关键词: 早期喘息, 病因, 预后, 影响因素

Abstract: Background：Wheezing is a common respiratory symptom in infants and young children. In recent years, the incidence of wheezing has been increasing year by year. Objective:To investigate the etiology of first-onset wheezing in infants (<3 months old) and the wheezing situation and influencing factors of infant patient within 6 years. Design:Retrospective cohort study. Methods:Hospitalized infants with first-time infection-related wheezing (excluding congenital heart disease and developmental anomalies) were followed up via phone six years later. The follow-up information included mother's delivery age, frequency of pregnancy and delivery, delivery method, birth weight and gestational age, family history of asthma, personal allergy history, frequency of wheezing within, age of last wheezing, lung function, and allergen IgE. Cases with first-time only infection-related wheezing were divided into the wheezing group (wheezing episodes ≥3 times) and the control group (wheezing episodes ≤2 times) based on wheezing frequency within 6 consecutive months after discharge. Univariate and multivariate logistic regression analyses were performed. Main outcome measures:Factors influencing recurrent wheezing six years after initial infection-related wheezing in infants. Results:Among 229 infants with initial wheezing, 187 cases (81.7%) were due to infection alone, and 42 cases (18.3%) due to infection combined with congenital anomalies, including congenital heart disease (31 cases, 13.5%), congenital laryngomalacia (6 cases, 2.6%), diaphragm elevation, bronchial foreign bodies, lung sequestration, tracheal bronchus, and bronchomalacia (1 case each, 0.4%). Of the 187 only infection-related cases, excluding 16 lost to follow-up, there were 58 cases in the wheezing group and 113 in the control group. Significant differences between the groups were found in factors such as low birth weight, macrosomia, advanced maternal age, family history of asthma, personal allergy history, eczema, elevated peripheral blood eosinophil count, use of IVIG, and combined antibiotic and antiviral therapy. Multivariate logistic analysis showed that eczema (OR=2.19, 95%CI: 1.04-4.62) and allergy history (OR=2.34, 95%CI: 1.09-5.03) doubled the risk of recurrent wheezing six years later. Advanced maternal age (OR=3.06, 95%CI: 1.02-9.21) was a potential risk factor, and family history of asthma (OR=5.07, 95%CI: 1.20-21.45), low birth weight (OR=4.97, 95%CI: 1.62-15.21), macrosomia (OR=9.73, 95%CI: 1.94-48.94), and elevated peripheral blood eosinophil count (OR=3.46, 95%CI: 1.07-11.14) were significant predictors. IVIG use reduced the risk of recurrent wheezing by 57% (OR=0.43, 95%CI: 0.20-0.94). Conclusion:Eczema and allergy history double the risk of recurrent wheezing six years after initial infection-related wheezing in infants, compared with non-eczema and non-allerty cases. IVIG use can reduce the risk of recurrent wheezing by 57%.

Key words: Wheezing, Etiology, Prognosis, Influencing factor