哮喘联盟

   摘要
   背景: 对于儿童时期出现气喘是否预示着其为哮喘或一类疾病的易感人群目前仍存在争议。对于疾病表型的分类通常基于主观判定标准、小样本群体和/或很少来自儿童群体的数据。考虑到哮喘的相关症状通常出现在6～7岁的儿童群体，因此以上分类标准是非常有问题的。本项研究目的是甄别儿童早期出现的气喘和其它过敏性症状与哮喘发生的相关性，并且将该症状的出现与儿童社会－经济背景进行关联性分析。同时，寻找可避免这些症状的潜在干预措施。
   数据与方法：本研究是大规模队列研究，纳入2000-2002年间出生英国儿童，对11,632例儿童分别在其3岁、5岁和7岁时对主要变量进行评估，包括在过去的一年中气喘的发生，是否患干草热或湿疹等，由儿童的主要看护者汇报，评估采用经过验证的国际儿童哮喘和过敏性疾病研究模块。我们采用聚类分析法（纵向潜在类别分析）对研究群体的异质性进行分类。
   结果：我们的研究模型将哮喘相关症状分为四类：一，轻度的气喘及其它过敏性症状（占54%）；二，轻度的气喘伴严重的过敏性症状（占29%）；三，严重的气喘伴严重的过敏性症状（占9%）；四，严重的气喘伴轻微的过敏性症状（8%）。这四组儿童群体间社会经济状况不同，且潜在的可干预手段也不同（包括居住环境的湿度及母乳喂养开始时间等）。
   结论：本项目通过基于大样本量研究数据的分析，将儿童群体哮喘相关症状分为四类，且该四类儿童群体间的社会－经济背景不同。此外，我们还提出了婴儿期的潜在干预措施，包括居住环境的湿度及母乳喂养开始时间等。
 

（杨冬 审校）
PLoS One. 2014 Nov 7;9(11):e111922. doi: 10.1371/journal.pone.0111922. eCollection 2014.
 

Asthma trajectories in early childhood: identifying modifiable factors.
 

Panico L1, Stuart B2, Bartley M3, Kelly Y3.
 

ABSTRACT
BACKGROUND: There are conflicting views as to whether childhood wheezing represents several discreet entities or a single but variable disease. Classification has centered on phenotypes often derived using subjective criteria, small samples, and/or with little data for young children. This is particularly problematic as asthmatic features appear to be entrenched by age 6/7. In this paper we aim to: identify longitudinal trajectories of wheeze and other atopic symptoms in early childhood; characterize the resulting trajectories by the socio-economic background of children; and identify potentially modifiable processes in infancy correlated with these trajectories.
DATA AND METHODS: The Millennium Cohort Study is a large, representative birth cohort of British children born in 2000-2002. Our analytical sample includes 11,632 children with data on key variables (wheeze in the last year; ever hay-fever and/or eczema) reported by the main carers at age 3, 5 and 7 using a validated tool, the International Study of Asthma and Allergies in Childhood module. We employ longitudinal Latent Class Analysis, a clustering methodology which identifies classes underlying the observed population heterogeneity.
RESULTS: Our model distinguished four latent trajectories: a trajectory with both low levels of wheeze and other atopic symptoms (54% of the sample); a trajectory with low levels of wheeze but high prevalence of other atopic symptoms (29%); a trajectory with high prevalence of both wheeze and other atopic symptoms (9%); and a trajectory with high levels of wheeze but low levels of other atopic symptoms (8%). These groups differed in terms of socio-economic markers and potential intervenable factors, including household damp and breastfeeding initiation.
CONCLUSION: Using data-driven techniques, we derived four trajectories of asthmatic symptoms in early childhood in a large, population based sample. These groups differ in terms of their socio-economic profiles. We identified correlated intervenable pathways in infancy, including household damp and breastfeeding initiation.
 

PLoS One. 2014 Nov 7;9(11):e111922. doi: 10.1371/journal.pone.0111922. eCollection 2014.