不良的童年经历与哮喘：一个全国性队列的（哮喘表型）轨迹
2021/07/28
摘要：
目的：研究表明，早期不良童年经历（ACEs）与哮喘的发展过程相关；然而，现有的研究一般以来父母报告的暴露与结果。本研究旨在使用关于暴露与结果的独立的登记信息探索早年生活的ACEs与根据经验确定的童年哮喘风险的轨迹之间的相关性。
方法：基于全国的登记资料，我们构建了一个包括466556名出生与丹麦的儿童（1997-2004）的研究dui列。我们丛丹麦国家患者登记处与处方登记处获取人生前2年的ACEs信息（丧亲之痛，父母慢性躯体疾病及/或精神疾病）及第0-10岁期间的儿童哮喘诊断或用药情况。我们使用组基轨迹建模确定哮喘表型。随后，我们使用多项logistic回归研究早期ACEs与哮喘表型之间的相关性。
结果：我们确定了4种哮喘表型：非哮喘、早发短暂型哮喘、早发持续型哮喘及迟发型哮喘。与无哮喘的女孩相比，存在早发短暂型哮喘（OR 1.13，95%CI 1.04-1.24）、早发持续型哮喘（1.27，95%CI 1.08-1.48）或迟发型哮喘（OR 1.28，95%CI 1.11-1.48）的女孩更可能存在早年ACE暴露。男孩具有相似的结果，三组男孩经历早年ACEs的Ors分别为1.16（95%CI 1.08-1.25），1.34（95%CI 1.20-1.51）及1.11（95%CI 0.98-1.25）。
结论：在一个全国性人群研究中，我们确定了三种童年发病的哮喘表型，并且发现，在男孩与女孩中，早年的ACEs与每一种哮喘表型的几率升高相关。
Adverse childhood experiences and asthma: trajectories in a national cohort
Kathrine Pape, Whitney Cowell , Camilla Sandal Sejbaek, Niklas Worm Andersson, Cecilie Svanes, Henrik Albert Kolstad, Xiaoqin Liu, Karin Sørig Hougaard, Rosalind J Wright, Vivi Schlünssen
Abstract
Objective: Research has linked early adverse childhood experiences (ACEs) with asthma development; however, existing studies have generally relied on parent report of exposure and outcome. We aimed to examine the association of early life ACEs with empirically determined trajectories of childhood asthma risk, using independent register information on both exposures and outcome.
Methods: Based on nationwide registries, we established a study cohort of 466 556 children born in Denmark (1997-2004). We obtained information on ACEs during the first 2 years of life (bereavement, parental chronic somatic and/or mental illness) and childhood asthma diagnosis or medication use from birth through age 10 years from the Danish National Patient and Prescription Registries, respectively. We identified asthma phenotypes using group-based trajectory modelling. We then used multinomial logistic regression to examine the association between early ACEs and asthma phenotypes.
Results: We identified four asthma phenotypes: non-asthmatic, early-onset transient, early-onset persistent and late-onset asthma. Girls with early-onset transient asthma (OR 1.13, 95% CI 1.04 to 1.24), early-onset persistent asthma (1.27, 95% CI 1.08 to 1.48) or late-onset asthma (OR 1.28, 95% CI 1.11 to 1.48) vs no asthma were more likely to have early life ACE exposure compared with girls without ACE exposure. Results were similar for boys who also had experienced early life ACEs with ORs of 1.16 (95% CI 1.08 to 1.25), 1.34 (95% CI 1.20 to 1.51) and 1.11 (95% CI 0.98 to 1.25), respectively.
Conclusion: In a nationwide-population study, we identified three childhood onset asthma phenotypes and found that ACEs early in life were associated with increased odds for each of these asthma phenotypes among both girls and boys.
