我国城区门诊支气管哮喘患者疾病严重程度及合并症的调查分析
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摘要
目的调查我国城区门诊支气管哮喘患者疾病严重程度及合并症。方法 2015年10月至2016年5月于我国内地(除西藏外)30个省、自治区、直辖市的30家三级甲等医院进行面对面问卷调查研究,符合入选标准的门诊哮喘患者纳入研究。研究内容包括:(1)一般资料;(2)吸烟状态;(3)疾病严重程度;(4)合并症。结果本次调查共纳入3 875例门诊哮喘患者。根据GINA指南,疾病严重程度分级:间歇状态52.5%(2 033/3 875),轻度持续24.5%(951/3 875),中度持续16.9%(656/3 875),重度持续6.1%(235/3 875)。体重超重率32.9%(1 274/3 875),肥胖率10.3%(401/3 875);吸烟率为20.1%(777/3 875),其中现行吸烟率为7.7%(298/3 875)。肥胖、吸烟均与哮喘控制不佳相关。75.9%(2 941/3 875)的哮喘患者有合并症,依次为:过敏性鼻炎43.4%(1 682/3 875),高血压病16.4%(634/3 875),鼻窦炎8.7%(338/3 875),慢性阻塞性肺疾病7.3%(283/3 875),支气管扩张症3.0%(118/3 875),鼻息肉2.9%(114/3 875)。结论门诊就诊的哮喘患者轻度占多数。哮喘患者共患过敏性鼻炎、支气管扩张的比例显著高于人群平均水平。肥胖、吸烟均与哮喘控制不佳相关。
引文
1GINA Executive and Science Committee. Global Strategy for asthma management and prevention 2017[R/OL]. ttp://ginasthma.org/2017-gina-report-global-strategy-for-asthmamanagement-and-prevention/.
2林江涛,王文巧,周新,等.我国十城市支气管哮喘控制和疾病管理及患者认知水平的变化.中华结核和呼吸杂志, 2018, 41(3):191-195.
3FitzGerald JM, Boulet LP, McIvor RA, et al. Asthma control in Canada remains suboptimal:the Reality of Asthma Control(TRAC)study. Can Respir J, 2006, 13(5):253-259.
4Haselkorn T, Chen H, Miller DP, et al. Asthma control and activity limitations:insights from the Real-world Evaluation of Asthma Control and Treatment(REACT)study. Ann Allergy Asthma Immunol, 2010, 104(6):471-477.
5中华医学会呼吸病学分会哮喘学组,中国哮喘联盟.重症哮喘诊断与处理中国专家共识.中华结核和呼吸杂志, 2017, 40(11):813-829.
6GINA Executive and Science Committee. Global Strategy for asthma management and prevention 2015[R/OL]. http://ginasthma.org/wp-content/uploads/2016/01/GINA_Report_2015_Aug11-1.pdf.
7郑洁,张欣,郑静,等.肥胖与支气管哮喘控制水平及气道炎症表型的关系.中国呼吸与危重监护杂志, 2015, 14(6):546-552.
8Lin J, Wang W, Chen P, et al. Prevalence and risk factors of asthma in mainland China:The CARE study. Respir Med, 2018, 137:48-54.
9Fitzpatrick S, Joks R, Silverberg JI. Obesity is associated with increased asthma severity and exacerbations, and increased serum immunoglobulin E in inner-city adults. Clin Exp Allergy, 2012,42(5):747-59.
10农英,林江涛,陈萍,等.我国14岁以上人群吸烟状况及其与支气管哮喘发病和控制的关系.中华内科杂志, 2017, 56(7):485-489.
11Sharifi A, Ansarin K. Effect of gastroesophageal relux disease on disease severity and characteristics of lung functional changes in patients with asthma. J Cardiovasc Thorac Res, 2014, 6(4):223-228.
12Rameschandra S, Acharya V, Kunal, et al. Prevalence and spectrum of gastro esophageal reflux disease in bronchial asthma. J Clin Diagn Res, 2015, 9(10):OC11-OC14.
13 Moore WC, Bleecker ER, Curran-Everett D, et al. Characterization of the severe asthma phenotype by the National Heart, Lung, and Blood Institute's Severe Asthma Research Program. J Allergy Clin Immunol, 2007, 119(2):405-413.
14Ten BA, Grootendorst DC, Schmidt JT, et al. Chronic sinusitis in severe asthma is related to sputum eosinophilia. J Allergy Clin Immunol, 2002, 109(4):621-626.
15Bachert C, Zhang N. Chronic rhinosinusitis and asthma:novel understanding of the role of IgE ‘above atopy'. J Intern Med, 2012,272(2):133-143.
16Bousquet J, Khaltaev N, Cruz AA, et al. Allergic rhinitis and its impact on asthma(ARIA)2008. Allergy, 2008, 63 Suppl 86:8-160.
