小儿哮喘风险评分更好地预测儿童哮喘发展
2019/01/09
摘要
背景：哮喘表型目前不适合一级预防或早期干预，因为不能可靠预测哮喘的自然进程。由于缺乏更好的替代方案，临床医生仍然依赖于预测不佳的哮喘结果工具。我们寻求开发一种定量个性化工具来预测幼儿的哮喘发展。
方法：来自辛辛那提儿童过敏和空气污染研究（n = 762）出生队列的数据用于确定预测哮喘发展的因素。通过整合人口统计学和临床数据构建小儿哮喘风险评分 （PARS）。将PARS的敏感性和特异性与哮喘预测指数（API）的敏感性和特异性进行比较，并在怀特岛出生队列中进行复制。
结果：PARS能够可靠地预测辛辛那提儿童过敏和空气污染研究中的哮喘发展（敏感性= 0.68，特异性= 0.77）。虽然PARS和API都能预测高风险儿童的哮喘，但PARS在轻度至中度哮喘风险儿童哮喘的预测能力更显著。除了父母哮喘，湿疹和除感冒以外的喘息外，PARS中预测哮喘的变量还包括早期喘息（比值比[OR]，2.88; 95％CI，1.52-5.37），对2种或2种以上食物过敏原和/或空气过敏原的致敏（OR，2.44; 95％CI，1.49-4.05）和非裔美国人种族（OR，2.04; 95％CI，1.19-3.47）。 PARS在怀特岛出生队列中复制（敏感性= 0.67，特异性= 0.79），证明它是一种稳健，有效且可推广的哮喘预测工具。
结论：对于轻中度哮喘患儿，PARS的表现优于API。这一点很重要，因为这些儿童是最常见和最难预测的，PARS可能是最适合预防策略的哮喘预测工具。
A Pediatric Asthma Risk Score to better predict asthma development in young children.
Biagini Myers JM, Schauberger E, He H, Martin LJ, Kroner J, Hill GM, Ryan PH, LeMasters GK, Bernstein DI, Lockey JE, Arshad SH, Kurukulaaratchy R, Khurana Hershey GK.
Abstract
BACKGROUND:Asthma phenotypes are currently not amenable to primary prevention or early intervention because their natural history cannot be reliably predicted. Clinicians remain reliant on poorly predictive asthma outcome tools because of a lack of better alternatives. We sought to develop a quantitative personalized tool to predict asthma development in young children.
METHODS:Data from the Cincinnati Childhood Allergy and Air Pollution Study (n = 762) birth cohort were used to identify factors that predicted asthma development. The Pediatric Asthma Risk Score (PARS) was constructed by integrating demographic and clinical data. The sensitivity and specificity of PARS were compared with those of the Asthma Predictive Index (API) and replicated in the Isle of Wight birth cohort.
RESULTS:PARS reliably predicted asthma development in the Cincinnati Childhood Allergy and Air Pollution Study (sensitivity = 0.68, specificity = 0.77). Although both the PARS and API predicted asthma in high-risk children, the PARS had improved ability to predict asthma in children with mild-to-moderate asthma risk. In addition to parental asthma, eczema, and wheezing apart from colds, variables that predicted asthma in the PARS included early wheezing (odds ratio [OR], 2.88; 95% CI, 1.52-5.37), sensitization to 2 or more food allergens and/or aeroallergens (OR, 2.44; 95% CI, 1.49-4.05), and African American race (OR, 2.04; 95% CI, 1.19-3.47). The PARS was replicated in the Isle of Wight birth cohort (sensitivity = 0.67, specificity = 0.79), demonstrating that it is a robust, valid, and generalizable asthma predictive tool.
CONCLUSIONS:The PARS performed better than the API in children with mild-to-moderate asthma. This is significant because these children are the most common and most difficult to predict and might be the most amenable to prevention strategies.
