Increased Incidence of Asthma and Pulmonary Dysfunction after Severe Lower Respiratory Tract Infection in Infancy

下呼吸道感染對支氣管之過度反應、氣喘，及肺功能異常之影響因不同之作者而有正反不同的結論報告。本研究選於35名兒童，年齡為6~11歲，病兒於5~10年前當其年齡均小給12個月，而曾因肺炎而住院之病兒加以追蹤調查及進行系列之肺功能檢查其結果如下：13位（佔37%）小孩發生氣喘遠比著者重本地區之同年齡發生率為高。單純肺功能檢查發現：VC (17%)，IVC (46%)，FVC (20%)，FEV1 (17%)，FEF25~75% (37%)，FEF75% (26%)，FEV1／VC (20%)低於正常同齡中國兒童預測值之80％以下。經水蒸氣吸入後再測的肺功能發現VC (14%)，IVC (51%)，FVC (23%)，FEV1 (26%)，FEF25~75% (49%)，FEF75% (23%)，FEV1/VC (14%)呈現異常。經4.5%鹽水蒸氣吸入後再測的肪功能有VC (29%)，IVC (53%)，FVC (24%)，FEV1 (29%)，FEF25~75% (47%)，FEF75% (29%)，FEV1/VC (29%)呈現異常。乙醯丑甲基膽素(methacholine)激發測試(PC20)也明顯發現有氣喘的病兒的低於5mg/me。比較氣喘過敏性鼻炎及正常兒3組間於肺炎時之臨床症狀發現只有家庭中父母有過敏病兒及肺炎時有喘鳴發生兩項呈現差異而可因為危險因子。但在22位沒有父母過敏病史的小孩中仍有4位發生氣喘(18.2%)，也比正常兒童之發生率為高。此外，喘鳴之發生則可視爲氣喘之早期表徵。本研究相信遺傳因子可能是氣喘發生之主要原因之一，但嚴重的下呼吸道感染，尤其是愈小年齡之嬰幼兒將可能導致支氣管之發育受損而可能使不論是否帶有遺傳因子的小孩於兒童期時增高氣喘及肺功能異常之發生率。

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並列摘要

In the present study we tried to define the effect of lower respiratory tract infections upon pulmonary function and/or asthma in childhood, Thirty-five children with history of pneumonia in infancy were followed five to ten years later; all were asked to respond questionnaire, received physical examination and were diagnosed for pulmonary function. The results follow: 13 children (37%) had developed asthma, a significantly higher percentage than normal prevalence among students in this area. Simple pulmonary function test, pulmonary function test after distilled water mist and after hypertonic saline (4.5%) mitt all showed abnormal values in VC (17%, 14%, 29% respectively), in IVC (46%, 51%, 53%), in FVC (20%, 23%, 24%), in FEV1 (17%, 23%, 29%), in FEF25-75% (37%, 49%, 47%), in FEF75% (26%, 23%, 29%) and in FEV1/VC (20%, 14%, 29%). Methacholine challenge test (PC20) showed a marked decrease of PC20 in asthmatic children, each was less than 5 mg/ml (mean value; 0.99mg/ml). Family-allergy in at least one parent and wheeze were the two significant risk factors. Nevertheless, in 22 non-family-allergy children, the occurrence of asthma was also higher than general prevalence (18.2% vs 5.6%). Wheezing was evident in viral infections in infancy, but bacterial culture from sputum or throat swabs failed to find pathogenic bacteria. These results indicate that while the genetic factor may he important, viral infections may be more important because, even in non-family-allergy children, the occurrence of asthma was higher for infants infected in early infancy than the general prevalence for age-matched students.

並列關鍵字

asthma ； pulmonary function test ； methacholine challenge ； lower respiratory tract infection

國際替代計量

Increased Incidence of Asthma and Pulmonary Dysfunction after Severe Lower Respiratory Tract Infection in Infancy

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