持续性哮喘患儿真菌感染病情及危险因素分析
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摘要
目的分析持续性哮喘患儿真菌感染危险因素及其与病情严重程度的关系。方法选择2014年1月至2017年10月在绍兴第二医院儿科诊治的86例持续性哮喘患儿,采用皮肤点刺试验(SPT)检测黄曲霉、烟曲霉、链孢霉、毛霉和白色念珠菌抗原,同时检测血清总免疫球蛋白E(IgE)水平,根据SPT阳性结果和血清总IgE水平,将患儿分为真菌致敏组和非真菌致敏组,分析比较两组患儿哮喘严重程度及真菌致敏组患儿的主要致敏菌,分析患儿真菌感染危险因素。结果 21例患儿SPT检测阳性为真菌致敏组,真菌致敏组家族过敏史患儿显著多于非真菌致敏组,差异有统计学意义(χ~2=4.465,P<0.05);真菌致敏组重度哮喘患儿显著多于非真菌致敏组,差异有统计学意义(χ~2=9.128,P<0.05);两组血清总IgE水平、FEV1%、FEV1/FVC、近1年哮喘急性加重发作次数相比差异均有统计学意义(t值分别为4.361、2.205、3.852、2.154,均P<0.05);真菌致敏患儿中最常见的致病菌是黄曲霉,黄曲霉感染占52.38%,其次是毛霉(28.57%)和链孢霉(23.81%),且患儿哮喘越严重血清黄曲霉IgE水平越高;抗菌药物使用(OR=1.532,95%CI:1.125～2.086)、激素使用(OR=2.518,95%CI:1.943～2.397)和侵入性治疗(OR=4.251,95%CI:3.064～5.897)是持续性哮喘患儿真菌感染的危险因素。结论抗菌药物使用、激素使用和侵入性治疗是持续性哮喘患儿真菌感染的独立危险因素,与非真菌致敏患儿相比,真菌致敏患儿持续性哮喘更加严重,因此真菌致敏可能与持续性哮喘患儿哮喘严重程度有关。
Objective To analyze the risk factors of fungal infection in children with persistent asthma and their relationship with the severity of the disease. Methods Eighty-six children with persistent asthma were selected from January 2014 to October 2017 in Shaoxing Second Hospital. The skin prick test(SPT) was used to detect the Aspergillus flavus, Aspergillus fumigatus, Neurospora, Hairy Mould and Albicans Saccharomyces antigen, and the level of serum total immunoglobulin E(IgE) was detected. According to the positive results of SPT and the level of serum total IgE, the children were divided into fungal sensitization group and non fungal sensitization group. The severity of asthma of children in two groups and the main sensitization bacteria in the fungal sensitization group were compared and analyzed. The risk factors of fungal infection in children were analyzed. Results Twenty-one cases of SPT positive children were in fungal sensitization group, and in the fungal sensitization group the children with family allergy history were significantly more than those in the non fungal sensitization group(χ~2=4.465,P<0.05). The children with severe asthma in the fungal sensitization group were significantly more than those in the non fungal sensitization group(χ~2=9.128,P<0.05). The differences were statistically significant in the serum total IgE level, FEV1%, FEV1/FVC, and the frequency of acute exacerbation of asthma in the last 1 year between two groups(t value was 4.361, 2.205, 3.852 and 2.154, respectively, all P<0.05). Aspergillus Flavus was the most common pathogenic bacteria in children with fungal sensitization, occupying 52.38%, followed by Hairy Mould(28.57%) and Neurospora(23.81%). The more severe the asthma was, the higher the level of serum Aspergillus flavus IgE was. Antimicrobial(OR=1.532, 95%CI:1.125-2.086), hormone(OR=2.518, 95%CI:1.943-2.397), and invasive treatment(OR=4.251, 95%CI:3.064-5.897) were risk factors for fungal infection in children with persistent asthma. Conclusion Antimicrobial, hormone, and invasive treatment are independent risk factors for fungal infection in children with persistent asthma. Compared with non fungal sensitization children, persistent asthma is more severe in fungal sensitization children, so fungal sensitization may be related to the severity of asthma in children with persistent asthma.
