![[論文新知] 健康始於腸：“健康”的百歲人端和健康的30歲壯年人有著極度相似的的腸道菌相](https://static.wixstatic.com/media/72dee4_14147af85939420484e722537479788a~mv2_d_1920_1293_s_2.jpeg/v1/fill/w_102,h_69,fp_0.50_0.50,q_90/72dee4_14147af85939420484e722537479788a~mv2_d_1920_1293_s_2.jpeg)
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前言 肥胖與氣喘同屬近世紀文明疾病。近年來兩者的人數均呈增加趨勢，但兩者是否有相關性？肥胖的人會喘，與運動不耐的舊有觀感有關。常見肥胖的人跑步會呼吸不順暢，並且會停下來急促呼吸，喘得就像是氣喘的人一樣。過去一直有肥胖的人會氣喘的說法，但是實際上是否真有其事？ 基因與環境 肥胖與氣喘同屬多重成因疾病，基因佔一部分因素；但以近年快速增加的趨勢來看，生活習慣的改變，例如飲食西化、日常運動量降低、以及幼兒期環境的交互作用也佔了另一部分因素。也有人提出表觀基因調控的改變也在肥胖與氣喘交互作用中。 在歐洲八個Birth cohorts中，出生前兩年BMI的遽增會增加6歲的氣喘機率。在2-6歲以上仍持續有BMI遽增並不會更增加氣喘危機。在調控過出生體重、懷孕週數、性別、母親懷孕時抽菸、母乳哺餵、以及家族氣喘或過敏史後，出生前兩年BMI遽增的危險因素為1.3倍(95% CI, 1.1-1.5）。這個研究指出決定氣喘與肥胖的交互因素，或許在懷孕至出生後1000天內就已決定。 氣道敏感性 Airway hyperresponsiveness(AHR）是氣喘的核心表現。在成人有充足的資訊顯示過重與肥胖都有增加AHR，但是越肥胖並沒有越氣道敏感3。在兒童與青少年的資料並未有共識，有互相衝突(可能因為氣喘兒童較少使用challenge test），例如一研究中的氣喘兒童中，肥胖兒童和正常體重的運動測試陽性(exercise challenge test）盛行率上並無顯著不同。 發炎相關性 過去研究肥胖的人認為肥胖與低度發炎有關；脂肪組織會分泌adipokines，例如leptin(proinflamma