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中国循证儿科杂志

中国循证儿科杂志 ›› 2023, Vol. 18 ›› Issue (5): 375-381.DOI: 10.3969/j.issn.1673-5501.2023.05.008

• 论著 • 上一篇    下一篇

支气管哮喘患儿感染新型冠状病毒的横断面调查

施婷婷,颉雅萍,陈容珊,印根权,卢根,何春卉   

  1. 广州市妇女儿童医疗中心呼吸科 广州，510623
  • 收稿日期:2023-07-26 修回日期:2023-08-21 出版日期:2023-10-25 发布日期:2023-10-25
  • 通讯作者: 何春卉

COVID-19 infection in children with asthma: A cross-sectional survey

SHI Tingting, JIE Yaping, CHEN Rongshan, YIN Genquan, LU Gen, HE Chunhui   

  1. Department of Respiratory, Guangzhou Women and Children's Medical Center, Guangzhou 510623,China
  • Received:2023-07-26 Revised:2023-08-21 Online:2023-10-25 Published:2023-10-25
  • Contact: HE Chunhui

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摘要： 背景：调整新型冠状病毒(COVID-19)防控措施后，国内尚无足够数据特别是儿童数据证明哮喘与 COVID-19感染之间的关系。 目的：分析COVID-19感染是否影响儿童哮喘转归的控制及治疗。 设计：横断面调查。 方法：在中国COVID-19防疫政策调整后的1个月时间窗内（2023年3月10~31日）招募在我院呼吸、哮喘和脱敏-抗IgE治疗门诊，就医的儿童行改良过敏性鼻炎及哮喘患儿COVID-19感染后问卷（简称改良问卷）调查，近4个月（2022年11月16日至2023年3月16日）COVID-19感染并既往诊断哮喘患儿为哮喘组，哮喘组根据干预不同分为尘螨脱敏+奥马珠单抗亚组、尘螨脱敏亚组、规律吸入糖皮质激素（ICS）亚组和按需用药亚组；既往无哮喘病史的儿童为非哮喘组。 主要结局指标：COVID-19感染导致哮喘患儿的住院比例。 结果：招募时间窗内共纳入317例患儿，其中非哮喘组200例（63.1%），哮喘组117例，尘螨脱敏+奥马珠单抗亚组10例，尘螨脱敏亚组25例，规律ICS亚组29例，按需用药亚组53例。非哮喘组和哮喘组基线数据（性别、年龄、身高、体重）差异无统计学意义（P＞0.05），第一诊断及共病差异均有统计学意义（P<0.05），其中呼吸道感染比例非哮喘组高于哮喘组，过敏性鼻炎、食物过敏、过敏性皮炎比例哮喘组高于非哮喘组；已接种和接种2剂COVID-19疫苗比例差异有统计学意义（P<0.05）。无症状感染比例哮喘组高于非哮喘组，差异有统计学意义（P<0.05），发热、咳嗽有痰和呕吐比例及平均热峰值非哮喘组均高于哮喘组，差异均有统计学意义（P<0.05），哮喘组与非哮喘组感染COVID-19需要住院治疗比例差异无统计学意义(P＞0.05）。基于哮喘控制测试量表和家属视觉模拟评分的缓解期评估，基于因哮喘症状，是否有呼吸困难、夜间醒来或早醒和需要使用急救药物治疗（如硫酸沙丁胺醇吸入气雾剂）评估，哮喘组缓解期和急性期COVID-19感染前后不同亚组间比较差异均无统计学意义（P＞0.05）。 结论：与非哮喘患儿相比，哮喘患儿COVID-19无症状感染率更高、临床症状更轻；使用过敏原免疫疗法治疗和/或抗IgE治疗不会对哮喘患儿感染COVID-19时的疾病严重程度产生影响。

关键词: 哮喘, 儿童, 新型冠状病毒

Abstract: Background：After the adjustment of COVID-19 prevention and control measures in China, there is insufficient data to prove the relationship between asthma in children and COVID-19 infection. Objective：To analyze whether COVID-19 infection affects the control and treatment of asthma in children. Design：A cross-sectional study. Methods：From March 10th to 31rd in 2023, children were enrolled from the outpatient departments of respiratory, asthma, desensitization and anti-IgE at Guangzhou Women and Children's Medical Center during the first month after the new COVID-19 epidemic prevention policy was launched. The modified COVID-19 Post-infection questionnaire (Modified Questionnaire) for allergic rhinitis and asthma children was used.The children who had COVID-19 infection from November 16th, 2022 to March 16th, 2023 and had previously diagnosis of asthma were taken as the asthma group, including four subgroups of dust mite allergic immunotherapy(AIT)+ omalizumab, dust mite AIT, regular inhaled corticosteroids（ICS）and on-demand medication for different interventions. Children who had no history of asthma were taken as the non-asthma group. Main outcome measures：Hospitalization proportion by COVID-19 infection for children with asthma. Results：In total, 317 children who were infected by COVID-19 from November 16th, 2022 to March 16th, 2023 and voluntarily participated in the Modified Questionnaire investigation were enrolled from March 1, 2023 to March 31, 2023. There were 200 cases (63.1%) in the non-asthma group and 117 cases in the asthma group. Of the asthma group, there were 10 cases in dust mite AIT+omalizumab subgroup, 25 cases in dust mite AIT subgroup, 29 cases in ICS subgroup, and 53 cases in on-demand medication subgroup. There was no significant difference in baseline data of gender, age, height, and weight. There were significant differences in diagnosis and comorbidities between the non-asthma group and the asthma group (P<0.05). The proportion of respiratory tract infection in the non-asthma group was higher than that in the asthma group, and the proportion of allergic rhinitis, food allergy, and atopic dermatitis in the asthma group was higher than that in the non-asthma group(P<0.05). The COVID-19 vaccine coverage rate and the second dose of vaccine coverage rate in the asthma group were significantly higher than those in the non-asthma group (P< 0.05).The proportion of asymptomatic infection in the asthma group was higher than that in the non-asthma group, with statistically significant difference (P<0.05). The proportion of fever，peak body temperature，cough and phlegm and vomiting in the non-asthma group was higher than that in the asthma group. The difference was statistically significant (P<0.05). There was no significant difference in hospitalization for COVID-19 infection between the two groups. For remission and acute stages of asthma, there was no statistically significant difference(P> 0.05) between four subgroups in the asthma group before and after COVID-19 infection in terms of the assessment of ACTTM and VAS in the remission period and the assessment of dyspnea, night waking or early waking, and the need to use emergency medication (such as ventorin) in the acute stage. Conclusions：Compared with non-asthma children, children with asthma had higher rate of asymptomatic COVID-19 infection, and milder clinical symptoms of COVID-19 infection. The use of AIT and/or anti-IgE therapy has no impact on the severity of disease in children with asthma when they are infected with COVID-19.

Key words: Asthma, Children, COVID-19