广州城市和农村地区儿童支气管哮喘和变应性鼻炎流行病学研究

发布时间：2018-06-22 08:44

本文选题：支气管哮喘 + 过敏症　；参考：《广州医学院》2011年硕士论文

【摘要】：目的一、了解广州市区青少年支气管哮喘(简称哮喘)及变应性鼻炎的患病情况及严重程度。二、了解从化农村地区青少年哮喘及变应性鼻炎的患病情况及严重程度。三、了解广州市区15年间青少年哮喘流行病学变化趋势。四、了解广州城区与从化农村地区青少年哮喘流行情况的差异。方法第一部分广州市区青少年哮喘和变应性鼻炎患病率和患病趋势的流行学研究为横断面调查研究,按儿童哮喘及其他变应性疾病的国际对比研究(ISAAC)研究方案,在与ISAAC前两个阶段(阶段Ⅰ、阶段Ⅲ)相同的月份(2009年11月～12月),相同的4个城区中相同的10所中学,沿用与前相同的ISAAC中文问卷,包括书面问卷和录像问卷,对年龄在13～14岁的初一及初二级中学生,共计6928人进行调查。内容包括哮喘、变应性鼻炎的相关症状患病率和严重程度。在参与问卷调查的学生中随机抽取329人进行常见变应原皮肤点刺试验。结果分别与前两个阶段调查对比。第二部分从化农村地区青少年支气管哮喘流行病学调查及与广州市区的对比为横断面调查研究,在2009年11月～2010年1月,在从化农村4个乡镇的四所中学,采用与广州城区调查相同的ISAAC中文问卷(书面问卷和录像问卷),对5841名年龄在13～14岁的初一、初二级中学生调查哮喘、变应性鼻炎相关症状的患病率和严重程度进行调查,结果与同时期广州市区的调查对比。第三部分广州市区和从化农村地区青少年进一步临床检查的对比研究从广州市区参加问卷调查的学生抽取其中417人,从化农村地区抽取443人,共860人参加哮喘相关实验室客观检查,包括11种变应原皮肤点刺试验、嗜酸粒细胞计数、基础肺通气功能和支气管激发试验,结果进行地区间比较。统计学方法:用18.0版SPSS (SPSS Inc. Chicago, IL, USA)进行分析。患病率(即症状的阳性率)为报告症状阳性的人数与实际调查人数之比,并计算95%可信区间(95%CI)。用二元logistic回归、卡方检验、t检验分析地区间、性别间患病率及检查结果的差异, p0.05视为有统计学意义上的差异。结果第一部分广州市区青少年哮喘和变应性鼻炎患病率和患病趋势的流行学研究一、本次调查回收有效问卷6928张,应答率96.7%。平均年龄为13.3±0.64岁,13～14岁儿童共6062人,占总人数87.5%。男性3524人,女性3424人,分别占总人数50.6%和49.4%。以上年龄和性别构成与1994年(ISAAC阶段Ⅰ)、2001年(阶段Ⅲ)均大致相似。二、本次调查中,书面问卷的近12个月喘息为6.1% ,医生诊断的哮喘病史为6.9% ,1994年(阶段Ⅰ)相应的患病率为3.4%、3.9%,而2001年(阶段Ⅲ)为4.8%、4.6%,2009年均较前两阶段上升(p0.05)。三、录像问卷中,2009年近期休息时喘息的发病率为4.9%,较94年的2%与01年的3.8%增加(p0.05);运动后喘息的发病率为13.7%,较94年(6.9%)与01年(11.3%)有显著性增加(p0.01)。四、2009年医生诊断的变应性鼻炎、花粉症分别为25.1%、5.3%,较94年(17.4%、2.9%)、01年(22.7%、4.1%)显著性增高(p0.05)。09年近12个月鼻炎和鼻结膜炎症状的患病率,分别为43.2%、10.4%,较94年显著增高(p0.05)。五、2010年广州地区青少年特应性和变应原阳性率较前明显升高。2010年和2002年特应性分别为62.2%和46.3%,两次调查变应原分布基本相似,阳性率最高的是粉尘螨,在两次调查中分别是55.9%和44.9%。猫毛和蟑螂是次于尘螨的常见变应原。第二部分从化农村地区青少年支气管哮喘流行病学调查及与广州市区的对比一、从化市四所乡镇中学共6087人参加了问卷调查,回收有效问卷5841份,应答率96%。平均年龄14.2±0.83岁。13～14岁儿童4815人,占总人数82.4%。其中男性2953人,女性2888人,分别占总人数50.6%、49.4%。二、从化的哮喘及鼻炎相关症状的发病率均显著低于同时期广州的发病率:医生诊断的哮喘从化与广州分别为3.4%与6.9%,既往哮喘为4.2%与14.6%,近期喘息1.5%与6.1%;录像问卷中的近期症状中,休息时喘息的发病率为1.7%与4.9% (p0.01)。男性和女性的患病率无显著性差异。三、医生诊断的鼻炎、季节性花粉过敏症的发病率从化与广州分别为4.4%与25.1%、2.6%与5.3%,近期鼻炎患病率为25.8%与43.2%,以上指标均有显著性差异(p0.01)。第三部分广州市区和从化农村地区青少年进一步临床检查的对比研究从化与广州静脉血嗜酸性粒细胞计数分别为0.19和0.27(×109/l),特应性为51.1%和66.4%,气道高反应性为3.1%和20.2%,上述指标从化均低于广州(p0.05)。结合气道高反应性和病史,从化地区哮喘现患率为2.4%,远低于广州的7.4%。结论一、广州市13～14岁青少年的哮喘和变应性鼻炎病史和症状的患病率15年来整体呈上升趋势。二、广州市区13～14岁青少年特应性和变应原致敏性显著升高。三、从化农村地区13～14岁儿童的哮喘和变应性疾病的患病率低于同时期广州市区水平。从化地区皮试阳性率、嗜酸粒计数及气道高反应性的比例均显著低于广州市区。四、特应性和尘螨等变应原阳性是哮喘及变应性鼻炎发生的危险因素。
[Abstract]:objective
First, to understand the prevalence and severity of bronchial asthma (asthma) and allergic rhinitis in adolescents in Guangzhou.
Two, to understand the prevalence and severity of asthma and allergic rhinitis in adolescents in rural areas of Conghua.
