近日，国际权威医学期刊《柳叶刀》发表了我国学者完成的大规模人群研究“中国成人肺部健康研究”的重要成果“中国哮喘的患病率、危险因素和管理:一项全国性的横断面研究”，这一成果由中日友好医院、中国医学科学院王辰团队取得。该项研究成果发表在2019年8月2日出版的《柳叶刀》上。

本研究招募了779名年龄在20岁及以上的成年人，采用基于2010年人口普查数据的多阶段分层抽样方法对他们进行研究。从6个地理区域中选出10个省份，代表所有社会经济背景，并在当地的卫生中心进行了所有评估。不包括临时居住、无法进行肺量测定、因心血管疾病或结核病住院治疗、怀孕和哺乳。哮喘是根据医生自我报告的诊断病史或过去12个月的喘息症状确定的。所有参与者评估标准的哮喘问卷和被划分为有或没有气流限制通过肺功能测试之前和之后的主题一个支气管扩张剂(400μg舒喘灵)。对所有有相关变量数据的参与者进行多变量附加分析，以检查哮喘的危险因素。疾病管理是通过对哮喘患者的医生诊断、治疗和医院就诊的自我报告历史来评估的。2012年6月22日至2015年5月25日，57779名参与者被招募到CPH研究中。50991(21446个男人和29545个女人）完成问卷调查，并有可靠的支气管扩张剂后肺功能测试结果，纳入最终分析。在他们的样本中，哮喘的总患病率为4·2% (95% CI 3·1-5·6)，代表4500·700万中国成年人。伴有气流受限的哮喘患病率为1·1%(0·9-1·4)，代表1300万成年人。

吸烟(优势比[OR] 1·89,95% CI 1·26-2·84;变应性鼻炎(3·06,2·26-4·15;p < 0·0001)、儿童肺炎或支气管炎(2·43、1·44-4·10;p=0·002)，父母呼吸病史(1·44,1·02-2·04;哮喘患病率与教育程度低(p=0·045)有关。2032例哮喘患者中，仅有28·8% (95% CI 19·7-40·0)曾被医生诊断，23·4%(13·9 - 36·6)曾接受过肺功能测试，5·6%(3·1-9·9)曾接受吸入皮质类固醇治疗。此外，15·5%(11·4 - 20·8)的哮喘患者报告在前一年至少有一次急诊室就诊，7·2%(4·9-10·5)因呼吸系统症状加重至少入院一次。哮喘在中国很普遍，但在很大程度上没有得到诊断和治疗。重要的是提高对哮喘的认识，并在临床环境中推广标准化治疗，以减轻疾病负担。

据悉，哮喘是全球常见的慢性气道疾病。尽管中国人口众多，但还没有对全国哮喘的患病率、危险因素和管理进行全面的研究。因此，该课题组的目标是在中国人口的代表性样本中估计全国哮喘患病率。

更多阅读：

王辰，中国工程院院士，呼吸病学与危重症医学专家。该研究结果揭示了我国哮喘防控面临的严峻挑战，哮喘已成为与高血压、糖尿病并列的慢性重大疾病，构成了重大的疾病负担。同时也填补了中国慢性呼吸疾病流行现状数据的空白，对我国乃至全球制定哮喘相关防治策略和卫生政策具有重要意义和深远影响。（资料来源：中国工程院、四川大学华西医院）
 

附：英文原文

Title: Prevalence, risk factors, and management of asthma in China: a national cross-sectional study

Author: Kewu Huang, Ting Yang,Jianying Xu, Lan Yang, Jianping Zhao, Xiangyan Zhang, Chen Wang, et al

Issue&Volume: 2 August 2019

Abstract:

Background

Asthma is a common chronic airway disease worldwide. Despite its large population size, China has had no comprehensive study of the national prevalence, risk factors, and management of asthma. We therefore aimed to estimate the national prevalence of asthma in a representative sample of the Chinese population.

Methods

A representative sample of 57?779 adults aged 20 years or older was recruited for the national cross-sectional China Pulmonary Health (CPH) study using a multi-stage stratified sampling method with parameters derived from the 2010 census. Ten Chinese provinces, representative of all socioeconomic settings, from six geographical regions were selected, and all assessments were done in local health centres. Exclusion criteria were temporary residence, inability to take a spirometry test, hospital treatment of cardiovascular conditions or tuberculosis, and pregnancy and breastfeeding. Asthma was determined on the basis of a self-reported history of diagnosis by a physician or by wheezing symptoms in the preceding 12 months. All participants were assessed with a standard asthma questionnaire and were classed as having or not having airflow limitation through pulmonary function tests before and after the use of a bronchodilator (400 μg of salbutamol). Risk factors for asthma were examined by multivariable-adjusted analyses done in all participants for whom data on the variables of interest were available. Disease management was assessed by the self-reported history of physician diagnosis, treatments, and hospital visits in people with asthma.

Findings

Between June 22, 2012, and May 25, 2015, 57?779 participants were recruited into the CPH study. 50?991 (21?446 men and 29?545 women) completed the questionnaire survey and had reliable post-bronchodilator pulmonary function test results and were thus included in the final analysis. The overall prevalence of asthma in our sample was 4·2% (95% CI 3·1–5·6), representing 45·7 million Chinese adults. The prevalence of asthma with airflow limitation was 1·1% (0·9–1·4), representing 13·1 million adults. Cigarette smoking (odds ratio [OR] 1·89, 95% CI 1·26–2·84; p=0·004), allergic rhinitis (3·06, 2·26–4·15; p<0·0001), childhood pneumonia or bronchitis (2·43, 1·44–4·10; p=0·002), parental history of respiratory disease (1·44, 1·02–2·04; p=0·040), and low education attainment (p=0·045) were associated with prevalent asthma. In 2032 people with asthma, only 28·8% (95% CI 19·7–40·0) reported ever being diagnosed by a physician, 23·4% (13·9–36·6) had a previous pulmonary function test, and 5·6% (3·1–9·9) had been treated with inhaled corticosteroids. Furthermore, 15·5% (11·4–20·8) people with asthma reported at least one emergency room visit and 7·2% (4·9–10·5) at least one hospital admission due to exacerbation of respiratory symptoms within the preceding year.

Interpretation

Asthma is prevalent but largely undiagnosed and undertreated in China. It is crucial to increase the awareness of asthma and disseminate standardised treatment in clinical settings to reduce the disease burden.

DOI: https://doi.org/10.1016/S0140-6736(19)31147-X

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31147-X/fulltext#