17Burks AW, Tang M, Sicherer S, et al. ICON:food allergy. J Allergy Clin Immunol, 2012, 129(4):906-920.
18Price D, Kocevar VS, Zhang Q, et al. Effect of a concomitant diagnosis of allergic rhinitis on asthma-related health care use by adults. Clin Exp Allergy, 2005, 35(3):282-287.
19Thomas M, Kocevar VS, Zhang Q, et al. Asthma-related health care resource use among asthmatic children with and without concomitant allergic rhinitis. Pediatrics, 2005, 115(1):129-134.
20Bousquet J, Gaugris S, Kocevar VS, et al. Increased risk of asthma attacks and emergency visits among asthma patients with allergic rhinitis:a subgroup analysis of the improving asthma control trial.Clin Exp Allergy, 2005, 35(6):723-727.
21López-Chacón M, Mullol J, Pujols L. Clinical and biological markers of difficult-to-treat severe chronic rhinosinusitis. Curr Allergy Asthma Rep, 2015, 15(5):19.
22Lin JT, Gao J, Lai KF, et al. The characteristic of asthma control among nasal diseases population:results from a cross-sectional study. PLoS One, 2018, 13(2):e0191543.
23韩德民,张罗,黄丹,等.我国11个城市变应性鼻炎自报患病率调查.中华耳鼻咽喉头颈外科杂志, 2007, 42(5):378-384.
24 Zhang Y, Zhang L. Prevalence of allergic rhinitis in China. Allergy Asthma Immunol Res, 2014, 6(2):105-113.
25Gaugris S, Sazonov-Kocevar V, Thomas M. Burden of concomitant allergic rhinitis in adults with asthma. J Asthma, 2006, 43(1):1-7.
26Bachert C, Zhang L, Gevaert P. Current and future treatment options for adult chronic rhinosinusitis:focus on nasal polyposis.J Allergy Clin Immunol, 2015, 136(6):1431-1440.
27Wang XD, Zheng M, Lou HF, et al. An increased prevalence of self-reported allergic rhinitis in major Chinese cities from 2005 to2011. Allergy, 2016, 71(8):1170-1180.
28Shi JB, Fu QL, Zhang H, et al. Epidemiology of chronic rhinosinusitis:results from a cross-sectional survey in seven Chinese cities. Allergy, 2015, 70(5):533-539.
29Zhong NS, Wang C, Yao WZ, et al. Prevalence of chronic obstructive pulmonary disease in China:a large, population-based survey. Am J Respir Crit Care Med, 2007, 176(8):753-760.
30Twiss J, Metcalfe R, Edwards E, et al. New Zealand national incidence of bronchiectasis “too high” for a developed country.Arch Dis Child, 2005, 90(7):737-740.
31Singleton R, Morris A, Redding G, et al. Bronchiectasis in Alaska Native children:causes and clinical courses. Pediatr Pulmonol,2000, 29(3):182-187.
32王陇德.中国居民营养与健康状况调查报告之一2002综合报告.北京:人民卫生出版社, 2005, 53-57.
33Wang L, Gao P, Zhang M, et al. Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013. JAMA, 2017, 317(24):2515-2523.
34 国家心血管病中心.中国心血管病报告2016.北京:中国大百科全书出版社, 2017.
2林江涛,王文巧,周新,等.我国十城市支气管哮喘控制和疾病管理及患者认知水平的变化.中华结核和呼吸杂志, 2018, 41(3):191-195.
3FitzGerald JM, Boulet LP, McIvor RA, et al. Asthma control in Canada remains suboptimal:the Reality of Asthma Control(TRAC)study. Can Respir J, 2006, 13(5):253-259.
4Haselkorn T, Chen H, Miller DP, et al. Asthma control and activity limitations:insights from the Real-world Evaluation of Asthma Control and Treatment(REACT)study. Ann Allergy Asthma Immunol, 2010, 104(6):471-477.
5中华医学会呼吸病学分会哮喘学组,中国哮喘联盟.重症哮喘诊断与处理中国专家共识.中华结核和呼吸杂志, 2017, 40(11):813-829.
6GINA Executive and Science Committee. Global Strategy for asthma management and prevention 2015[R/OL]. http://ginasthma.org/wp-content/uploads/2016/01/GINA_Report_2015_Aug11-1.pdf.
7郑洁,张欣,郑静,等.肥胖与支气管哮喘控制水平及气道炎症表型的关系.中国呼吸与危重监护杂志, 2015, 14(6):546-552.
8Lin J, Wang W, Chen P, et al. Prevalence and risk factors of asthma in mainland China:The CARE study. Respir Med, 2018, 137:48-54.
