是否可以在出生时对儿童哮喘进行预测？
2010/12/31
摘要
背景：生命早期是预防哮喘的最佳时期，但是干预措施需针对目标人群。目前为止，尚未在婴儿出生时找到该目标人群。
目的：研究采用出生时已知的因素，预测10岁时发生哮喘和鼻炎的预测能力。
方法：本研究614名健康婴儿来自于奥斯陆1992/1993环境和儿童哮喘研究，研究对象出生时检测肺功能，研究随访期为10年，包括针对过敏症的结构化访谈和皮肤针刺试验(SPT)。logistic 回归分析了大范围出生问卷调查中的37个常规变量、肺功能、脐带血总免疫球蛋白E和可溶性CD14。计算哮喘既往病史、当前哮喘、鼻炎病史和健康状态（无哮喘病史和鼻炎病史，SPT阴性）对整体的预测和个体预测能力。
结果：对于哮喘既往病史、当前哮喘、鼻炎和健康状态，模型的预测能力（曲线下面积 [95%CI]）分别为0.74 (0.69, 0.79), 0.72 (0.64, 0.78), 0.69 (0.54, 0.72)和0.67 (0.62, 0.71)。最佳的模型正确预测了93/124 (75%)名患者哮喘既往病史，错误预测了176/490 (36%)名“哮喘”患儿。所有预后的阳性预测值均较低(19-61)，健康状态的预测值最高。
结论：虽然在出生时最多可以预测出75%的哮喘既往病史患儿，但在预测出存在哮喘高危因素的患儿中实施哮喘干预措施的几率更高。父母过敏性疾病不能独立鉴别未来发生哮喘和过敏性疾病的高危人群。
（陈欣 审校）
Clin Exp Allergy. 2010 Dec;40(12):1767-75. doi: 10.1111/j.1365-2222.2010.03620.x.
Can childhood asthma be predicted at birth?
Lødrup Carlsen KC, Mowinckel P, Granum B, Carlsen KH.
Department of Paediatrics, Oslo University Hospital, Ullevål, Norway Faculty of Medicine, the University of Oslo, Oslo, Norway Division of Environmental Medicine, Norwegian Institute of Public Health, Norway Department of Paediatrics, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Abstract
Background Early life appears optimal for prevention of asthma, but interventions require a relevant target population, to date not clearly identified at birth. Objective We therefore aimed to identify the predicting capacity of factors known around birth for asthma and rhinitis at 10 years. Methods The included 614 healthy term babies with lung function measured at birth in the 1992/1993 Environment and Childhood Asthma study in Oslo attended a 10-year follow-up visit including a structured interview and skin prick test (SPT) for allergies. The logistic regression analyses included 37 general variables from an extensive birth questionnaire; lung function; cord blood total immunoglobulin E and soluble CD14. A history of asthma, current asthma, history of rhinitis and ’healthy’ (no history of asthma, rhinitis and negative SPT) was predicted on a group level and individual predicted probabilities were calculated. Results The predictability of the models [area under the curve (95% confidence intervals)] was 0.74 (0.69, 0.79), 0.72 (0.64, 0.78), 0.69 (0.54, 0.72) and 0.67 (0.62, 0.71) for a history of asthma, current asthma, rhinitis and ’healthy’, respectively. The best model predicted a history of asthma correctly in 93/124 (75%), and incorrectly in 176/490 (36%) children without asthma. The positive predictive values for all outcomes were low (19-61), the highest predicting healthy. Conclusion Although at best 75% of children with a history of asthma could be predicted at birth, an intervention applied to our predicted high-risk children would be started more often in children without than with future disease. Parental allergic disease alone appears insufficient to identify high-risk populations in future studies of asthma and allergic disease
Clin Exp Allergy. 2010 Dec;40(12):1767-75. doi: 10.1111/j.1365-2222.2010.03620.x.
背景：生命早期是预防哮喘的最佳时期，但是干预措施需针对目标人群。目前为止，尚未在婴儿出生时找到该目标人群。
目的：研究采用出生时已知的因素，预测10岁时发生哮喘和鼻炎的预测能力。
方法：本研究614名健康婴儿来自于奥斯陆1992/1993环境和儿童哮喘研究，研究对象出生时检测肺功能，研究随访期为10年，包括针对过敏症的结构化访谈和皮肤针刺试验(SPT)。logistic 回归分析了大范围出生问卷调查中的37个常规变量、肺功能、脐带血总免疫球蛋白E和可溶性CD14。计算哮喘既往病史、当前哮喘、鼻炎病史和健康状态（无哮喘病史和鼻炎病史，SPT阴性）对整体的预测和个体预测能力。
结果：对于哮喘既往病史、当前哮喘、鼻炎和健康状态，模型的预测能力（曲线下面积 [95%CI]）分别为0.74 (0.69, 0.79), 0.72 (0.64, 0.78), 0.69 (0.54, 0.72)和0.67 (0.62, 0.71)。最佳的模型正确预测了93/124 (75%)名患者哮喘既往病史，错误预测了176/490 (36%)名“哮喘”患儿。所有预后的阳性预测值均较低(19-61)，健康状态的预测值最高。
结论：虽然在出生时最多可以预测出75%的哮喘既往病史患儿，但在预测出存在哮喘高危因素的患儿中实施哮喘干预措施的几率更高。父母过敏性疾病不能独立鉴别未来发生哮喘和过敏性疾病的高危人群。
（陈欣 审校）
Clin Exp Allergy. 2010 Dec;40(12):1767-75. doi: 10.1111/j.1365-2222.2010.03620.x.
Can childhood asthma be predicted at birth?
Lødrup Carlsen KC, Mowinckel P, Granum B, Carlsen KH.
Department of Paediatrics, Oslo University Hospital, Ullevål, Norway Faculty of Medicine, the University of Oslo, Oslo, Norway Division of Environmental Medicine, Norwegian Institute of Public Health, Norway Department of Paediatrics, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Abstract
Background Early life appears optimal for prevention of asthma, but interventions require a relevant target population, to date not clearly identified at birth. Objective We therefore aimed to identify the predicting capacity of factors known around birth for asthma and rhinitis at 10 years. Methods The included 614 healthy term babies with lung function measured at birth in the 1992/1993 Environment and Childhood Asthma study in Oslo attended a 10-year follow-up visit including a structured interview and skin prick test (SPT) for allergies. The logistic regression analyses included 37 general variables from an extensive birth questionnaire; lung function; cord blood total immunoglobulin E and soluble CD14. A history of asthma, current asthma, history of rhinitis and ’healthy’ (no history of asthma, rhinitis and negative SPT) was predicted on a group level and individual predicted probabilities were calculated. Results The predictability of the models [area under the curve (95% confidence intervals)] was 0.74 (0.69, 0.79), 0.72 (0.64, 0.78), 0.69 (0.54, 0.72) and 0.67 (0.62, 0.71) for a history of asthma, current asthma, rhinitis and ’healthy’, respectively. The best model predicted a history of asthma correctly in 93/124 (75%), and incorrectly in 176/490 (36%) children without asthma. The positive predictive values for all outcomes were low (19-61), the highest predicting healthy. Conclusion Although at best 75% of children with a history of asthma could be predicted at birth, an intervention applied to our predicted high-risk children would be started more often in children without than with future disease. Parental allergic disease alone appears insufficient to identify high-risk populations in future studies of asthma and allergic disease
Clin Exp Allergy. 2010 Dec;40(12):1767-75. doi: 10.1111/j.1365-2222.2010.03620.x.
