摘要
背景：最新研究提示哮喘风险可追溯至孕期及生命早期暴露因素。要实现精准预防，需早期识别高风险婴儿。
目的：利用婴儿出生第一年内呼吸道及非呼吸道症状的指标，预测儿童哮喘风险。
方法：本研究为前瞻性队列研究（"婴儿免疫研究"），于孕晚期纳入孕妇队列。通过基线调查与定期随访收集父母哮喘史、婴儿期症状数据及儿童期哮喘诊断。采用多重对应分析对6月龄及9月龄婴儿的11项呼吸道与非呼吸道症状进行降维处理，提取潜在症状维度纳入多因素Logistic回归模型。通过校正偏倚后的Brier评分、受试者工作特征曲线下面积（AUC）及预测效能曲线评估模型的区分度与校准度。
结果：在393例（82%）完成随访的婴儿中，17%后续发展为哮喘。预测模型分析显示：1.症状数量相关的潜在维度（反映症状累积数量）与哮喘发病风险显著相关（OR=1.32，95%CI:1.12-1.55）。2.喘息-湿疹共现维度（呼吸道与过敏表型）独立预测哮喘（OR=1.25，95%CI:1.05-1.49）3.腹泻-呕吐维度（胃肠功能紊乱表型）亦具预测价值（OR=1.18，95%CI:1.01-1.38）。模型整体预测效能优异（校正后Brier评分=0.136），AUC达0.71（95%CI:0.64-0.78）。
结论：婴儿第一年内的呼吸道症状严重程度可能是哮喘的早期征兆，其机制可能独立于典型喘息，并可能与气道－胃肠功能失调相关。
关键词：儿童哮喘；呼吸系统症状；胃肠道；湿疹；喘息；多重对应分析；出生队列研究；预测模型
文献来源：(Rabe BA, Stern DA,et, al. Respiratory and non-respiratory symptoms before age 1 year predict school age asthma. J Allergy Clin Immunol. 2025 Feb 26:S0091-6749(25)00219-2. doi: 10.1016/j.jaci.2025.02.023. Epub ahead of print. PMID: 40020934.)
Abstract
Background:New research traces the origins of asthma to prenatal and early life exposures. Targeted interventions require early identification of infants that are at increased risk.
Objectives: We aimed to use a composite measure of symptoms and related signs of respiratory and non-respiratory illness collected in the first year of life to predict childhood asthma.
Methods:The Infant Immune Study enrolled pregnant women in their third trimester. Parental asthma, infant symptom data, and childhood asthma were collected at enrollment and over repeated visits. We applied multiple correspondence analysis to reduce the dimensionality of eleven respiratory and non-respiratory symptoms at 6 and 9-months. Latent dimensions were used in a multivariable logistic regression model of childhood asthma. Bias-corrected Brier scores, AUC statistics, and predictiveness curves assessed model discrimination and calibration.
Results:Among 393 (82%) enrolled infants with complete data, 17% developed asthma. Predictive model estimates showed that a latent dimension associated with the number of symptoms reported-interpreted as the intensity of illness-was predictive of subsequent asthma. Additionally, two other independent symptom dimensions were predictive: one characterized by wheezing and eczema, and another associated with diarrhea and vomiting. The bias-corrected Brier score was 0.136, indicating excellent prediction performance, and the AUC was 0.71 (95% CI 0.64, 0.78).
Conclusion:Intensity of respiratory signs and symptoms during the first year of life may be an early clinical expression of asthma risk. This risk could also be associated with disease mechanisms distinct from those causing wheezing and related to airway and gastrointestinal dysfunction.
Keywords:Childhood asthma;respiratory symptoms;gastrointestinal;eczema;wheeze
multiple correspondence analysis;;birth cohort study;predictive model
背景：最新研究提示哮喘风险可追溯至孕期及生命早期暴露因素。要实现精准预防，需早期识别高风险婴儿。
目的：利用婴儿出生第一年内呼吸道及非呼吸道症状的指标，预测儿童哮喘风险。
方法：本研究为前瞻性队列研究（"婴儿免疫研究"），于孕晚期纳入孕妇队列。通过基线调查与定期随访收集父母哮喘史、婴儿期症状数据及儿童期哮喘诊断。采用多重对应分析对6月龄及9月龄婴儿的11项呼吸道与非呼吸道症状进行降维处理，提取潜在症状维度纳入多因素Logistic回归模型。通过校正偏倚后的Brier评分、受试者工作特征曲线下面积（AUC）及预测效能曲线评估模型的区分度与校准度。
结果：在393例（82%）完成随访的婴儿中，17%后续发展为哮喘。预测模型分析显示：1.症状数量相关的潜在维度（反映症状累积数量）与哮喘发病风险显著相关（OR=1.32，95%CI:1.12-1.55）。2.喘息-湿疹共现维度（呼吸道与过敏表型）独立预测哮喘（OR=1.25，95%CI:1.05-1.49）3.腹泻-呕吐维度（胃肠功能紊乱表型）亦具预测价值（OR=1.18，95%CI:1.01-1.38）。模型整体预测效能优异（校正后Brier评分=0.136），AUC达0.71（95%CI:0.64-0.78）。
结论：婴儿第一年内的呼吸道症状严重程度可能是哮喘的早期征兆，其机制可能独立于典型喘息，并可能与气道－胃肠功能失调相关。
关键词：儿童哮喘；呼吸系统症状；胃肠道；湿疹；喘息；多重对应分析；出生队列研究；预测模型
文献来源：(Rabe BA, Stern DA,et, al. Respiratory and non-respiratory symptoms before age 1 year predict school age asthma. J Allergy Clin Immunol. 2025 Feb 26:S0091-6749(25)00219-2. doi: 10.1016/j.jaci.2025.02.023. Epub ahead of print. PMID: 40020934.)
（南方医科大学南方医院 樊可可 朱邦 赵文驱 赵海金）
Abstract
Background:New research traces the origins of asthma to prenatal and early life exposures. Targeted interventions require early identification of infants that are at increased risk.
Objectives: We aimed to use a composite measure of symptoms and related signs of respiratory and non-respiratory illness collected in the first year of life to predict childhood asthma.
Methods:The Infant Immune Study enrolled pregnant women in their third trimester. Parental asthma, infant symptom data, and childhood asthma were collected at enrollment and over repeated visits. We applied multiple correspondence analysis to reduce the dimensionality of eleven respiratory and non-respiratory symptoms at 6 and 9-months. Latent dimensions were used in a multivariable logistic regression model of childhood asthma. Bias-corrected Brier scores, AUC statistics, and predictiveness curves assessed model discrimination and calibration.
Results:Among 393 (82%) enrolled infants with complete data, 17% developed asthma. Predictive model estimates showed that a latent dimension associated with the number of symptoms reported-interpreted as the intensity of illness-was predictive of subsequent asthma. Additionally, two other independent symptom dimensions were predictive: one characterized by wheezing and eczema, and another associated with diarrhea and vomiting. The bias-corrected Brier score was 0.136, indicating excellent prediction performance, and the AUC was 0.71 (95% CI 0.64, 0.78).
Conclusion:Intensity of respiratory signs and symptoms during the first year of life may be an early clinical expression of asthma risk. This risk could also be associated with disease mechanisms distinct from those causing wheezing and related to airway and gastrointestinal dysfunction.
Keywords:Childhood asthma;respiratory symptoms;gastrointestinal;eczema;wheeze
multiple correspondence analysis;;birth cohort study;predictive model
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