9Fitzpatrick S, Joks R, Silverberg JI. Obesity is associated with increased asthma severity and exacerbations, and increased serum immunoglobulin E in inner-city adults. Clin Exp Allergy, 2012,42(5):747-59.
10农英,林江涛,陈萍,等.我国14岁以上人群吸烟状况及其与支气管哮喘发病和控制的关系.中华内科杂志, 2017, 56(7):485-489.
11Sharifi A, Ansarin K. Effect of gastroesophageal relux disease on disease severity and characteristics of lung functional changes in patients with asthma. J Cardiovasc Thorac Res, 2014, 6(4):223-228.
12Rameschandra S, Acharya V, Kunal, et al. Prevalence and spectrum of gastro esophageal reflux disease in bronchial asthma. J Clin Diagn Res, 2015, 9(10):OC11-OC14.
13 Moore WC, Bleecker ER, Curran-Everett D, et al. Characterization of the severe asthma phenotype by the National Heart, Lung, and Blood Institute's Severe Asthma Research Program. J Allergy Clin Immunol, 2007, 119(2):405-413.
14Ten BA, Grootendorst DC, Schmidt JT, et al. Chronic sinusitis in severe asthma is related to sputum eosinophilia. J Allergy Clin Immunol, 2002, 109(4):621-626.
15Bachert C, Zhang N. Chronic rhinosinusitis and asthma:novel understanding of the role of IgE ‘above atopy'. J Intern Med, 2012,272(2):133-143.
16Bousquet J, Khaltaev N, Cruz AA, et al. Allergic rhinitis and its impact on asthma(ARIA)2008. Allergy, 2008, 63 Suppl 86:8-160.
17Burks AW, Tang M, Sicherer S, et al. ICON:food allergy. J Allergy Clin Immunol, 2012, 129(4):906-920.
18Price D, Kocevar VS, Zhang Q, et al. Effect of a concomitant diagnosis of allergic rhinitis on asthma-related health care use by adults. Clin Exp Allergy, 2005, 35(3):282-287.
19Thomas M, Kocevar VS, Zhang Q, et al. Asthma-related health care resource use among asthmatic children with and without concomitant allergic rhinitis. Pediatrics, 2005, 115(1):129-134.
20Bousquet J, Gaugris S, Kocevar VS, et al. Increased risk of asthma attacks and emergency visits among asthma patients with allergic rhinitis:a subgroup analysis of the improving asthma control trial.Clin Exp Allergy, 2005, 35(6):723-727.
21López-Chacón M, Mullol J, Pujols L. Clinical and biological markers of difficult-to-treat severe chronic rhinosinusitis. Curr Allergy Asthma Rep, 2015, 15(5):19.
22Lin JT, Gao J, Lai KF, et al. The characteristic of asthma control among nasal diseases population:results from a cross-sectional study. PLoS One, 2018, 13(2):e0191543.
23韩德民,张罗,黄丹,等.我国11个城市变应性鼻炎自报患病率调查.中华耳鼻咽喉头颈外科杂志, 2007, 42(5):378-384.
24 Zhang Y, Zhang L. Prevalence of allergic rhinitis in China. Allergy Asthma Immunol Res, 2014, 6(2):105-113.
25Gaugris S, Sazonov-Kocevar V, Thomas M. Burden of concomitant allergic rhinitis in adults with asthma. J Asthma, 2006, 43(1):1-7.
26Bachert C, Zhang L, Gevaert P. Current and future treatment options for adult chronic rhinosinusitis:focus on nasal polyposis.J Allergy Clin Immunol, 2015, 136(6):1431-1440.
27Wang XD, Zheng M, Lou HF, et al. An increased prevalence of self-reported allergic rhinitis in major Chinese cities from 2005 to2011. Allergy, 2016, 71(8):1170-1180.
28Shi JB, Fu QL, Zhang H, et al. Epidemiology of chronic rhinosinusitis:results from a cross-sectional survey in seven Chinese cities. Allergy, 2015, 70(5):533-539.
29Zhong NS, Wang C, Yao WZ, et al. Prevalence of chronic obstructive pulmonary disease in China:a large, population-based survey. Am J Respir Crit Care Med, 2007, 176(8):753-760.
30Twiss J, Metcalfe R, Edwards E, et al. New Zealand national incidence of bronchiectasis “too high” for a developed country.Arch Dis Child, 2005, 90(7):737-740.
31Singleton R, Morris A, Redding G, et al. Bronchiectasis in Alaska Native children:causes and clinical courses. Pediatr Pulmonol,2000, 29(3):182-187.
32王陇德.中国居民营养与健康状况调查报告之一2002综合报告.北京:人民卫生出版社, 2005, 53-57.
33Wang L, Gao P, Zhang M, et al. Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013. JAMA, 2017, 317(24):2515-2523.
34 国家心血管病中心.中国心血管病报告2016.北京:中国大百科全书出版社, 2017.