【摘要】 目的 针对上海市宝山区罗店医院所属周边医疗服务区的儿童进行有关反复呼吸道感染（recurrent respiratory tract infections,RRTIs）发生率和危险因素的调查研究，以为优化临床诊治和疾病防控提供参考。方法 采用问卷调查法，于2021年7月—2022年6月调研上海市宝山区罗店医院所属周边医疗服务区的2家幼儿园和2家小学的学龄前期和学龄期儿童家属，分析该调研单位儿童RRTIs的发生率及其影响因素。RRTIs诊断参照《儿童呼吸道感染判断条件和防治》标准。问卷调查内容涵盖与儿童RRTIs病因相关的数据，包括一般资料、近期呼吸道感染病史、儿童出生史和喂养史、不良饮食习惯、过敏史、家庭环境、平素是否注重户外活动或参加体育锻炼项目和是否存在不规范使用抗生素等。使用logistic回归模型分析儿童发生RRTIs的相关危险因素，采用ROC曲线评估不同风险因素预测儿童发生RRTIs的价值。结果 共收集有效问卷1 584份，其中，符合诊断标准的儿童RRTIs共281例（17.7%）。学龄前期儿童RRTIs发生率显著高于学龄期儿童（21.1%比14.9%，χ~2=10.212,P=0.001）。单因素分析结果显示，低龄（即学龄前期儿童）、存在不良饮食习惯、自身或近亲属有过敏史、直系亲属学历为专科及以下、被动吸烟、不注重户外活动和锻炼，以及不规范使用抗生素是影响儿童发生RRTIs的相关因素（P值均<0.05）。logistic多因素回归分析结果显示，低龄（即学龄前期儿童）、存在不良饮食习惯、自身或近亲属有过敏史、直系亲属学历为专科及以下、被动吸烟、不注重户外活动和锻炼，以及不规范使用抗生素均为儿童发生RRTIs的独立危险因素（P值均<0.05）。经ROC分析显示，自身或近亲属有过敏史（AUC=0.716）、挑食或偏食等不良饮食习惯（AUC=0.624）和被动吸烟（AUC=0.625）对该疾病的发生均具有一定预测作用。2～3项风险因素联合可提高对该疾病的预测效能：自身或近亲属过敏史+被动吸烟（AUC=0.763，灵敏度为0.764，特异度为0.719），自身或近亲属过敏史+被动吸烟+不良饮食习惯（AUC=0.800，灵敏度为0.818，特异度为0.783）。结论 当儿童处于非药物干预方式（non-pharmaceutical interventions,NPIs）保护下，多种非病原学间接因素仍可促进该地区儿童发生RRTIs，故应加强包括低龄儿童保护、改善特应性体质、合理膳食、改善育儿环境、规范使用抗菌药物，以及推广合理的个体化体育锻炼方式等防护措施。更多还原

【Abstract】 Objective To investigate the incidence and risk factors of recurrent respiratory tract infections(RRTIs)in children in the medical service area surrounding Luodian Hospital,Baoshan District,Shanghai,and to provide references for optimizing clinical diagnosis and treatment as well as disease prevention and control.Methods A questionnaire survey was conducted from July 2021 to June 2022 among the families of preschool and school-age children from two kindergartens and two primary schools in the medical service area of Luodian Hospital,Baoshan District,Shanghai.The incidence of RRTIs and its influencing factors in children were analyzed.The diagnosis of RRTIs was based on the criteria established by the Judgment Criteria and Prevention and Treatment of Pediatric RRTIs.The questionnaire content covered data related to the etiology of pediatric RRTIs,including general information,recent history of respiratory tract infections,birth and feeding history,poor dietary habits,allergy history,family environment,whether outdoor activities or sports exercises were emphasized,and whether antibiotics were used irregularly.Logistic regression models were used to analyze the risk factors associated with RRTIs in children,and ROC curves were used to evaluate the predictive value of different risk factors for RRTIs in children.Results A total of 1 584valid questionnaires were collected,among which 281children(17.7%)met the diagnostic criteria for RRTIs.The incidence of RRTIs in preschool children was significantly higher than that in school-age children(21.1% vs.14.9%,χ~2=10.212,P=0.001).Univariate analysis showed that young age(preschool children),picky eating or selective eating,a history of allergic diseases in the child or close relatives,parental education level of associate degree or below,passive smoking,lack of emphasis on outdoor activities and exercise,and irregular use of antibiotics were factors associated with RRTIs in children(all P<0.05).Multivariate logistic regression analysis showed that young age(preschool children),picky eating or selective eating,a history of allergic diseases in the child or close relatives,parental education level of associate degree or below,passive smoking,lack of emphasis on outdoor activities and exercise,and irregular use of antibiotics were all independent risk factors for RRTIs in children(all P<0.05).ROC analysis showed that a history of allergies in the child or close relatives(AUC=0.716),poor dietary habits such as picky eating or selective eating(AUC=0.624),and passive smoking(AUC=0.625)all had certain predictive effects on the occurrence of the disease.Combining2to 3risk factors could improve the predictive efficacy of the disease,a history of allergies in the child or close relatives+passive smoking(AUC=0.763,sensitivity 0.764,specificity 0.719),and a history of allergies in the child or close relatives+passive smoking+ picky eating or selective eating(AUC=0.800,sensitivity 0.818,specificity 0.783).Conclusion Under the protection of non-pharmaceutical interventions(NPIs),various non-pathogen-related indirect factors can still promote the occurrence of RRTIs in children in this area.Therefore,protective measures should be strengthened,including protection of young children,improvement of atopic constitution,rational diet,improvement of child-rearing environment,standardized use of antimicrobial drugs,and promotion of reasonable individualized physical exercise.更多还原