Objective To analyze the risk factors of fungal infection in children with persistent asthma and their relationship with the severity of the disease. Methods Eighty-six children with persistent asthma were selected from January 2014 to October 2017 in Shaoxing Second Hospital. The skin prick test(SPT) was used to detect the Aspergillus flavus, Aspergillus fumigatus, Neurospora, Hairy Mould and Albicans Saccharomyces antigen, and the level of serum total immunoglobulin E(IgE) was detected. According to the positive results of SPT and the level of serum total IgE, the children were divided into fungal sensitization group and non fungal sensitization group. The severity of asthma of children in two groups and the main sensitization bacteria in the fungal sensitization group were compared and analyzed. The risk factors of fungal infection in children were analyzed. Results Twenty-one cases of SPT positive children were in fungal sensitization group, and in the fungal sensitization group the children with family allergy history were significantly more than those in the non fungal sensitization group(χ~2=4.465,P<0.05). The children with severe asthma in the fungal sensitization group were significantly more than those in the non fungal sensitization group(χ~2=9.128,P<0.05). The differences were statistically significant in the serum total IgE level, FEV1%, FEV1/FVC, and the frequency of acute exacerbation of asthma in the last 1 year between two groups(t value was 4.361, 2.205, 3.852 and 2.154, respectively, all P<0.05). Aspergillus Flavus was the most common pathogenic bacteria in children with fungal sensitization, occupying 52.38%, followed by Hairy Mould(28.57%) and Neurospora(23.81%). The more severe the asthma was, the higher the level of serum Aspergillus flavus IgE was. Antimicrobial(OR=1.532, 95%CI:1.125-2.086), hormone(OR=2.518, 95%CI:1.943-2.397), and invasive treatment(OR=4.251, 95%CI:3.064-5.897) were risk factors for fungal infection in children with persistent asthma. Conclusion Antimicrobial, hormone, and invasive treatment are independent risk factors for fungal infection in children with persistent asthma. Compared with non fungal sensitization children, persistent asthma is more severe in fungal sensitization children, so fungal sensitization may be related to the severity of asthma in children with persistent asthma.
引文
[1]刘传合,洪建国,尚云晓,等.中国16城市儿童哮喘患病率20年对比研究[J].中国实用儿科杂志,2015,30(8):596-600.
[2]Pinto C R,Almeida N R,Marques T S,et al.Local adverse effects associated with the use of inhaled corticosteroids in patients with moderate or severe asthma[J].Jornal Brasileiro de Pneumologia e Tisilogia,2013,39(4):409-417.
[3]张冉,田庆秀,余丽君.支气管哮喘患者吸入糖皮质激素治疗依从性的研究[J].中华护理杂志,2015,50(1):2.
[4]贺娟梅,李小荣,李复红.支气管哮喘流行病学观察以及危险因素分析[J].山西医科大学学报,2015,46(12):1224-1227.
[5]中华医学会儿科学分会呼吸学组.儿童支气管哮喘诊断与防治指南(2016年版)[J].中华儿科杂志,2016,54(3):167-181.
[6]Guleria R,Ayub I,Madan K,et al.Prevalence of allergic bronchopulmonary aspergillosis using two different diagnostic criteria in patients with bronchial asthma[J].Chest,2016,150(4):11A.
[7]Brusselle G,Mcelhattan J,Canvin J,et al.Reslizumab (RES) in asthma patients (pts) with severe eosinophilic asthma stratified by GINA asthma steps 4 and 5:Analysis of two phase 3, placebo (PBO)-controlled trials[J].European Respiratory Journal,2016,48(Suppl 60):PA4107.
[8]史春华,张玮,景玉华,等.吉林市0～14岁儿童支气管哮喘流行病学调查[J].中国儿童保健杂志,2013,21(6):645-648.
[9]范雪金,彭琪,陆小梅,等.东莞地区儿童支气管哮喘流行病学调查及危险因素分析[J].中华实用儿科临床杂志,2014,29(6):443-445.
