儿童哮喘的相关危险因素分析

中图分类号 密级儿童哮喘的相关危险因素分析The Analysis of Risk Factors for Childhood Asthma计：学位论文：41页表 格：1 O个插 图： 5幅唐路路指导教师：杨谊平教授申请学位级别：硕士学位 学科(专业)：儿科学培养单位：大连医科大学附属第二医院 完成时间：二。一三年四月答辩委员会主席：独创性声明本人声明所呈交的学位论文是本人在导师指导下进行的研究工作及取得的研究成果。据我所知，除了文中特另lJ)jrl以标注和致谢的地方外，论文中不包含其他人已经发表或撰写过的研究成果，也不包含为获得大连医科大学或其他教育机构的学位或证书而使用过的材料。与我一同工作的同志对本研究所做的任何贡献均已在论文中作了明确的说明并表示谢意。学位论文作者签名： 2量堕盘签字日期：生年月上日关于学位论文使用授权的说明本学位论文作者完全了解学校有关保留、使用学位论文的规定，同意学校保留并向国家有关部门或机构送交论文的复印件和电子版，允许论文被查阅和借阅。本人授权大连医科大学可以将本学位论文的全部或部分内容编入有关数据库进行检索，可以采用影印、缩印或扫描等复制手段保存和汇编本学位论文。本学位论文属于(请在以下相应方框内打“4”)：1保密口，在一年解密后适用本授权书。2不保密口。日期：卅J弓年f月夕日日期：f年岁月7日蹄n形、结一以，、害j奄，l止-扩一名名签签者师作导目 录一、摘要1(一)中文摘要1(二)英文摘要3二、正文6(一)前言6(二)材料和方法7(三)结果81哮喘儿童的一般情况82儿童哮喘发作的一般情况103儿童哮喘过敏原检测分析114哮喘的及时诊断及确诊后的系统规范治疗135儿童哮喘发生的危险因素1 3(四)讨论15(五)结论23(六)参考文献24三、综述0 OO OOO OOO27(一)综述27(二)参考文献34四、附录38五、致谢41大连医科大学硕士学位论文儿童哮喘的相关危险因素分析硕士生姓名：唐路路指导教师：杨谊平教授专业名称：儿科学摘要研究背景：近20年来，哮喘尤其是儿童哮喘的发病率和死亡率在全世界大部分地区正以惊人的速度呈现上升趋势，成为儿童最常见的慢性呼吸道疾病之一。哮喘不仅影响儿童的身体健康，其反复的发作对儿童的心理发育亦有影响。哮喘的发病机制复杂，遗传、环境、感染等多种因素以及机体免疫功能在儿童哮喘发病中均起到重要作用。目的：寻找哮喘发生的危险因素及哮喘急性发作的诱因，从而避免诱发因素，为能有效的预防与控制哮喘的发生和发作提供依据，从而降低儿童哮喘的发病率，提高哮喘儿童的生活质量。方法：本调查研究采用病例对照研究，研究对象病例组为2012212013131在大连医科大学第二附属医院儿科住院部住院的卜14岁的支气管哮喘患儿，对照组为同期就诊的非支气管哮喘且无哮喘既往史的呼吸道感染患儿，与病例组为1：1配对，其住院就诊时间、性别均相同，年龄相差不超过1周岁。采用问卷调查法，调查与儿童哮喘相关的因素。应用SPSSl90统计软件进行统计分析。先后对相关变量进行单因素及多因素分析，估计儿童哮喘发生中各因素的相对危险度。最终探讨各因素的作用。结果：1在142例病例中，男童87例，女童55例，男女患儿的性别比例158-1。2哮喘儿童以38岁者居多，占774，多在4岁以内首次发作，35JL童哮喘好发于夜间，好发季节为秋季，占267。3哮喘儿童过敏原检测中5岁及以上的患儿以吸入性过敏原为主，占688，多见户尘螨、猫狗皮屑、屋尘等。5岁以下患儿以食入性过敏原为主，占523，以牛奶、海鲜、牛羊肉多见。4哮喘的急性发作873是由感染诱发引起，99的患儿运动可致哮喘加重；大连医科大学硕士学位论文85是由于接触过敏原诱发，42是由于气温骤降等诱发。5此次调查中有528的患儿为首次诊断哮喘，之前未曾使用治疗哮喘的药物。已诊断哮喘的患儿有67例，其中规范治疗的有40例，占597，未规范治疗的有27例，占403。6在多因素Logistic回归分析中，家族哮喘史、家族过敏史、个人过敏史、被动吸烟史、室内装修、室内有霉菌、饲养宠物、感染、过早添加肉类及海鲜为哮喘发生的危险因素，顺产、母乳喂养，父母学历高及母孕期受过健康教育为哮喘发生的保护因素。结论：1儿童哮喘以男童居多，好发于38岁的学龄前及学龄期儿童，首发年龄多在4岁以内。2哮喘好发于夜间及秋季，感染、接触过敏原、过度运动等可诱发哮喘的急性发作；及时诊断哮喘并系统规范的哮喘治疗可控制哮喘、减少哮喘的急性发作。3年长儿的血清过敏原以吸入性过敏原为主，而婴幼儿以食入性过敏原为主。4家族哮喘史及过敏史、个人过敏史、婴幼儿期呼吸道感染、过早添加不恰当辅食、被动吸烟、环境及致敏物质接触为儿童哮喘的发生的危险因素。5顺产、母乳喂养、父母学历高及母孕期受过健康教育为儿童哮喘发生的保护因素。关键词：哮喘危险因素儿童2大连医科大学硕士学位论文The Analysis of Risk Factors for Childhood AsthmaMaster 7 S name：Tang LuluSupervisor：Yang Yiping professorMajor：PediatricsAbstractBackground：During the past 20 years asthma has been becoming one of the mostcommon chronic respiratory diseases in children witll a rapidly increasing rate ofmorbidity and mortalityThe repeated attack of asthma Can not only affect the health ofchildren，but also play a negtive role in the psychological development of childrenThepathogenesis of asthma is very complex involving in genetic，environmental，infection，immune and other factorsObjeetive：To find risk factors for asthma and asthma trigger and provide evidencefor effective prevention and control of asthma occurrence and attack，and in order toreduce the