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喘鸣表型和年幼儿童哮喘的预测

Authors
Theresa W Guilbert, MD
Robert F Lemanske, Jr, MD
Section Editor
Gregory Redding, MD
Deputy Editor
Elizabeth TePas, MD, MS
Translators
蔡晓红, 主任医师

引言

反复发生喘鸣的婴幼儿父母常会咨询医生：“我的孩子是否得了哮喘？”这是参与治疗的临床医生以及研究哮喘的专家们也想回答的问题。学龄前喘鸣是可以预测儿童今后是否发生哮喘的症状[1]，同时是一个世界性的普遍问题。然而，许多儿童喘鸣在达到学龄期或之前就会改善并最终消失。正确识别发生持续哮喘的风险增加的婴儿和年幼儿童可帮助预测远期结局并改善预防和治疗，但目前识别此类儿童的能力仍然很有限。

为了对反复喘鸣儿童进行分类和确定哪些患儿最终会发展为哮喘，已研发了数种喘鸣表型的分类和其他工具。本专题将总结这些喘鸣表型和预测工具。儿童哮喘的定义和诊断；哮喘危险因素、遗传学及自然病史；毛细支气管炎和病毒诱发的喘鸣；以及其他引起儿童喘鸣的病因将单独讨论。 (参见“12岁以下儿童的哮喘：初始评估和诊断”和“12岁以下儿童的哮喘：定义、流行病学和病理生理学”和“哮喘的自然病程”和“哮喘遗传学”和“哮喘的危险因素”和“婴儿和儿童喘鸣的评估方法”和“病毒诱导的喘鸣和哮喘：概述”和“幼儿复发性病毒诱发性喘鸣的治疗”和“婴儿及儿童毛细支气管炎的临床特征和诊断”)

喘鸣表型

有报道显示大约50%儿童1岁内会发生喘鸣，然而仅20%的患儿在之后的儿童期仍持续存在喘鸣症状[2]。为了识别喘鸣儿童的特点和危险因素，人们定义了喘鸣表型[3]。其中一些表型描述了儿童期后期仍然持续喘鸣的儿童，而另外一些表型可确定青春期和成人期仍有喘鸣的儿童。然而，危险因素和随后发展为儿童期后期及成人期哮喘之间的关系并不明确。

许多这些早期儿童喘鸣表型是基于纵向研究回顾性地确认的。然而，临床上很难对学龄前期儿童进行表型分类，因为随着时间的推移症状和危险因素的表现会发生变化。此外，还没确定这些表型能否应用到不同人群，目前也不明确治疗特定喘鸣表型的最有效方法以及早期干预能否改变将来的病程和结局。

流行病学表型 — 根据喘鸣病史，现已确立了几种流行病学表型。在区分一过性、持续性和迟发性喘鸣时所用的年龄界限不同，对于哪些危险因素与各表型相关也有不一致的观点。同时，还有关于这些表型的前瞻性效度方面的担忧。

                     

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Literature review current through: 2017-07 . | This topic last updated: 2017-02-22.
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