| PartⅠ Clinical Characteristics and Follow-up Study of54 Wheezing Children with < 6-Year-Old inChongqingObjective: Our Center is one of the 6 sub-centers of the multi-center research project “Study on Diagnostic Techniques and Standardized Management of Asthma in Young Children” led by the Capital Institute of pediatrics.Prospective study of clinical features of wheezing children under 6 years old,and analysis the relationship between the recurrence of wheezing and clinical features.Methods: From October 2016 to December 2017,54 nasopharyngeal aspirate(NPA)from wheezing children were collected to detect Respiratory syncytial virus(RSV),Human rhinovirus(HRV),Human metapneumovirus(HMPV),Influenza virus(IFV),Human coronavirus(HCoV),parainfluenza virus(PIV)and adenovirus(ADV)by Polymerase Chain Reaction(PCR),detect Human bocavirus(HBoV)by quantitative polymerase chain reaction;NPA smear and staining for detection of Creola bodies.Whether or not the children have reoccurred wheezing within one year will be observed.Results:1.The group of wheezing children less than 3 years old is mainly composed of boys,while the group ≥3 years old is Mainly composed of girls;The proportion of children aged 3 to 5 with rhinitis and preterm birth increased,and there are no differences in other clinical features between children of two ages.2.the positive rate of serum allergen was 62.7%,and the main allergens are milk,eggs,dust mites,and the detection rate of inhaled allergens in children aged 3-5 years was higher than those in children <3 years old,but the difference was not statistically significant.3.The detection rate of respiratory virus was 81.1%,and the main virus are RSV and HRV;the detection rate of RSV in children aged <3 years old was significantly higher than that aged 3 to 5 years,there was no difference in detection rate of HRV and CrBs between the two groups.4.When the children complete pulmonary function one month later,we found that the pulmonary function of the children improved,but the FeNO value increased,and there is no correlation between changes in FeNO values and lung function changes.5.One year clinical follow-up results: 1)Recurrent wheezing rate increased in children <3 years old with a history of food allergies;Recurrent wheezing rate increased in children with history of eczema;and other risk factors also increased in the recurrent wheezing children,while the difference was not statistically significant.2)There was no difference in risk factors between 3-5 years old children with recurrent wheezing and not.3)There was no difference between in the detection of respiratory virus and CrBs in children with with recurrent wheezing and not.4)Baseline and re-examination of lung function in children with recurrent wheezing showed aggravating trend compared with children without recurrent wheezing,and the improvement rate of lung function was higher after the use of bronchodilator at baseline,but the difference was not statistically significant.Conclusion: Wheezing infants are dominated by boys,while preschool children with wheezing are dominated by girls,and the latter is more prone to premature birth and rhinitis than the former.RSV and HRV are the main viruses that cause wheezing in young children,and RSV mainly affects infants,while there is no difference in HRV infection between infants and preschool children.One year clinical follow-up indicated that wheezing infants with a history of food allergies may consider early intervention.Nevertheless the relationship between other risk factors and pulmonary function with recurrent wheezeing has not been discovered.PartⅡ Analysis of Respiratory Etiology and Clinical Features in 277 Hospitalized Children with Acute Asthma Exacerbation in ChongqingObjective:This study is designed to investigate the characteristics of respiratory pathogens among children hospitalized with asthma exacerbation,then combined with the clinical characteristics,the characteristics of pathogens distribution in children of different ages and conditions were further studied.Methods:From June 2009 to December 2016,277 nasopharyngeal aspirate(NPA)from hospitalized children with acute asthma exacerbations were collected to detect Respiratory syncytial virus(RSV),Influenza virus(IFV),Parainfluenza virus(PIV),Human metapneumovirus(HMPV),Human coronavirus(HCo V),human rhinovirus(HRV)and adenovirus(ADV)by Polymerase Chain Reaction(PCR),detect Human bocavirus(HBo V)by quantitative polymerase chain reaction,and detect Bacteria and mycoplasma at the same time.Results: 1.Among these 277 NPA specimens,207(74.7%)were positive for Respiratory viruses,NPA culture was positive in 109(39.4%),17(6.1%)were positive for Mycoplasma pneumoniae,but none was positive for Pneumonia chlamydia.2.Respiratory viruses detected rate was significantly increased in children < 6 years of age,RSV and HRV are mostdetected in individuals< 6 years of age,HRV are most often detected in children ≥6 years of age.3.Virus are most ofen detected during the winter,and mycoplasma is more likely to trigger acute asthma symptoms in the summer and fall,while the bacteria detection rate is lowest in autumn.4.The detection rate of single bacteria increased in children with severe attack.5.Compared with the children < 6 years of age,the proportion of children who had been diagnosed with asthma and not been treated regularly will increase in the children ≥6 years of age,and the proportion of blood eosinophil increased in children aged 6 and older.Conclusion: Our results indicate that respiratory virus infection is closely related to acute asthma exacerbations,while with the aging increasing,the detection of virus is decreased.RSV infections are also associated with asthma exacerbations of young children,while HRV is more likely to trigger acute asthma symptoms in school-age children.Respiratory virus are a major cause of acute asthma in small age children,while which children with asthma have been treated irregularity and allergic sensitization may be a risk factor for school age children. |
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