儿童肥胖与过敏性疾病：以儿童哮喘为模型的一体化管理

文献信息

中文摘要

目的： 肥胖和过敏性疾病在儿童中高度流行。哮喘是特征最明确的模型，其中过多的脂肪堆积会改变疾病表现、临床负担和治疗反应。本综述总结了近期儿科证据，重点关注具有临床可操作性的机制、肥胖相关哮喘表型以及一体化管理策略。
近期发现： 肥胖相关哮喘日益被认为是一种异质性疾病表型，而非单纯的合并症。近期儿科数据强调了氧化应激改变、IL-6相关免疫代谢通路、独特的CD4+ T细胞转录程序以及特定的肺功能模式，如肺发育不良（dysanapsis）和保留比值受损肺量计（PRISm）样生理。这些机制提示，持续症状可能反映气道炎症、肺力学改变、体能下降、睡眠呼吸障碍和代谢功能障碍的综合作用。干预性研究支持将结构化有氧训练和抗炎饮食方法作为肥胖管理的一部分。关于代谢药物治疗（包括二甲双胍和胰高血糖素样肽-1（GLP-1）受体激动剂）的证据正在涌现，并提示潜在的呼吸获益，尽管目前儿科数据大多为观察性，且缺乏针对哮喘的随机试验。
总结： 在儿童中，肥胖应被视为一种可治疗的特征，需要对哮喘控制、肺力学、体能状况、睡眠呼吸障碍、饮食质量和代谢健康进行综合评估。当前证据支持多学科生活方式干预，而需要表型驱动的儿科治疗试验来确定靶向代谢、营养、运动、数字或药理学策略能否改善长期呼吸结局。

英文摘要

PURPOSE OF REVIEW: Obesity and allergic diseases are highly prevalent in childhood. Asthma represents the best-characterized model in which excess adiposity modifies disease presentation, clinical burden, and treatment response. This review summarizes the recent pediatric evidence, with a focus on clinically actionable mechanisms, obesity-associated asthma phenotypes, and integrated management strategies.
RECENT FINDINGS: Obesity-associated asthma is increasingly recognized as a heterogeneous disease phenotype rather than simple comorbidity. Recent pediatric data highlight altered oxidative stress, IL-6-related immunometabolic pathways, distinctive CD4+ T-cell transcriptional programs, and specific lung function patterns, such as dysanapsis and preserved ratio impaired spirometry (PRISm)-like physiology. These mechanisms suggest that persistent symptoms may reflect a combination of airway inflammation, altered lung mechanics, deconditioning, sleep-disordered breathing, and metabolic dysfunction. Interventional studies support structured aerobic training and anti-inflammatory dietary approaches as part of obesity management. Evidence on metabolic pharmacotherapy, including metformin and glucagon-like peptide-1 (GLP-1) receptor agonists, is emerging and suggests potential respiratory benefits, although current pediatric data remain largely observational and randomized asthma-specific trials are lacking.
SUMMARY: In children, obesity should be considered a treatable trait requiring an integrated assessment of asthma control, lung mechanics, physical conditioning, sleep-disordered breathing, diet quality, and metabolic health. Current evidence supports multidisciplinary lifestyle interventions, whereas phenotype-driven pediatric therapeutic trials are needed to determine whether targeted metabolic, nutritional, exercise-based, digital, or pharmacological strategies can improve long-term respiratory outcomes.