芬兰和爱沙尼亚儿童特应性致敏的发展 —一个多中心队列的潜类分析
2019/02/19
摘要
背景：特应性的患病率与西方生活方式有关，这是通过比较具有不同社会经济背景的邻近地区的研究所表明的。特应性可能反映了它们对环境因素的敏感性不同的各种条件。明确儿童早期特应性致敏的表型，并检查它们与芬兰和爱沙尼亚的过敏性疾病和遗传背景的关系。
方法：该分析包括来自DIABIMMUNE多中心幼儿队列的1603名芬兰儿童和1657名爱沙尼亚儿童。分别在3岁，4岁和5岁时测量特异性IgE水平，并分为三类CAP类别。使用R中的统计软件包poLCA进行潜类分析（LCA）。
结果：两个群体在社会经济状况和环境决定因素方面存在差异，例如宠物所有权，农场相关暴露，户外活动时间和过敏性疾病的流行（所有p值<0.001）。尽管如此，我们在两个群体中发现了类似的潜在类别（LC）：一个未致敏类别，一个食物类别，两个区分季节性和常年空气过敏原的吸入类别，以及严重的特应性类别。后者的特点是总IgE和特异性IgE水平高，与喘息强烈相关（OR值5.64 [3.07-10.52]和4.56 [2.35-8.52]），过敏性鼻炎（22.4 [11.67-44.54]和13.97 [7.33-26.4]）和特应性湿疹（9.39 [4.9-19.3]和9.5 [5.2-17.5]，芬兰和爱沙尼亚）。在芬兰环境差异反映在较大的季节性吸入性特应性类别中，尽管不同国家之间的类别构成相似。
结论：尽管环境暴露存在巨大差异，但可能存在特应性致敏的真实模式。这些模式的分布可以确定特应性致敏对疾病发作的贡献。
Development Of Atopic Sensitization In Finnish And Estonian Children - A Latent Class Analysis In A Multicenter Cohort.
Schmidt F, Hose AJ, Mueller-Rompa S, Brick T, Hämäläinen AM, Peet A, Tillmann V, Niemelä O, Siljander H, Knip M, Weber J, von Mutius E, Ege MJ; DIABIMMUNE Study Group.
Abstract
BACKGROUND:The prevalence of atopy is associated with a western lifestyle as illustrated by studies comparing neighboring regions with different socioeconomic backgrounds. Atopy might reflect various conditions differing in their susceptibility to environmental factors. To define phenotypes of atopic sensitization in early childhood and to examine their association with allergic diseases and hereditary background in Finland and Estonia
METHODS:The analysis included 1603 Finnish and 1657 Estonian children from the DIABIMMUNE multicenter young children cohort. Specific IgE levels were measured at age 3, 4 and 5 respectively, and categorized into three CAP classes. Latent Class Analysis (LCA) was performed with the statistic software package poLCA in R.
RESULTS:Both populations differed in terms of socioeconomic status and environmental determinants such as pet ownership, farm-related exposure, time of playing outdoors and prevalence of allergic diseases (all p-values <0.001). Nevertheless, we found similar latent classes (LC) in both populations: an unsensitized class, a food class, two inhalant classes differentiating between seasonal and perennial aero-allergens, and a severe atopy class. The latter was characterized by high total and specific IgE levels and strongly associated with wheeze (odds ratio 5.64 [3.07-10.52] and 4.56 [2.35-8.52]), allergic rhinitis (22.4 [11.67-44.54] and 13.97 [7.33-26.4]) and atopic eczema (9.39 [4.9-19.3] and 9.5 [5.2-17.5], for Finland and Estonia, respectively). Environmental differences were reflected in the larger seasonal inhalant atopy class in Finland though composition of classes was comparable between countries.
CONCLUSIONS:Despite profound differences in environmental exposures there may exist genuine patterns of atopic sensitization. The distribution of these patterns may determine the contribution of atopic sensitization to disease onset.
