计值），FEV₁/用力肺活量（forced vital capacity,FVC）和用力呼出50%肺活量的呼气流量(forced expiratory flow at 50%of FVC exhaled,FEF₅₀)、FEF₇₅、FEF_25-75占预计值百分比]、气道炎症指标[呼出气一氧化氮（fraction exhaled nitric oxide,FeNO）检测值]和过敏状态指标[外周血嗜酸性粒细胞（eosinophil,EOS）计数和总血清免疫球蛋白E（immunoglobulin E,IgE）浓度]。所有队列成员分别在其进入队列的第3、6、9和12个月至该院哮喘专病门诊接受再次评估。结果·至队列终点时，有52例（7.7%）患儿被诊断为重症哮喘。处于二手烟暴露环境、家中常年使用空调、共存疾病为鼻炎/鼻窦炎、FEV₁%预计值<80%、FEV₁/FVC<80%、小气道功能障碍、EOS>300/μL、IgE>200国际单位（international unit,IU）/L、FeNO>20/25 ppb[FeNO>20 ppb（≤12岁），>25 ppb（>12岁），1 ppb=1×10^-9 mol/L]在重症哮喘患儿中占比较高，母乳喂养至6月龄及以上、药物依从性好在非重症患儿中占比较高，差异有统计学意义（均P<0.05）。6～11岁重症哮喘患儿中男性占比更多，12～17岁重症哮喘患儿中女性占比更多，差异有统计学意义（均P<0.05）。多因素Logistic回归分析显示，小气道功能障碍是发生重症哮喘的独立危险因素[OR=5.158（95%CI 2.516～10.572）]。结论·难治性哮喘患儿在规范管理1年后，重症哮喘患儿占比有显著下降趋势；小气道功能障碍是其进展为重症哮喘的独立危险因素。更多还原

【Abstract】 Objective·To explore the epidemiological characteristics of severe asthma in children and analyze the risk factors.Methods·A single-center prospective cohort study was conducted.Six hundred and seventy four children with difficult-to-treat asthma who visited the Children’s Hospital of Fudan University from January 1 to December 31,2021 were included to establish a dynamic cohort.Basic information（including gender,age,gestational age at birth,birth weight,etc.） and comorbidity of the cohort members were collected.The asthma control status,drug inhalation technique level,medication compliance,pulmonary function parameters[forced expiratory volume in one second（FEV₁） as a percent-age of the predicted value（FEV₁%pred）,FEV₁/forced vital capacity（FVC）,and the rate of estimated values of forced expiratory flow at 50% of FVC exhaled(FEF₅₀),FEF₇₅,and FEF_25-75 in percent-predicted value,respectively],airway inflammation index[fraction exhaled nitric oxide（FeNO）],and allergy status parameters[eosinophil（EOS） and immunoglobulin E（IgE）]of all cohort members were evaluated.All cohort members underwent re-evaluation respectively at the specialist asthma clinic of the hospital at 3,6,9,and 12 months.Results·At the endpoint of the cohort,52 children were diagnosed with severe asthma,accounting for 7.7%.A high proportion of severe asthma was found in children who were exposed to secondhand smoke,used air conditioning at home all year round,or had coexisting rhinitis/nasosinusitis,FEV₁%pred<80%,FEV₁/FVC<80%,small airway dysfunction,EOS>300/μL,IgE>200 IU/L,or FeNO>20/25 ppb[FeNO>20 ppb（≤12 years old） or>25 ppb（>12 years old）,1 ppb=1×10^-9 mol/L].A high proportion of non-severe asthma was found in children who were breastfed for 6 months or longer,or had good medication compliance.The differences were statistically significant（all P<0.05）.There were more males in children with severe asthma aged 6-11 years,and more females in children with severe asthma aged 12-17 years,with statistical significance（both P<0.05）.Multiple-factor Logistic regression analysis showed that only small airway dysfunction was an independent risk factor for severe asthma[OR=5.158（95%CI 2.516-10.572）].Conclusion·The proportion of children with severe asthma has a significantly decrease after one year of standardized management in children with difficult-to-treat asthma.Small airway dysfunction is an independent risk factor for the progression to severe asthma.更多还原