童年至中年期间纵向哮喘表型研究：一项基于人群的队列研究
2023/06/25
摘要
背景：支气管哮喘（以下简称哮喘）是一种异质性疾病，纵向表型可能为该疾病的起源和结局提供新的见解。
目的：本研究为基于人群的队列研究，旨在描述哮喘在十岁到六十岁之间的纵向表型特征。
方法：在塔斯马尼亚纵向健康研究的七个时间点收集呼吸问卷，受试者年龄分别为7岁、13岁、18岁、32岁、43岁、50岁和53岁。在每个时间点确定当前哮喘和既往哮喘状态，并使用基于组的轨迹模型来表征不同的纵向表型。采用拟合线性和逻辑回归模型来研究纵向表型与儿童因素和成人结果的相关性。
结果：在8583名原始受试者中，1506人曾报告过哮喘。共确定五种纵向哮喘表型：早发性青少年缓解型（40%）、早发性成人缓解型（11%）、早发性持续型（9%）、晚发性缓解型（13%）和晚发性持续型（27%）。所有表型在53岁时均与慢性阻塞性肺病（COPD）相关，除了晚发缓解性哮喘（比值比：早发性青少年缓解型：2.00，95%CI 1.13-3.56；早发性成人缓解型：3.61，95%CI 1.30-10.02；早发性持续型：8.73，95%CI 4.10-18.55；晚发性持续型：6.69，95%CI 3.81-11.73），同时精神健康障碍和心血管危险因素的风险增加。
结论：本研究共鉴定出十岁到六十岁期间五种纵向哮喘表型，其中包括两种新的缓解表型。本研究发现这些表型对中年COPD和非呼吸道合并症风险的影响不同。
Longitudinal Asthma Phenotypes from Childhood to Middle-Age: A Population-based Cohort Study
Tan DJ, Lodge CJ, Walters EH, Lowe AJ, Bui DS, Bowatte G, Pham J, Erbas B, Hui J, Hamilton GS, Thomas PS, Hew M, Washko G, Wood-Baker R, Abramson MJ, Perret JL, Dharmage SC.
Abstract
BACKGROUND:Asthma is a heterogeneous condition and longitudinal phenotyping may provide new insights into origins and outcomes of the disease.
OBJECTIVE:
We aimed to characterize the longitudinal phenotypes of asthma between the first and sixth decades of life in a population-based cohort study.
METHODS:Respiratory questionnaires were collected at seven time-points in the Tasmanian Longitudinal Health Study when participants were aged 7, 13, 18, 32, 43, 50 and 53 years. Current-asthma and ever-asthma status were determined at each time-point and group-based trajectory modelling used to characterize distinct longitudinal phenotypes. Linear and logistic regression models were fitted to investigate associations of the longitudinal phenotypes with childhood factors and adult outcomes.
RESULTS:Of 8,583 original participants, 1,506 had reported ever-asthma. Five longitudinal asthma phenotypes were identified: early-onset adolescent-remitting (40%), early-onset adult-remitting (11%), early-onset persistent (9%), late-onset remitting (13%), and late-onset persistent (27%). All phenotypes were associated with chronic obstructive pulmonary disease (COPD) at age 53 years, except for late-onset remitting asthma (odds ratios: early-onset adolescent-remitted: 2.00, 95%CI 1.13-3.56; early-onset adult-remitted: 3.61, 1.30-10.02; early-onset persistent: 8.73, 4.10-18.55; and late-onset persistent: 6.69, 3.81-11.73). Late-onset persistent asthma was associated with the greatest comorbidity at age 53 years, with increased risk of mental health disorders and cardiovascular risk factors.
CONCLUSIONS:Five longitudinal asthma phenotypes were identified between the first and sixth decades of life, including two novel remitting phenotypes. We found differential effects of these phenotypes on risk of COPD and non-respiratory comorbidities in middle-age.
