控制良好且无明显运动相关症状的哮喘儿童中的运动诱发性支气管收缩：患病率及相关因素

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中文摘要

背景/目的： 运动诱发性支气管收缩（EIB）可能在哮喘看似控制良好的情况下持续存在，并且在无明显运动相关症状的儿童中可能未被识别。本研究旨在确定未报告明显运动相关呼吸道症状的控制良好哮喘儿童中经客观证实的EIB患病率，并识别与EIB相关的因素。方法：这项横断面研究纳入67名控制良好的哮喘儿童，他们接受了标准化运动激发试验并连续进行肺量计检查。评估了人口学、环境、过敏、实验室、气传变应原致敏以及基线肺功能特征。根据运动后FEV1反应将儿童分为EIB阳性或EIB阴性。采用单因素分析和多因素logistic回归评估与EIB相关的因素。结果：67名儿童中有24名（35.8%）检出EIB。基线肺功能总体保持良好，且在EIB阳性与EIB阴性儿童之间无显著差异。特应性湿疹史在EIB阳性组中更为常见（37.5% vs. 14.0%；p = 0.035）。过敏性鼻炎、食物过敏、总IgE、嗜酸性粒细胞百分比以及气传变应原致敏与EIB均无显著相关。在多因素logistic回归中，特应性湿疹史仍与EIB相关（校正比值比3.95；95% CI 1.08-14.41；p = 0.038），尽管较宽的置信区间表明效应估计存在相当大的不确定性。结论：在无明显运动相关症状且基线肺功能保持良好、控制良好的哮喘儿童中，超过三分之一经客观检测出EIB。特应性湿疹史可能有助于识别那些原本可能未被发现、持续存在运动诱发性气道狭窄易感性的儿童。

英文摘要

Background/Objectives: Exercise-induced bronchoconstriction (EIB) may persist despite apparently adequate asthma control and may remain unrecognized in children without prominent exercise-related symptoms. This study aimed to determine the prevalence of objectively confirmed EIB in children with controlled asthma who did not report prominent exercise-related respiratory symptoms and to identify factors associated with EIB. Methods: This cross-sectional study included 67 children with controlled asthma who underwent standardized exercise challenge testing with serial spirometry. Demographic, environmental, allergic, laboratory, aeroallergen sensitization, and baseline pulmonary function characteristics were evaluated. Children were classified as EIB-positive or EIB-negative according to their post-exercise FEV1 response. Factors associated with EIB were assessed using univariate analyses and multivariable logistic regression. Results: EIB was identified in 24 of 67 children (35.8%). Baseline pulmonary function was generally preserved and did not differ significantly between EIB-positive and EIB-negative children. A history of atopic eczema was more frequent in the EIB-positive group (37.5% vs. 14.0%; p = 0.035). Allergic rhinitis, food allergy, total IgE, eosinophil percentage, and aeroallergen sensitization were not significantly associated with EIB. In multivariable logistic regression, a history of atopic eczema remained associated with EIB (adjusted odds ratio, 3.95; 95% CI, 1.08-14.41; p = 0.038), although the wide confidence interval indicates substantial uncertainty in the effect estimate. Conclusions: EIB was objectively detected in more than one-third of children with controlled asthma without prominent exercise-related symptoms despite preserved baseline pulmonary function. A history of atopic eczema may help identify children with persistent susceptibility to exercise-induced airway narrowing who might otherwise remain unrecognized.