背景：哮喘表型目前不适合一级预防或早期干预，因为不能可靠预测哮喘的自然进程。由于缺乏更好的替代方案，临床医生仍然依赖于预测不佳的哮喘结果工具。我们寻求开发一种定量个性化工具来预测幼儿的哮喘发展。
方法：来自辛辛那提儿童过敏和空气污染研究（n = 762）出生队列的数据用于确定预测哮喘发展的因素。通过整合人口统计学和临床数据构建小儿哮喘风险评分 （PARS）。将PARS的敏感性和特异性与哮喘预测指数（API）的敏感性和特异性进行比较，并在怀特岛出生队列中进行复制。
结果：PARS能够可靠地预测辛辛那提儿童过敏和空气污染研究中的哮喘发展（敏感性= 0.68，特异性= 0.77）。虽然PARS和API都能预测高风险儿童的哮喘，但PARS在轻度至中度哮喘风险儿童哮喘的预测能力更显著。除了父母哮喘，湿疹和除感冒以外的喘息外，PARS中预测哮喘的变量还包括早期喘息（比值比[OR]，2.88; 95％CI，1.52-5.37），对2种或2种以上食物过敏原和/或空气过敏原的致敏（OR，2.44; 95％CI，1.49-4.05）和非裔美国人种族（OR，2.04; 95％CI，1.19-3.47）。 PARS在怀特岛出生队列中复制（敏感性= 0.67，特异性= 0.79），证明它是一种稳健，有效且可推广的哮喘预测工具。
结论：对于轻中度哮喘患儿，PARS的表现优于API。这一点很重要，因为这些儿童是最常见和最难预测的，PARS可能是最适合预防策略的哮喘预测工具。
(中日友好医院呼吸与危重症医学科 王瑞茵 摘译 林江涛 审校)
(J Allergy Clin Immunol. 2018 Dec 7. pii: S0091-6749(18)31577-X. doi: 10.1016/j.jaci.2018.09.037. [Epub ahead of print])
(J Allergy Clin Immunol. 2018 Dec 7. pii: S0091-6749(18)31577-X. doi: 10.1016/j.jaci.2018.09.037. [Epub ahead of print])
A Pediatric Asthma Risk Score to better predict asthma development in young children.
Biagini Myers JM, Schauberger E, He H, Martin LJ, Kroner J, Hill GM, Ryan PH, LeMasters GK, Bernstein DI, Lockey JE, Arshad SH, Kurukulaaratchy R, Khurana Hershey GK.
Abstract
BACKGROUND:Asthma phenotypes are currently not amenable to primary prevention or early intervention because their natural history cannot be reliably predicted. Clinicians remain reliant on poorly predictive asthma outcome tools because of a lack of better alternatives. We sought to develop a quantitative personalized tool to predict asthma development in young children.
METHODS:Data from the Cincinnati Childhood Allergy and Air Pollution Study (n = 762) birth cohort were used to identify factors that predicted asthma development. The Pediatric Asthma Risk Score (PARS) was constructed by integrating demographic and clinical data. The sensitivity and specificity of PARS were compared with those of the Asthma Predictive Index (API) and replicated in the Isle of Wight birth cohort.
RESULTS:PARS reliably predicted asthma development in the Cincinnati Childhood Allergy and Air Pollution Study (sensitivity = 0.68, specificity = 0.77). Although both the PARS and API predicted asthma in high-risk children, the PARS had improved ability to predict asthma in children with mild-to-moderate asthma risk. In addition to parental asthma, eczema, and wheezing apart from colds, variables that predicted asthma in the PARS included early wheezing (odds ratio [OR], 2.88; 95% CI, 1.52-5.37), sensitization to 2 or more food allergens and/or aeroallergens (OR, 2.44; 95% CI, 1.49-4.05), and African American race (OR, 2.04; 95% CI, 1.19-3.47). The PARS was replicated in the Isle of Wight birth cohort (sensitivity = 0.67, specificity = 0.79), demonstrating that it is a robust, valid, and generalizable asthma predictive tool.
CONCLUSIONS:The PARS performed better than the API in children with mild-to-moderate asthma. This is significant because these children are the most common and most difficult to predict and might be the most amenable to prevention strategies.
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儿童鼻上皮，特应性和特应性哮喘中的DNA甲基化：一项全基因组研究
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英国成人哮喘急性发作模式：一项基于人群的研究