背景：特应性的患病率与西方生活方式有关，这是通过比较具有不同社会经济背景的邻近地区的研究所表明的。特应性可能反映了它们对环境因素的敏感性不同的各种条件。明确儿童早期特应性致敏的表型，并检查它们与芬兰和爱沙尼亚的过敏性疾病和遗传背景的关系。
方法：该分析包括来自DIABIMMUNE多中心幼儿队列的1603名芬兰儿童和1657名爱沙尼亚儿童。分别在3岁，4岁和5岁时测量特异性IgE水平，并分为三类CAP类别。使用R中的统计软件包poLCA进行潜类分析（LCA）。
结果：两个群体在社会经济状况和环境决定因素方面存在差异，例如宠物所有权，农场相关暴露，户外活动时间和过敏性疾病的流行（所有p值<0.001）。尽管如此，我们在两个群体中发现了类似的潜在类别（LC）：一个未致敏类别，一个食物类别，两个区分季节性和常年空气过敏原的吸入类别，以及严重的特应性类别。后者的特点是总IgE和特异性IgE水平高，与喘息强烈相关（OR值5.64 [3.07-10.52]和4.56 [2.35-8.52]），过敏性鼻炎（22.4 [11.67-44.54]和13.97 [7.33-26.4]）和特应性湿疹（9.39 [4.9-19.3]和9.5 [5.2-17.5]，芬兰和爱沙尼亚）。在芬兰环境差异反映在较大的季节性吸入性特应性类别中，尽管不同国家之间的类别构成相似。
结论：尽管环境暴露存在巨大差异，但可能存在特应性致敏的真实模式。这些模式的分布可以确定特应性致敏对疾病发作的贡献。
(中日友好医院呼吸与危重症医学科 瑞茵 摘译 林江涛 审校)
(J Allergy Clin Immunol. 2019 Jan 22. pii: S0091-6749(19)30081-8. doi: 10.1016/j.jaci.2018.12.1014. [Epub ahead of print])
(J Allergy Clin Immunol. 2019 Jan 22. pii: S0091-6749(19)30081-8. doi: 10.1016/j.jaci.2018.12.1014. [Epub ahead of print])
Development Of Atopic Sensitization In Finnish And Estonian Children - A Latent Class Analysis In A Multicenter Cohort.
Schmidt F, Hose AJ, Mueller-Rompa S, Brick T, Hämäläinen AM, Peet A, Tillmann V, Niemelä O, Siljander H, Knip M, Weber J, von Mutius E, Ege MJ; DIABIMMUNE Study Group.
Abstract
BACKGROUND:The prevalence of atopy is associated with a western lifestyle as illustrated by studies comparing neighboring regions with different socioeconomic backgrounds. Atopy might reflect various conditions differing in their susceptibility to environmental factors. To define phenotypes of atopic sensitization in early childhood and to examine their association with allergic diseases and hereditary background in Finland and Estonia
METHODS:The analysis included 1603 Finnish and 1657 Estonian children from the DIABIMMUNE multicenter young children cohort. Specific IgE levels were measured at age 3, 4 and 5 respectively, and categorized into three CAP classes. Latent Class Analysis (LCA) was performed with the statistic software package poLCA in R.
RESULTS:Both populations differed in terms of socioeconomic status and environmental determinants such as pet ownership, farm-related exposure, time of playing outdoors and prevalence of allergic diseases (all p-values <0.001). Nevertheless, we found similar latent classes (LC) in both populations: an unsensitized class, a food class, two inhalant classes differentiating between seasonal and perennial aero-allergens, and a severe atopy class. The latter was characterized by high total and specific IgE levels and strongly associated with wheeze (odds ratio 5.64 [3.07-10.52] and 4.56 [2.35-8.52]), allergic rhinitis (22.4 [11.67-44.54] and 13.97 [7.33-26.4]) and atopic eczema (9.39 [4.9-19.3] and 9.5 [5.2-17.5], for Finland and Estonia, respectively). Environmental differences were reflected in the larger seasonal inhalant atopy class in Finland though composition of classes was comparable between countries.
CONCLUSIONS:Despite profound differences in environmental exposures there may exist genuine patterns of atopic sensitization. The distribution of these patterns may determine the contribution of atopic sensitization to disease onset.
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