| PART 1 Analysis of related factors affecting the level of asthma control in children Objective: To investigate the current status of asthma control in our hospital,and to explore the possible risk factors for asthma control,in order to provide basis for developing appropriate asthma interventions and improving asthma management.Methods: From September 2017 to September 2018,we studied 213 children with asthma who visited the Pediatric Asthma Clinic in The Second Hospital of Jiaxing.The children who met the inclusion criteria,agreed to participate in the study and completed the relevant questionnaires(200 effective cases)were selected as research object.According to the level of asthma symptom control,the control levels of asthma children in our hospital were evaluated,and the well-controlled children were included in the complete control group(76 cases),Partly control and uncontrolled cases were merged into the incompletely control group(124 cases).These risk factors associated with childhood asthma were analyzed including age,sex,family history of asthma,rhinitis,eczema,Place of residence,dust mite allergy,respiratory infection,inhaled glucocorticoid(ICS)asthma treatment compliance,overweight or obesity,passive smoking.Multivariate logistic regression model analysis was carried out after meaningful variables screened from univariate analysis.Results:1、A total of 200 children with asthma were included in this study,ranging from 3to 14 years old,with an average age of 8.5±3.1 years.111 cases(55.5%)were male and 89 cases(44.5%)were female.55 patients were overweight or obese(27.5%),and 145 patients had a normal BMI(72.5%).2、According to the level of asthma control symptoms,76 cases(38%)were well controlled;95 cases(47.5%)were partially controlled,and 29 cases(14.5%)were uncontrolled.3、Univariate analysis screened five factors that may affect the control level of asthmatic children in our hospital,including rhinitis(OR2.35,95%CI 1.31-4.21,P=0.004),dust mite allergy(OR1.98,95%CI 1.03-3.79,P=0.04),respiratory infection(OR1.9,95%CI 0.19-0.67,P=0.048),age<6years(OR0.35,95%CI 0.19-0.67,P=0.01),Poor adherence to ICS standard treatment(OR0.2,95%CI 0.10-0.39,P<0.001)wereapossible risk factors which affected asthma control in children.4、Multivariate logistic regression analysis showed that rhinitis(OR2.33,95% CI1.21-4.41,P=0.011)、 age<6years(OR0.38,95% CI 0.19-0.76,P=0.006)、 Poor adherence to ICS standard treatment(OR0.23,95%CI 0.11-0.45,P<0.001)were independent risk factors for asthma control.Conclusions :1、The rate of complete control of asthma in our hospital is lower than that in developed countries.2、Children younger than 6 years old,rhinitis and Poor adherence to ICS standard treatment are independent risk factors for the control of asthma in our hospital.PART 2 Preliminary study on the correlation between asthma control level and intestinal flora in childrenObjective:To analyze the difference characteristics of intestinal flora between asthma children with different control levels and healthy population,and to explore the correlation between the control level of asthma children and intestinal flora,so as to provide new clues for the prevention,management and treatment of asthma in clinical practice.Methods:A total of 30 children with asthma who were admitted to the Department of Pediatric Respiratory Asthma in The Second Hospital of Jiaxing from October 2018 to December 2018 were enrolled.According to the classification criteria of asthma symptom control,there were 15 cases of well-controlled children,15 cases of uncontrolled and partially controlled children,which were classified into complete control group(15 cases)and incomplete control group(15 cases).In addition,20 healthy children with matching age,gender and BMI were selected as the healthy control group.The fecal specimens of the first day of the children were collected,and the gut microbial DNA was extracted from the gut microbiota.The V3-V4 sequence of the bacterial 16 Sr DNA was amplified by specific primers,sequenced by the Illumina Miseq platform,and related bioinformatics analysis was performed.Results1、A total of 28 children with asthma were enrolled in the study,including 15 effective fecal specimens in the complete control group,13 effective stool specimens in the incomplete control group,and 17 stool specimens in the healthy control group.There were no statistically significant differences in sex,age,BMI,mode of delivery,breastfeeding time,preterm or full-term,rhinitis and eczema(P>0.05).2、Alpha diversity analysis results The abundance of the flora(Chao1 index)and diversity of the flora(Shannon index)in the healthy control group,the complete control group and the incomplete control group were deceasing.Especially,the abundance and diversity of the flora decreased significantly in the incomplete controlled group(P<0.01).Which suggesting that the abundance and diversity of intestinal microbial species may be related to asthma control levels.3 、 Comparison of intestinal microecological flora among three groups on phylum level On phylum level,there was a significant difference among the three groups of actinobacteria,and the relative abundance of actinobacteria was significantly decreasing along the healthy control group-complete control group-incomplete control group(P<0.001).4、Comparison of intestinal microecological flora among three groups on genus level On genus level,there were significant differences among the three groups:Bifidobacterium,Alistipes,Parasutterella,Fusicatenibacter,Megasphaera,Oscillibacter,Barnesiella,Dorea,Bilophila,f_Ruminococcaceae,o_Clostridiales and f_Coriobacteriaceae,f_Bifidobacteriaceae(P<0.05).The relative abundances of Bifidobacterium,Alistipes,Parasutterella,Barnesiella,O.Clostridiales,f_Coriobacteriaceae,f_Bifidobacteriaceae in the incomplete control group were lower than those in the healthy control group and the complete control group.The downward trend was statistically significant(P<0.05).The relative abundances of Oscillibacter,Dorea,and Bilophila were increasing in the incomplete control group compared with the healthy control group and the complete control group,which was statistically significant(P<0.05).Compared with the healthy control group,the relative abundance of Bifidobacterium in the complete control group also was decreasing significantly(p<0.05),and the relative abundance of Megasphaera was increasing(P<0.05),which suggesting that the difference in intestinal flora was not obvious between these two groups.In summary,the proportion of Bifidobacterium bacteria in the healthy control group-complete control group-incomplete control group were decreasing(P<0.05).However,other strains had no obvious regularity.Conclusions1、The intestinal flora of the incomplete control group was significantly different from that of the complete control group and the healthy control group,while the intestinal flora of the complete control group was not significantly different from that of the healthy control group.2、The relative abundance of Bifidobacteria was significantly different among three groups,and showed a descending trend,which suggesting that the decrease of relative abundance of bifidobacteria may be related to the poor control of asthma in children. |
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