背景：支气管哮喘（以下简称哮喘）是一种异质性疾病，纵向表型可能为该疾病的起源和结局提供新的见解。
目的：本研究为基于人群的队列研究，旨在描述哮喘在十岁到六十岁之间的纵向表型特征。
方法：在塔斯马尼亚纵向健康研究的七个时间点收集呼吸问卷，受试者年龄分别为7岁、13岁、18岁、32岁、43岁、50岁和53岁。在每个时间点确定当前哮喘和既往哮喘状态，并使用基于组的轨迹模型来表征不同的纵向表型。采用拟合线性和逻辑回归模型来研究纵向表型与儿童因素和成人结果的相关性。
结果：在8583名原始受试者中，1506人曾报告过哮喘。共确定五种纵向哮喘表型：早发性青少年缓解型（40%）、早发性成人缓解型（11%）、早发性持续型（9%）、晚发性缓解型（13%）和晚发性持续型（27%）。所有表型在53岁时均与慢性阻塞性肺病（COPD）相关，除了晚发缓解性哮喘（比值比：早发性青少年缓解型：2.00，95%CI 1.13-3.56；早发性成人缓解型：3.61，95%CI 1.30-10.02；早发性持续型：8.73，95%CI 4.10-18.55；晚发性持续型：6.69，95%CI 3.81-11.73），同时精神健康障碍和心血管危险因素的风险增加。
结论：本研究共鉴定出十岁到六十岁期间五种纵向哮喘表型，其中包括两种新的缓解表型。本研究发现这些表型对中年COPD和非呼吸道合并症风险的影响不同。
(中日友好医院呼吸与危重症医学科 张婧媛 摘译 林江涛 审校)
(Am J Respir Crit Care Med. 2023 May 20. doi: 10.1164/rccm.202208-1569OC.)
(Am J Respir Crit Care Med. 2023 May 20. doi: 10.1164/rccm.202208-1569OC.)
Longitudinal Asthma Phenotypes from Childhood to Middle-Age: A Population-based Cohort Study
Tan DJ, Lodge CJ, Walters EH, Lowe AJ, Bui DS, Bowatte G, Pham J, Erbas B, Hui J, Hamilton GS, Thomas PS, Hew M, Washko G, Wood-Baker R, Abramson MJ, Perret JL, Dharmage SC.
Abstract
BACKGROUND:Asthma is a heterogeneous condition and longitudinal phenotyping may provide new insights into origins and outcomes of the disease.
OBJECTIVE:
We aimed to characterize the longitudinal phenotypes of asthma between the first and sixth decades of life in a population-based cohort study.
METHODS:Respiratory questionnaires were collected at seven time-points in the Tasmanian Longitudinal Health Study when participants were aged 7, 13, 18, 32, 43, 50 and 53 years. Current-asthma and ever-asthma status were determined at each time-point and group-based trajectory modelling used to characterize distinct longitudinal phenotypes. Linear and logistic regression models were fitted to investigate associations of the longitudinal phenotypes with childhood factors and adult outcomes.
RESULTS:Of 8,583 original participants, 1,506 had reported ever-asthma. Five longitudinal asthma phenotypes were identified: early-onset adolescent-remitting (40%), early-onset adult-remitting (11%), early-onset persistent (9%), late-onset remitting (13%), and late-onset persistent (27%). All phenotypes were associated with chronic obstructive pulmonary disease (COPD) at age 53 years, except for late-onset remitting asthma (odds ratios: early-onset adolescent-remitted: 2.00, 95%CI 1.13-3.56; early-onset adult-remitted: 3.61, 1.30-10.02; early-onset persistent: 8.73, 4.10-18.55; and late-onset persistent: 6.69, 3.81-11.73). Late-onset persistent asthma was associated with the greatest comorbidity at age 53 years, with increased risk of mental health disorders and cardiovascular risk factors.
CONCLUSIONS:Five longitudinal asthma phenotypes were identified between the first and sixth decades of life, including two novel remitting phenotypes. We found differential effects of these phenotypes on risk of COPD and non-respiratory comorbidities in middle-age.
上一篇：
流感与其他呼吸道病毒——评估住院儿童的严重程度，比利时，2011 年至 2020 年
下一篇：
极端天气和哮喘:一项系统回顾和荟萃分析
