Risk Factors Analysis For Recurrent Wheezing In Infant After The First Episode

Objective: All of the included children was followed up for 1 years to observe the recurrent wheezing status.We compared the potential factors and discuss their correlation expecially for EDN.To evaluate the risk factors for recurrent wheezing in children less than 3 years old.Evaluate EDN whether could be a potential biomarker for predicting recurrent wheezing.Methods: One hundrend and forty five cases with first diagnosis of wheelzing were recruited in this study form Oct 2015 to Jan 2016.All of the cases were divided into recurrent group(n=62)and control group(n=83)according to whether the wheezing relapsed in the following 1 year.1.The general information such as age,gender,dwelling,premature delivery,the mode of delivery(birth / cesarean section),and duration of hospitalization was recorded.The medical history such as personal history,family history of wheezing,allergic rhinitis and other allergic diseases were also recorded.All the children received serum total Ig E,allergen specific Ig E,food specific Ig G,serum EDN,peripheral blood routine test,serum antibody detection of respiratory pathogens nine-alliance,seven respiratory virus detection of nasopharyngeal liquid.All the patiens received chest film,CT,EKG,and echocardiography examination in order to exclude abnormal development of heart and lung and tracheobronchial foreign body.The above factors were compared between the recurrent group and control group.2.The recurrence sensitivity,specificity were evaluated according to serum EDN,which could provide predictive value for wheezing relapsing.3 The prediction of recurrent wheezing was also evaluated by serum E% and calculated the sensitivity and specificity.Results: The mean age of recurrent group was 6.66±7.01 months with 42 male and 20 female children.City dewellings was 40 with the mean hospital stay of 6.32±2.14 days.For control group the mean age was 6.82±7.07 months with 53 male and 30 femalechildren.City dewellings was 52 with the mean hospital stay of7.02±3.01 days.There was no statistical difference for the above factors(P>0.05).2.For recurrent group,28 cases were fist baby,58 cases were full-term infants,35 cases were spontaneous delivery.For control group,36 cases was the fist baby,with full-term infants in 71 cases,83 cases were natral birth.There was no statistical difference for children born factors between the two gorups(P>0.05).3.For recurrent group,46 cases had the history of eczema,4 cases had individual food and drug allergic history,and family history of allergic diseases in 11 cases.For the control group,history of eczema was in 38 cases,5 cases had food allergy history and 10 cases with family history of allergic diseases.There was no statistical difference for family history of allergic diseases and food drug allergic history(P>0.05).However,the positive rate of eczema in recurrent group was significantly higher than the control group(P<0.05).4.For the recurrent group,RSV infection in 20 cases,5 cases had mycoplasma infection,1 cases of Haemophilus influenzae infection,4 cases of influenza B virus;For the control group,RSV infection in 11 cases,5 cases had mycoplasma infection,2 cases of Haemophilus influenzae infection,1 case of influenza B virus.The positive rate of RSV infection in the recurrent group was significantly higher than that in the control group(P<0.05).5 For the recurrent group,the serum total Ig E was(43.71 ± 80.44)IU/m L,allergen specific Ig E was positive in 8 cases(12.90%),food allergen specific Ig G was positive in 32 cases(48.39%),the average value of EDN was(68.67 ± 55.5)ng/m L,WBC(9.16 ± 3.76)× 109/L,the percentage of neutrophil(N%)was(27.10 × 13.19)%,the percentage of eosinophils(E%)was(3.10 ± 2.54)%.For control group,total Ig E was(44.58 + 92.23)IU/m L,allergen specific Ig E was positive in 7 cases(20.48%),food specific Ig G was positive in 44 cases(53.01%),the average value of EDN was(27.36 ± 19.51)ng/m L,WBC(8.99 ± 2.86)× 109/L,the percentage of neutrophil(N%)was(30.17 ± 13.61)%,the percentage of eosinophils(E%)was(1.31 ± 1.15)%.Inhalant allergen was mainly dust mites,house dust,mold,allergen Ig G mainly for milk protein,egg etc..The levels of EDN and E(%)in the recurrent group were significantly higher than those in the control group,and the difference wasstatistically significant(P<0.05).6.The value of serum EDN were(68.67±55.5)ng/m L and(27.36±19.51)ng/m L respectively for the recurrent group and control group with statistically significant difference(t=6.331,P<0.05).7.The percentage of eosinophils were(3.10±2.54)% and(1.31±1.15)%,respectively for the recurrent group and control group with statistically significant difference(t=5.68,P<0.05).8.The diagnostic sensitivity,specificity were 72.69% and 66.13% respectively,AUC=0.79 with the cut-off value of 29.95 according to EDN.9.The diagnostic sensitivity,specificity were 90.36% and 51.61% respectively,AUC=0.75 with the cut-off value of 2.50 according to percentage of eosinophils.10.There was no correlation between EDN and percentage of eosinophils in recurrent group(r=-0.02,P>0.05).Conclusions: 1 RSV positive rate was higher in recurrent group which may be a risk factor for recurrent wheezing.2 The percentage of eosinophils was much higher in recurrent group which may play a key role in the wheezing development.3 EDN had a relative high sensitivity and specificity for recurrent wheezing prediction,which could be a potential biomarker.