急性細支氣管炎與兒童氣喘之長期性研究

A Longitudinal Study on Acute Bronchiolitis and Subsequent Childhood Asthma

張日錦(Jih-Chin Chang)

指導教授 ： 呂克桓 ； 柯俊良

中山醫學大學/醫學院/醫學研究所/碩士(2016年)

摘要

研究背景：
喘鳴及呼吸急促的表現在細支氣管炎和氣喘皆是相當類似，而細支氣管炎的發生次數是否為氣喘的危險因素還未被清楚地研究。
研究目的：
本研究主要目的在了解2歲前細支氣管炎與日後發展成為氣喘的相關性。
研究方法及資料：
本研究為回溯性世代追蹤研究。我們使用台灣全民健康保險資料庫，選取2001-2010年2歲前就診細支氣管炎的個案，與未有細支氣管炎就診者針對氣喘作比較，並且將可能的共病及資療資訊列入分析。
研究結果：
總共有64013人進入分析，其中31058人為細支氣管炎暴露組，另外32955人為對照組。依照傾向分數配對後的暴露組氣喘發生率顯著高於對照組（13.87 v.s. 9.06每千人年，p＜0.0001）。其中2歲前門診次數＞3次者及住院次數＞2次者有最高的氣喘風險對比值（HR=5.892，95%C.I.：3.254-10.667）。性別及異位性皮膚炎在細支氣管炎對氣喘風險比值無顯著修飾效果。
結論與建議：
幼年期罹患細支氣管炎會增加日後氣喘的風險，尤其感染次數增加則風險也越高。此外細支氣管炎可能與氣喘提早發生有關；因此我們建議，2歲前感染細支氣管炎的幼童，其父母應被告知會有較高的罹患氣喘風險、以及接受評估，尤其是細支氣管炎門診次數超過3次及住院次數超過2次者。

關鍵字

細支氣管炎 ； 氣喘

並列摘要

Background:
The symptoms of wheezing and dyspnea in acute asthmatic attacks are similar to bronchiolitis. Whether the occurrence times of bronchiolitis poses a risk for the development of asthma has not been clearly investigated.
Objective:
The aim is to analyze the relationship between acute bronchiolitis in children younger than 2 years of age and subsequent childhood asthma.
Design:
This was a retrospective cohort study design.
Methods:
Children younger than 24 months who were diagnosed with acute bronchiolitis from 2001-2010 were retrieved from the National Health Insurance Research Database of Taiwan, and compared to subjects without bronchiolitis diagnosis with regards to asthma. Potential comorbidities and medical care conditions were also compared between two groups.
Results:
In total, 64013 children were enrolled into analysis inclusive of 31058 exposure subjects compared with 32955 controls. The incidence of childhood astma was significantly higher in the study group (13.87 v.s. 9.06 per 103 person years after propensity score match，p<0.0001). The hazard ratio was highest (5.892，95%C.I.：3.254-10.667) for bronchiolitis outpatient visits more than three times and hospitalized more than twice before 24 months of age. Gender and atopic dermatitis have no adjust effect on hazard ratios of bronchiolitis with regards to asthma development.
Conclusion:
Early bronchiolitis infection do increase the risk of developing subsequent childhood asthma, and more bronchiolitis episodes significantly increase the effect. Nevertheless bronchiolitis may be related with earlier onset of asthma. We suggest the parents of children with bronchiolitis before 24 months of age should be informed for the higher risk of developing subsequent asthma and be well evaluated, especially in children with increased outpatient visits (>3 times) and hospitalization (>2 times).

並列關鍵字

bronchiolitis ； asthma

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