背景：各種過敏性疾病通常在兒童早期共同發(fā)展，但在發(fā)病、緩解和進(jìn)展的時(shí)間上有所不同。隨著時(shí)間的推移，他們的病程往往很難預(yù)測，而且決定因素也不太清楚。
目的：本研究旨在確定過敏性疾病直到青春期的發(fā)展軌跡，并研究它們與早期生活、遺傳決定因素和臨床特征的關(guān)系。
方法：使用縱向k均值聚類推導(dǎo)兩個(gè)德國出生隊(duì)列（GINIplus/LISA）中過敏性疾?。ㄏ?、特應(yīng)性皮炎和鼻炎）的軌跡。通過多項(xiàng)模型估計(jì)了與早期生活決定因素、多基因風(fēng)險(xiǎn)評分、食物和空氣過敏原致敏以及肺功能的相關(guān)性。這些結(jié)果在獨(dú)立的瑞典BAMSE隊(duì)列中得到了重復(fù)。
結(jié)果：確定了七種過敏性疾病軌跡：“間歇性過敏”、“鼻炎”、“早期消退性皮炎”、“中期持續(xù)性皮炎”，“多發(fā)性過敏”、“持續(xù)性皮炎加鼻炎”和“早期短暫性哮喘”。與非過敏對照組相比，過敏家族史在所有過敏性疾病軌跡中更為普遍，對包括一種以上過敏性疾病的集群的影響更大（例如，在RRR=5.0的情況下，多發(fā)性過敏組的95%置信區(qū)間=[3.1-8.0]，而輕度間歇性過敏的集群為1.8[1.4-2.4]）。單一過敏性疾病的特定多基因風(fēng)險(xiǎn)評分與其相關(guān)軌跡顯著相關(guān)。得出的軌跡及其與遺傳效應(yīng)和臨床特征的關(guān)聯(lián)在BAMSE中顯示出類似的結(jié)果。
結(jié)論：本研究確定了7個(gè)強(qiáng)烈的過敏性集群，并顯示出與早期生活、遺傳因素以及臨床特征有關(guān)。


延伸閱讀
Allergy
Allergic disease trajectories up to adolescence: Characteristics,early-life, and genetic determinants
DOI: 10.1111/all.15511
Abstract:
Background: Allergic diseases often develop jointly during early childhood but differ in timing of onset, remission, and progression. Their disease course over time is often difficult to predict and determinants are not well understood.
Objectives: We aimed to identify trajectories of allergic diseases up to adolescence and to investigate their association with early-life and genetic determinants and clinical characteristics.
Methods: Longitudinal k-means clustering was used to derive trajectories of allergic diseases (asthma, atopic dermatitis, and rhinitis) in two German birth cohorts (GINIplus/LISA). Associations with early-life determinants, polygenic risk scores, food and aeroallergen sensitization, and lung function were estimated by multinomial models.The results were replicated in the independent Swedish BAMSE cohort.
Results: Seven allergic disease trajectories were identified: “Intermittently allergic,” “rhinitis,” “early-resolving dermatitis,” “mid-persisting dermatitis,” “multimorbid,” “persisting dermatitis plus rhinitis,” and “early-transient asthma.” Family history of allergies was more prevalent in all allergic disease trajectories compared the non-allergic controls with stronger effect sizes for clusters comprising more than one allergic disease(e.g., RRR = 5.0, 95% CI = [3.1–8.0] in the multimorbid versus 1.8 [1.4–2.4] in the mild intermittently allergic cluster). Specific polygenic risk scores for single allergic diseases were significantly associated with their relevant trajectories. The derived trajectories and their association with genetic effects and clinical characteristics showed similar results in BAMSE.
Conclusion: Seven robust allergic clusters were identified and showed associations with early life and genetic factors as well as clinical characteristics.
First Author:
Anna Kilanowski
Corresponding author:
Marie Standl
Correspondence:
Marie Standl, Helmholtz Zentrum München –Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH),Institute of Epidemiology, Ingolst?dter Landstra?e 1, D-85764 Neuherberg, Germany.
Email: marie.standl@helmholtz-muenchen.de