incidence of asthma in children and improve the quality of life of childrenwith asthmaMethods：In this casecontrol study,questionnaire was used to investigate thefactors associated with childhood asthmaThe cases of study group were asthmachildren aged from 1 to 1 4 years and hospitalized in the department of pediatrics of theSecond Affiliated Hospital of Dalian Medical University from Feb 1 520 1 2 to Jan 1吼20 1 3，being matched to nonbronchial asthma patients hospitalized谢tll respiratory tractinfection during the same period without past history of asthmaThe diagnosis ofasthma refered to childhood asthma diagnostic criteria established by the NationalChildrenS Asthma Collaborative GroupSPSS 1 90 statistical software was used forstatistical analysisUnivariate and multivariate regression analysis was used to estimaterelmive risk of all factors for asthma in children and to further explore the role ofvariOUS factorsResults：1The study group included 87 boys cases and 55 girls cases with sex ratio of158：12Asthma commonly occurred in the 3-8 year-old children accounting for 774and the first attack was seen mostly before the age of 4 yearsAsthma usually occurredin the evening and autumn with respective rate of 35and 2673大连医科大学硕士学位论文3Allergens of asthma in children 5 years of age and older were inhaled allergensmainly，accounting for 688，such as mite，cat，dog dander,house dust and SO onne patients under 5 years of age were the more possibility of food allergens like milk，seafood，beef and mutton they had，accounting for 523487-3of acute asthma exacerbation was caused by infection and 99of themwas due to exercise85and 42of asthma were induced by contacting allergensand the sudden drop in air temperature respectively5In this study，528of asthma patients were diagnosed for the first timewithout therapyPrevious diagnosis of asthma in children in 67 cases，40 case receivedsystemic asthma treatment，accounting for 597，and 27cases without systemicasthma treatment，accounting for 4036It is showed by analysis of multi-factor regression that family history of asthmaand allergies，personal history of allergies，passive smoking，interior decoration，mold，pets，infection，too early and inappropriately adding complementary feeding were riskfactors for asthmaHowever,spontaneous delivery,breastfeeding，high educationallevel of parents and motherS health education during the period of pregnancy wereprotective factors for asthmaConclusion：1Asthma is commonly seen in the 3-8 year-old children witll the first attack beforethe age of4 years2Asthma commonly occur in the evening and autumnInfection，exposure toallergens，excessive exercise can induce an acute attack of asthmaEarly diagnosissystemic and professional therapy are crucial to control asthma and reducing acuteexacerbation