目的：研究表明，早期不良童年经历（ACEs）与哮喘的发展过程相关；然而，现有的研究一般以来父母报告的暴露与结果。本研究旨在使用关于暴露与结果的独立的登记信息探索早年生活的ACEs与根据经验确定的童年哮喘风险的轨迹之间的相关性。
方法：基于全国的登记资料，我们构建了一个包括466556名出生与丹麦的儿童（1997-2004）的研究dui列。我们丛丹麦国家患者登记处与处方登记处获取人生前2年的ACEs信息（丧亲之痛，父母慢性躯体疾病及/或精神疾病）及第0-10岁期间的儿童哮喘诊断或用药情况。我们使用组基轨迹建模确定哮喘表型。随后，我们使用多项logistic回归研究早期ACEs与哮喘表型之间的相关性。
结果：我们确定了4种哮喘表型：非哮喘、早发短暂型哮喘、早发持续型哮喘及迟发型哮喘。与无哮喘的女孩相比，存在早发短暂型哮喘（OR 1.13，95%CI 1.04-1.24）、早发持续型哮喘（1.27，95%CI 1.08-1.48）或迟发型哮喘（OR 1.28，95%CI 1.11-1.48）的女孩更可能存在早年ACE暴露。男孩具有相似的结果，三组男孩经历早年ACEs的Ors分别为1.16（95%CI 1.08-1.25），1.34（95%CI 1.20-1.51）及1.11（95%CI 0.98-1.25）。
结论：在一个全国性人群研究中，我们确定了三种童年发病的哮喘表型，并且发现，在男孩与女孩中，早年的ACEs与每一种哮喘表型的几率升高相关。
(中日友好医院呼吸与危重症医学科 张清 摘译 林江涛 审校)
(Thorax. 2021 Jun;76(6):547-553. doi: 10.1136/thoraxjnl-2020-214528.)
(Thorax. 2021 Jun;76(6):547-553. doi: 10.1136/thoraxjnl-2020-214528.)
Adverse childhood experiences and asthma: trajectories in a national cohort
Kathrine Pape, Whitney Cowell , Camilla Sandal Sejbaek, Niklas Worm Andersson, Cecilie Svanes, Henrik Albert Kolstad, Xiaoqin Liu, Karin Sørig Hougaard, Rosalind J Wright, Vivi Schlünssen
Abstract
Objective: Research has linked early adverse childhood experiences (ACEs) with asthma development; however, existing studies have generally relied on parent report of exposure and outcome. We aimed to examine the association of early life ACEs with empirically determined trajectories of childhood asthma risk, using independent register information on both exposures and outcome.
Methods: Based on nationwide registries, we established a study cohort of 466 556 children born in Denmark (1997-2004). We obtained information on ACEs during the first 2 years of life (bereavement, parental chronic somatic and/or mental illness) and childhood asthma diagnosis or medication use from birth through age 10 years from the Danish National Patient and Prescription Registries, respectively. We identified asthma phenotypes using group-based trajectory modelling. We then used multinomial logistic regression to examine the association between early ACEs and asthma phenotypes.
Results: We identified four asthma phenotypes: non-asthmatic, early-onset transient, early-onset persistent and late-onset asthma. Girls with early-onset transient asthma (OR 1.13, 95% CI 1.04 to 1.24), early-onset persistent asthma (1.27, 95% CI 1.08 to 1.48) or late-onset asthma (OR 1.28, 95% CI 1.11 to 1.48) vs no asthma were more likely to have early life ACE exposure compared with girls without ACE exposure. Results were similar for boys who also had experienced early life ACEs with ORs of 1.16 (95% CI 1.08 to 1.25), 1.34 (95% CI 1.20 to 1.51) and 1.11 (95% CI 0.98 to 1.25), respectively.
Conclusion: In a nationwide-population study, we identified three childhood onset asthma phenotypes and found that ACEs early in life were associated with increased odds for each of these asthma phenotypes among both girls and boys.
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吸入甘露醇的气道高反应性确定了一组高症状负担的非嗜酸性哮喘患者
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普通人群中肥胖者患慢性咳嗽的风险和影响