[10]Agarwal R,Gupta D.Severe asthma and fungi:current evidence[J].Medical Mycology,2011,49(Suppl 1):S150-S157.
[11]Medrek S K,Kao C C,Yang D H,et al.Fungal sensitization is associated with increased risk of life-threatening asthma[J].Journal of Allergy & Clinical Immunology in Practice,2016,5(4):L1025-L1031.
[12]Gupta A,Singh M,Chakrabarti A,et al.Correlation between fungal sensitization in childhood persistent asthma and disease severity[J].Mycoses,2018,61(3):195-200.
[13]Vicencio A G,Santiago M T,Tsirilakis K,et al.Fungal sensitization in childhood persistent asthma is associated with disease severity[J].Pediatric Pulmonology,2013,49(1):8-14.
[14]邹晖,苏磊,方秋红,等.真菌特异性IgE与支气管哮喘严重程度[J].中国耳鼻咽喉头颈外科,2013,20(3):133-136.
[15]Agarwal R,Noel V,Aggarwal A N,et al.Clinical significance of Aspergillus,sensitisation in bronchial asthma[J].Mycoses,2011,54(5):e531-e538.
[2]Pinto C R,Almeida N R,Marques T S,et al.Local adverse effects associated with the use of inhaled corticosteroids in patients with moderate or severe asthma[J].Jornal Brasileiro de Pneumologia e Tisilogia,2013,39(4):409-417.
[3]张冉,田庆秀,余丽君.支气管哮喘患者吸入糖皮质激素治疗依从性的研究[J].中华护理杂志,2015,50(1):2.
[4]贺娟梅,李小荣,李复红.支气管哮喘流行病学观察以及危险因素分析[J].山西医科大学学报,2015,46(12):1224-1227.
[5]中华医学会儿科学分会呼吸学组.儿童支气管哮喘诊断与防治指南(2016年版)[J].中华儿科杂志,2016,54(3):167-181.
[6]Guleria R,Ayub I,Madan K,et al.Prevalence of allergic bronchopulmonary aspergillosis using two different diagnostic criteria in patients with bronchial asthma[J].Chest,2016,150(4):11A.
[7]Brusselle G,Mcelhattan J,Canvin J,et al.Reslizumab (RES) in asthma patients (pts) with severe eosinophilic asthma stratified by GINA asthma steps 4 and 5:Analysis of two phase 3, placebo (PBO)-controlled trials[J].European Respiratory Journal,2016,48(Suppl 60):PA4107.
[8]史春华,张玮,景玉华,等.吉林市0～14岁儿童支气管哮喘流行病学调查[J].中国儿童保健杂志,2013,21(6):645-648.
[9]范雪金,彭琪,陆小梅,等.东莞地区儿童支气管哮喘流行病学调查及危险因素分析[J].中华实用儿科临床杂志,2014,29(6):443-445.
[10]Agarwal R,Gupta D.Severe asthma and fungi:current evidence[J].Medical Mycology,2011,49(Suppl 1):S150-S157.
[11]Medrek S K,Kao C C,Yang D H,et al.Fungal sensitization is associated with increased risk of life-threatening asthma[J].Journal of Allergy & Clinical Immunology in Practice,2016,5(4):L1025-L1031.
[12]Gupta A,Singh M,Chakrabarti A,et al.Correlation between fungal sensitization in childhood persistent asthma and disease severity[J].Mycoses,2018,61(3):195-200.
[13]Vicencio A G,Santiago M T,Tsirilakis K,et al.Fungal sensitization in childhood persistent asthma is associated with disease severity[J].Pediatric Pulmonology,2013,49(1):8-14.
[14]邹晖,苏磊,方秋红,等.真菌特异性IgE与支气管哮喘严重程度[J].中国耳鼻咽喉头颈外科,2013,20(3):133-136.
[15]Agarwal R,Noel V,Aggarwal A N,et al.Clinical significance of Aspergillus,sensitisation in bronchial asthma[J].Mycoses,2011,54(5):e531-e538.