鼻炎和哮喘发病:一项纵向人群研究
2009/03/09
许多流行病学和临床研究都报道了过敏性鼻炎和哮喘的密切相关性，但是其本质尚不清楚。作者应用欧洲社区呼吸健康普查的随访资料调查过敏性及非过敏性鼻炎患者随访8.8年中哮喘的发病情况。这一纵向人群研究涉及29个中心（14个国家），大部分位于西欧。共纳入6461人，年龄在20～44岁之间，入选时未诊断哮喘。 如果在2次调查间期由医生诊断为哮喘则定义为新发哮喘。如果对螨，猫，黑斑病，番茄，草，白桦树， 墙草 ，橄榄油，或豚草的皮肤划痕试验阳性则定义为过敏体质。根据入选时情况将参加研究者分为四组：对照组（无过敏体质，无鼻炎； n=3163),仅有过敏体质 (有过敏体质，无鼻炎；n=704), 非过敏性鼻炎(有鼻炎，无过敏体质；n=1377),过敏性鼻炎 (过敏体质合并鼻炎；n=1217). 应用Cox比例风险回归模型分析四组间哮喘发生率的差异。
结果发现8.8年中哮喘的累积发病率为2.2% (140例)，且四组间有显著性差异（分别为1.1% (36), 1.9% (13), 3.1% (42), 4.0% (49)；p<0.0001)。在校正了国家、性别、基线年龄、体重指数、FEV1、总IgE对数值，哮喘家族史，吸烟因素后，仅有过敏体质组发生哮喘的校正后相对风险度为1.63(95% CI 0.82-3.24)，非过敏性鼻炎组为2.71(1.64-4.46)，过敏性鼻炎组为3.53(2.11-5.91)。对MITE过敏的过敏性鼻炎与哮喘发病危险性增加(2.79 [1.57-4.96])。
因此该研究证实即使不伴有过敏，单纯鼻炎也是成人发生哮喘的高危因素。
结果发现8.8年中哮喘的累积发病率为2.2% (140例)，且四组间有显著性差异（分别为1.1% (36), 1.9% (13), 3.1% (42), 4.0% (49)；p<0.0001)。在校正了国家、性别、基线年龄、体重指数、FEV1、总IgE对数值，哮喘家族史，吸烟因素后，仅有过敏体质组发生哮喘的校正后相对风险度为1.63(95% CI 0.82-3.24)，非过敏性鼻炎组为2.71(1.64-4.46)，过敏性鼻炎组为3.53(2.11-5.91)。对MITE过敏的过敏性鼻炎与哮喘发病危险性增加(2.79 [1.57-4.96])。
因此该研究证实即使不伴有过敏，单纯鼻炎也是成人发生哮喘的高危因素。
（马艳良 北京大学人民医院呼吸科 100044 摘译）
（Lancet. 2008 Sep 20;372(9643):1049-1057）
Rhinitis and onset of asthma: a longitudinal population-based study.
Shaaban R, Zureik M, Soussan D, Neukirch C, Heinrich J, Sunyer J, Wjst M, Cerveri I, Pin I, Bousquet J, Jarvis D, Burney PG, Neukirch F, Leynaert B.
Lancet. 2008 Sep 20;372(9643):1049-57.
BACKGROUND: A close relation between asthma and allergic rhinitis has been reported by several epidemiological and clinical studies. However, the nature of this relation remains unclear. We used the follow-up data from the European Community Respiratory Health Survey to investigate the onset of asthma in patients with allergic and non-allergic rhinitis during an 8.8-year period.
METHODS: We did a longitudinal population-based study, which included 29 centres (14 countries) mostly in western Europe. Frequency of asthma was studied in 6461 participants, aged 20-44 years, without asthma at baseline. Incident asthma was defined as reporting ever having had asthma confirmed by a physician between the two surveys. Atopy was defined as a positive skin-prick test to mites, cat, Alternaria, Cladosporium, grass, birch, Parietaria, olive, or ragweed. Participants were classified into four groups at baseline: controls (no atopy, no rhinitis; n=3163), atopy only (atopy, no rhinitis; n=704), non-allergic rhinitis (rhinitis, no atopy; n=1377), and allergic rhinitis (atopy+rhinitis; n=1217). Cox proportional hazards models were used to study asthma onset in the four groups. FINDINGS: The 8.8-year cumulative incidence of asthma was 2.2% (140 events), and was different in the four groups (1.1% (36), 1.9% (13), 3.1% (42), and 4.0% (49), respectively; p<0.0001). After controlling for country, sex, baseline age, body-mass index, forced expiratory volume in 1 s (FEV(1)), log total IgE, family history of asthma, and smoking, the adjusted relative risk for asthma was 1.63 (95% CI 0.82-3.24) for atopy only, 2.71 (1.64-4.46) for non-allergic rhinitis, and 3.53 (2.11-5.91) for allergic rhinitis. Only allergic rhinitis with sensitisation to mite was associated with increased risk of asthma independently of other allergens (2.79 [1.57-4.96]).
INTERPRETATION: Rhinitis, even in the absence of atopy, is a powerful predictor of adult-onset asthma.
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哮喘孕妇、哮喘加重及平喘药物应用对后代先天畸形发生率的影响
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青春期室外游泳和哮喘的关系