Three, to understand the epidemiological trend of asthma among adolescents in Guangzhou during the past 15 years.
Four, understand the difference between the prevalence of asthma among adolescents in urban areas of Guangzhou and Conghua.
Method
Part one epidemiological study on prevalence and prevalence of asthma and allergic rhinitis in adolescents in Guangzhou urban area
For the cross-sectional study, the international comparative study (ISAAC) study of children's asthma and other allergic diseases (ISAAC) was used in the same month (from November 2009 to December), the same 10 middle schools in the same 4 urban districts (from November 2009 to December), with the same ISAAC Chinese questionnaire, including written questionnaires and videotapes. A total of 6928 students aged 13~14 years of age at the age of first and first grade two were investigated. The contents included the prevalence and severity of asthma, allergic rhinitis, and 329 of the students who participated in the questionnaire survey. The results were compared with the first two stages.
The second part is the epidemiological survey of bronchial asthma in adolescents in rural areas of Conghua and the comparison with the urban area of Guangzhou.
For the cross-sectional study, from November 2009 to January 2010, four middle schools in 4 villages and towns in Conghua, using the same ISAAC Chinese questionnaire (written questionnaire and video questionnaire) which were the same as Guangzhou city survey, were used to examine the prevalence and severity of allergic rhinitis related symptoms in 5841 junior middle school students at the age of 13~14. The results were compared with the survey of Guangzhou city in the same period.
The third part is a comparative study of further clinical examination among adolescents in Guangzhou and Conghua rural areas.
417 of them were selected from the Guangzhou urban area. 443 people were selected from the rural area of Conghua. A total of 860 people participated in the objective examination of asthma related laboratory, including 11 allergen skin pricking tests, eosinophil count, basic lung ventilation function and bronchial provocation test, and the results were compared between regions.
Statistical methods: analysis was made with the 18 version of SPSS (SPSS Inc. Chicago, IL, USA). The prevalence rate (the positive rate of symptoms) was the ratio of the number of positive symptoms to the actual number of people, and the 95% confidence interval (95%CI). Two yuan logistic regression, chi square test, and t test were used to analyze the differences between the sexes and the results of the examination, P. 0.05 considered a statistically significant difference.
Result
Part one epidemiological study on prevalence and prevalence of asthma and allergic rhinitis in adolescents in Guangzhou urban area
First, 6928 valid questionnaires were collected, the average age of response rate of 96.7%. was 13.3 + 0.64 years, and 6062 children were 13~14 years old, accounting for 3524 men and 3424 women. The total number of age and sex was 50.6% and more than 49.4%. and in 1994 (ISAAC stage I), and 2001 (stage III) were roughly similar.
Two, in this survey, the written questionnaire was 6.1% for the last 12 months, the history of asthma diagnosed by doctors was 6.9%, and the corresponding prevalence rate was 3.4%, 3.9% in 1994 (stage I), while 2001 (stage III) was 4.8%, 4.6% and 2009 (P0.05) compared with the previous two stages.
Three, in the video questionnaire, the incidence of wheezing was 4.9% in 2009, compared with 2% in 94 years and 3.8% in 01 years (P0.05); the incidence of wheezing after exercise was 13.7%, compared with 94 years (6.9%) and 01 years (11.3%) significantly increased (P0.01).
Four, in 2009, the allergic rhinitis diagnosed by doctors, 25.1%, 5.3%, 94 years (17.4%, 2.9%), 01 years (22.7%, 4.1%) significantly increased (P0.05) the incidence of nearly 12 months of rhinitis and rhinoconjunctivitis, respectively, 43.2%, 10.4%, significantly higher than the 94 years (P0.05).
Five, in 2010, the positive rates of adolescent idiosyncrasy and allergens in the Guangzhou area were significantly higher than those before.2010 and 2002, respectively 62.2% and 46.3%. The two survey allergens were basically similar, and the highest positive rate was the dust mites. In the two investigations, 55.9% and 44.9%. cat hair and cockroaches were the common allergens inferior to dust mites.
The second part is the epidemiological survey of bronchial asthma in adolescents in rural areas of Conghua and the comparison with the urban area of Guangzhou.
A total of 6087 people from four Township Middle Schools in Conghua participated in the questionnaire survey and recovered 5841 copies of effective questionnaires. The response rate was 4815 from.13 to 14 years old, with the average age of 96%. 14.2 + 0.83 years old, accounting for the total number of 82.4%. among men 2953 and 2888, accounting for 50.6%, 49.4%., respectively.
Two, the incidence of asthma and rhinitis related symptoms in Conghua was significantly lower than the incidence of Guangzhou at the same time: the doctors diagnosed asthma in Conghua and Guangzhou were 3.4% and 6.9%, the asthma was 4.2% and 14.6%, and the short term wheezing 1.5% and 6.1%; the incidence of wheezing at rest was 1.7% and 4.9% (P0.01) in the short term symptoms of the videotape. There was no significant difference in the prevalence of women.
Three, the incidence of seasonal allergic rhinitis and seasonal pollen allergy in Conghua and Guangzhou was 4.4% and 25.1%, 2.6% and 5.3% respectively. The incidence of recent rhinitis was 25.8% and 43.2%, and the above indexes were significantly different (P0.01).
The third part is a comparative study of further clinical examination among adolescents in Guangzhou and Conghua rural areas.
The eosinophil counts of venous blood in Conghua and Guangzhou were 0.19 and 0.27 (x 109/l), the atopy was 51.1% and 66.4%, the airway hyperresponsiveness was 3.1% and 20.2%, the above index in Conghua was lower than that of Guangzhou (P0.05). The prevalence rate of asthma in Conghua was 2.4% in combination with the history of airway hyperresponsiveness, far below the 7.4%. of Guangzhou.
conclusion
First, the prevalence of asthma and allergic rhinitis and the prevalence of symptoms in 13~14 year olds in Guangzhou have been on the rise for 15 years.
Two, sensitization of atopic and allergens in adolescents aged 13~14 years in Guangzhou increased significantly.
Three, the prevalence rate of asthma and allergic disease of 13~14 years old children in rural areas of Conghua was lower than that of Guangzhou city. The ratio of skin test positive, eosinophil count and airway hyperresponsiveness in Conghua area were significantly lower than that of Guangzhou city.
Four, atopic and dust mite allergen positive is a risk factor for asthma and allergic rhinitis.
【学位授予单位】：广州医学院
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R725.6;R765.21

【引证文献】